Periapical Abscess — ORE Part 1 MCQ

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EasyEndodonticsPeriapical AbscessORE Part 1

A patient has a sinus tract draining from the buccal sulcus adjacent to the upper right first premolar. A gutta-percha point is placed through the sinus tract and a periapical radiograph is taken. The point terminates at the apex of the upper right first premolar. What does this confirm?

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Correct answer: D — The tract arises from this tooth's periapical region

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

A is correct. A gutta-percha point placed into a draining sinus tract and seen radiographically to end at a tooth apex traces the pathway to that tooth's periapical region. This supports an endodontic/periapical source for the sinus and identifies the upper right first premolar as the associated tooth. It does not diagnose the underlying cause beyond that. A lateral canal could only be suspected if the tract traced to a lateral root site, not simply because a tract is present. A periodontal sinus would require periodontal findings, such as a localised deep pocket, rather than apical tracing. Root fracture and external resorption may sometimes be associated with drainage, but neither is confirmed by sinus-tract tracing alone.

Reference: Cotti E, Musu D, Goddi A, et al. Ultrasound Examination to Visualize and Trace Sinus Tracts of Endodontic Origin. Journal of Endodontics, 2019. https://pubmed.ncbi.nlm.nih.gov/31451288/