Which is the most likely diagnosis and recommended treatment for a radiolucent lesion at the apex of tooth 14 with a sinus tract to the buccal mucosa?

• A. Acute apical abscess with a spreading infection requiring immediate surgical drainage.
• B. Chronic apical abscess/granuloma; treat with root canal therapy or extraction with follow-up to resolve the sinus tract.
• C. Osteomyelitis of the jaw requiring hospitalization.
• D. Radicular cyst requiring extraction without endodontic therapy.

Answer: (B)

A radiolucent area at the root tip with a sinus tract draining to the cheek mucosa points to chronic periapical pathology from a nonvital tooth. The sinus tract shows the body’s way of draining infection over time, which is classic for a chronic apical abscess or a granulating lesion rather than an acute, spreading infection. The primary goal is to remove the source of infection and allow healing of the periapical tissues. That’s achieved by disinfecting and填 sealing the root canal system through endodontic therapy; if the tooth isn’t restorable, extraction is the alternative, followed by healing of the sinus tract.

An acute apical abscess would usually present with sudden pain, swelling, and possibly systemic symptoms, and would demand immediate drainage rather than relying on root canal therapy alone. Osteomyelitis involves bone infection with more extensive bone destruction and often systemic signs, requiring more intensive management. A radicular cyst is a chronic lesion as well, but it can often heal with successful endodontic treatment of the nonvital tooth rather than mandating extraction, so it isn’t as prescriptive as the chosen approach.