Abstract
Background: Periodontitis is defined as an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone. Clinical manifestations of Persistent chronic periodontitis may mimic varied clinical manifestations, including those of apical abscess and systemic involvement.
Case report: This report presents the management of an intraoral sinus mimicking a chronic apical abscess in the mandibular anterior region associated with deep periodontal pockets in two male patients in their early thirties. With careful clinical and radiological examination and ruling out of endodontic and systemic involvement, the diagnosis of primary periodontal infection was made.
Results: The treatment plan involved initially phase 1 therapy and correction of occlusal discrepancies. After 2 weeks of periodontal surgical intervention that included open flap debridement, both patients reported marked symptomatic improvement, with complete resolution of pain and swelling, and sinus with no recurrence at 3 and 6 months.
Conclusions: This case report emphasized careful periodontal examination and diagnosis of primary periodontal infection with intraoral draining sinus mimicking endodontic involvement, which can prevent unnecessary endodontic therapy and tooth extraction.
References
- Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4(1):1–6.
- Kareha MJ, Rosenberg ES, Dehaven H. Therapeutic considerations in the management of a periodontal abscess with an intrabony defect. J Clin Periodontol. 1981;8(5):375–86.
- Newman MG, Sims TN. The Predominant cultivable microbiota of the periodontal abscess. J Periodontol. 1979;50(7):350–4.
- Yang ZP, Lai YL. Healing of a sinus tract of periodontal origin. J Endod. 1992;18(4):178–80.
- Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. J Clin Periodontol. 2018;45:S75–94.
- Bashar AKM, Akter K, Chaudhary GK, Rahman A. Primary molar with chronic periapical abscess showing atypical presentation of simultaneous extraoral and intraoral sinus tract with multiple stomata. BMJ Case Rep. 2019;12(9):e229039.
- Kambale S, Aspalli N, Munavalli A, Ajgaonkar N, Babannavar R. A sequential approach in treatment of endo-perio lesion a case report. J Clin Diagn Res. 2014;8(8):ZD22–4.
- Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D. The CARE guidelines: Consensus-based clinical case reporting guideline development. Glob Adv Health Med. 2013;2(5):38–43.
- Jain A, Reche A, Singhai S, Paul P, Raisoni K, Agrawal K. Misdiagnosis of an odontogenic infection as a skin lesion: The diagnostic dilemma. Cureus. 2024;16(8):e66024.
- Yeoh WC, Banavar SR, Rajaran JR, Siew KL. Unveiling periapical actinomycosis: A rare extraradicular infection. Cureus. 2025;17(3):e79907.
- Mohanavalli S, David J, Gnanam A. Rare foreign bodies in oro-facial regions. Indian J Dent Res. 2011;22(5):713–5.
- López-Carriches C, Mateos-Moreno MV, Taheri R, Martínez JLQ, Madrigal-Martínez-Pereda C. Chronic osteomyelitis of the Jaw. Osteomyelitis. J Clin Exp Dent. 2025;17(3):e324–8.
- Liao W-C, Chen C-H, Pan Y-H, Chang M-C, Jeng J-H. Vertical root fracture in non-endodontically and endodontically treated teeth: Current understanding and future challenge. J Pers Med. 2021;11(12):1375.
- AbdullGaffar B, Awadhi F. Oral manifestations of Langerhans cell histiocytosis with unusual histomorphologic features. Ann Diagn Pathol. 2020;47:151536.
- Alagl AS. Periodontal abscess as a possible oral clinical sign in the diagnosis of undiagnosed diabetes mellitus of elderly in a dental clinic set up–a 7-year cross-sectional study. J Investig Clin Dent. 2017;8(3):e12217.
- Rosa DE, Hapid MH, Hidayat W. Non-healing chronic traumatic ulcer, an entity that can resemble other chronic ulcers. Int Med Case Rep J. 2023;16:585–90.
- Okano Y, Yoshida S, Shinohara T, Takahashi N, Naito N, Kagawa K, et al. Primary gingival tuberculosis diagnosed based on genetic identification. Intern Med. 2015;54(21):2765–8.
- Cabral Ramos J, César Silva L, Schausltz Pereira Faustino I, Carolina Evangelista Colafemina A, de Pauli Paglioni M, Almeida Leite A, et al. A rare case of squamous cell carcinoma of the gingiva: A diagnostic challenge. Oral Oncol. 2022;132:105995.
- DeWitt GV, Cobb CM, Killoy WJ. The acute periodontal abscess: microbial penetration of the soft tissue wall. Int J Periodontics Restorative Dent. 1985;5(1):38–51.
- Jaglan S, Tewari S. Treatment of gingival fenestration using mucoperiosteal flap with connective tissue graft: A report of two cases. J Dent Indones. 2023;30(1):52–6.
- Ryan ME, Carnu O, Kamer A. The influence of diabetes on the periodontal tissues. J Am Dent Assoc. 2003;134(Supplement 1):34S–40S.
- Abbott P, Salgado JC. Strategies for the endodontic management of concurrent endodontic and periodontal diseases. Aust Dent J. 2009;54(s1):S70–85.
- Jaoui L, Machtou P, Ouhayoun JP. Long-term evaluation of end- odontic and periodontal treatment. Int Endod J. 1995;28(5):249–54.
Recommended Citation
Kumari, A., & Tewari, S. Sinus Formation as a Manifestation of Chronic Periodontitis In Mandibular Anterior Region: A Report on 2 Cases. J Dent Indones. 2026;33(1): 69-74