Which is the Infected Tooth?

A 47-year-old woman with autoimmune hepatitis has a fistula distal to the tooth #28, but the tooth #27 is discolored and necrotic (pulpal test: 28 vital, Fig.1) with an incisal dimple (wear facet, Fig.2).  Periapical radiolucency appears to involve the teeth #27 and 28.  RCT is initiated at #27 through the incisal dimple.  The orifice is reached immediately.  Occasionally Sodium Hydro chlorite solution seems to leak out of the fistula.  After debridement and placement of Ca(OH)2 paste (Fig.4 *) in the canal, the fistula is apparently shrunken (data not shown).  The patient is scheduled to return 1 month.

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Xin Wei, DDS, PhD, MS 1st edition 02/14/2018, last revision 05/26/2018