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JOURNALOF ENDODONTICS Printed in U.S.A.
Copyright © 1992 by The American Association of Endodontists VOL.18, NO. 4, APRIL1992

CASE REPORT

Healing of a Sinus Tract of Periodontal Origin

/
Zu-Pyn Yang, BDS, and Yu-Lin Lai, BDS

A sinus tract adjacent to teeth is usually considered

to be of endodontic origin and root canal therapy is
the primary treatment to achieve healing. A case of
a sinus tract is presented in which a suspected
endodontic-periodontic lesion was successfully
treated by periodontal therapy alone. The sinus tract
healed and the radiograph showed bony repair.

A sinus tract is defined as a tract leading from an enclosed

area of inflammation to an epithelial surface. Sinus tracts on
the oral mucosa adjacent to teeth usually disappear sponta-
neously with elimination of the causative factor by endodontic
therapy (1). Although sinus tracts of pulpal origin are com-
mon, they are seldom of periodontal origin (2). This report
presents a case of healing of a periodontally derived intraoral
sinus tract following conservative periodontal treatment
alone.

CASE R E P O R T

A 31-yr-old man was referred for an endodontic consulta-

tion with a sinus tract emerging on the lingual mucosa be-
tween the apices of the left central and lateral incisors (Fig.

FiG 2. Periapical radiograph of lower anterior teeth. A radiolucency

associated with the lower left central and lateral incisors is seen.

1). The patient reported no pain or swelling although he had

Fie 1. A sinus tract emerging on the lingual mucosa between the
apices of the left central and lateral incisors.
178
been aware of the formation of a nodule several days before
this visit. Medical history was not significant.
Vitality tests carried out on both lower central and lateral
incisors were positive (electric pulp test scores of 2 out of 10).
The teeth showed slight sensitivity to palpation and percus-
sion, but no pathological mobility was observed.
Periodontal examinations showed that marginal gingivitis
and gingival recession were noted on both labial and lingual
surfaces of the lower anterior teeth. There was also heavy
Vol. 18, No. 4, April 1992
FtG 3. Gutta-percha probe tracing the sinus tract.
deposition of calculus in the anterior lingual region and
gingival swelling in the apical third of the lingual surface of
left lower central and lateral incisors. The crevicular probing
was done immediately after calculus removal. The depths
around both incisors were 2 m m except for an abrupt 6-ram
deep defect at the middle of the lingual margin of the lower
central incisor. The bottom of this pocket communicated
with the sinus tract.
Periapical radiographs revealed horizontal bone destruction
in the lower incisors area and a radiolucent lesion measuring
3 x 7 mm between the apices of the lower left central and
lateral incisors (Fig. 2). A gutta-percha point was introduced
into the sinus tract, and it led to the mesial surface of the
apex of the lower left lateral incisor (Fig. 3).
The patient denied any traumatic history. The possibility
of a vertical root fracture was cautiously ruled out by exam-
ining the teeth with a fiberoptic light.
Because of the vitality but poor periodontal condition of
the teeth near the radiolucent lesion, the decision was made
to initiate periodontal therapy alone despite the existence of
the lingual sinus tract. The patient was referred for oral
hygiene instruction, scaling, and root planing.
The patient returned about 1 month later and the sinus
tract had completely healed. Probing depth was 1 to 2 m m
throughout the lower anterior dentition (Fig. 4). Vitality tests
on the lower anterior teeth showed the same positive reaction
as before. The patient was recalled 1 yr later and the clinical
Sinus Tract of Periodontic Origin 179
FiG 4. Five weeks after periodontal therapy, the sinus tract had
completely healed.
FtG 5. One year after last treatment.
examination revealed a generally healthy dentition (Fig. 5).
The follow-up radiograph exhibited bony repair (Fig. 6).
DISCUSSION
Many articles have stressed the importance of an accurate
diagnosis in the treatment of endodontic-periodontic lesions
(4-6). Frequently when a sinus tract appears in the oral
mucosa near the apex of a tooth, endodontic treatment is the
first consideration. Typical "sinus tract type probing" reveals
a sulcus depth within normal limits, with the exception of
one very narrow area which can be probed some distance
down the root surface of the tooth and in many cases all of
the way to the apex of the tooth. It has been suggested that
this clinical problem is not of periodontal origin and does not
need to be curretted or flapped because the sinus tract will
close after endodontic treatment (3). These principles are
applicable in most clinical cases. However, vitality of the
tooth is an important finding and cannot be neglected. Pro-
vided that vitality of the tooth is within normal limits, endo-
dontic treatment can usually be delayed, pending a review of
signs and symptoms in subsequent appointments. In this case,
the vitality of the teeth was positive and was retained by
correct diagnosis and treatment. The localized gingival swell-
180 Yang and Lai Journal of Endodontics

ing and a sinus tract over the lingual mucosa between the
apices of the left central and lateral incisors was diagnosed as
a periodontal abscess because of the suppurative yellowish
color exhibited in the localized swelling mass. It is probable
that the sinus tract provided the drainage from a periodontal
abscess that had been unble to take place along the periodontal
ligament because of the narrow deep pocket and the heavy
deposition of calculus.
It has not previously been reported in the endodontic
literature that a sinus tract of the oral mucosa adjacent to a
tooth can be healed by periodontal therapy alone. The case
has been presented to alert dentists that this possibility should
be considered in the diagnosis and treatment planning of
sinus tract cases.
The author wishes to thank associate professor Roland W. Bryant for his
help in reviewing and editing the manuscript.

Dr. Yang is a senior lecturer, Department of Operative Dentistry, University

of Sydney, Surry Hills, Australia. Dr. Lai is a member of the Department of
Pedodontics, Veterans General HospitaI-Taipei, Taiwan, Republic of China.
Address requests for reprints to Dr. Zu-Pyn Yang, Department of Operative
Dentistry, University of Sydney, 2 Chalmers Street, Surry Hills NSW 2010,
Australia.

FIG 6. Periapical radiograph of lower anterior teeth at 12-month follow-
up examination. Observe complete repair of periapical tissues.
References
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Association of Endodontists. 4th ed. Chicago, IL: American Association of
Endodontists, 1984:15.
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1984:320.
3. Harrington GW. The perio-endo question: differential diagnosis. Dent
Clin North Am 1979;23:673-90.
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