Severe swelling and pain

 This 40 year old male patient presented
  to us with severe swelling and pain. Any thoughts? - Marga 




My thoughts are:

  1) tooth number 11, 12 and 21 were involved previously. may be trauma. but 

  12 was partially vital then so the prev dentist didn't suspect 

  involvement. now that it is involved I suspect the 13 is also needs some 

  attention - Vipin
Hi Vipin, Yes, it is a brain
  teaser....:-)) - Marga

Crown appears to be leaking
  on central. Maybe apex is contaminated but I could be a bit confused. Guy

Marga, Is there an anatomic defect
  on the lingual, a deep lingual pit or lingual groove? Pulp tests on the lateral
  incisor? - Randy Hedrick
No anatomic defect Randy.
  12 responded pos to cold test and EPT. - Marga

    

Interesting case Marga: I need all
  the clinicical findings on 12, 11 , 13 and the medical history. Those should
  include - vitality tests, mobility. Also tracing of the S. Tract is not clear.
  With those that you allready posted my thoughts are on a crack/endo problem
  with #12. - Thomas
Thomas, Medical history:
  non contributory Vitality tests: WNL, except for 11 . No mobility.- Marga
No mobility, but is the bridge retainer
  loose from the abuttment on the central incisor? - Randy
No - Marga
S. Tract traced where ? Exploratory
  surgery on 12 is indicated. A crack suspected...- Thomas 



Crown appears to be leaking on central.
  Maybe apex is contaminated but I could be a bit confused. Guy

  Guy W. Moorman, Jr. DDS
 Guy, Stay tuned, to be continued...................
  Marga 

This was an easy
  thermafil removal. Initially I could not figure out what the canal configuration
  was, but after finishing the C&S, I went back in with a precurved hand file,
  and found a second POE. 

  Fiber post and build-up of composite. - Marga Ree, DDS, MSc