Partially Necrotic cases can be very difficult to diagnosis even for many Endodontists. This was the case on tooth 2 in which the patient had a sinus tract on the palatal that could not be traced. Tooth 2 did not have any prior dental work. Tooth 2 and 3 responded within normal limits to thermal pulp testing. However, upon percussion, tooth 2 was slightly more percussion sensitive than tooth 3. Based on my previous experience with these cases, I decided to do endodontic treatment on tooth 2. The patient was told if area does not heal, I would refer her to an oral surgeon for a biopsy. The tooth was opened and the pulp was partially necrotic (the palatal root was completely necrotic). Medication was placed and the patient return in 2 weeks to complete endodontic treatment. Proper endodontic therapy caused the sinus tract to resolve. Tooth 2 had a microscopic crack which contributed to this issue.

Dr. Rico D. Short
Diplomate, American Board of Endodontics