Pulpal-periradicular pathosis causing sinus tract formation through the periodontal ligament of adjacent teeth

Sinus tract formation frequently occurs secondary to pulpal-periradicular disease. Although sinus tracts usually exit through the gingiva or the mucosa, they may also drain extraorally or through the gingival sulcus of the involved or an adjacent tooth. Those opening through the gingival sulcus may traverse a pathway directly through the periodontal ligament, or they may leave the alveolar housing and dissect subperiosteally to the osseous crest where they subsequently enter the gingival sulcus. Resorption of underlying bone may secondarily obscure any clinical distinction between the two variations.

Four case histories are presented whereby pulpal-periradicular disease originating from one tooth established a sinus tract exiting through the gingival sulcus of an adjacent tooth. The pathogenesis and diagnostic problems of these unusual variations are described.

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