Enamel pearl on an unusual location associated with localized periodontal disease: A clinical report
A 21-year-old male patient presented to the Department of Periodontics for treatment, with a chief complaint of bleeding from gums. Intra-oral clinical examination of the patient revealed generalized pale pink gingiva with reddish pink interdental papilla and marginal gingiva in mandibular central incisors []. Notably, significant deposits of plaque and calculus were also present on the lingual surface of mandibular incisors. Bleeding on probing was noted. Grade II and grade I mobility was present in mandibular right and left central incisor respectively. A sinus opening was also seen at the apex of mandibular right central incisor []. Radiographic examination of mandibular anterior teeth showed severe bone loss in mandibular central incisors along with involvement of peri-apex in mandibular right central incisor. The sinus tract on the facial surface of mandibular right central incisor could be traced up to the apex of the tooth with gutta percha point []. Vitality testing of mandibular right central incisor showed the tooth to be non-vital. Patient gave no history of trauma to mandibular right central incisor and trauma from occlusion was absent. A diagnosis of chronic localized periodontitis was made on the basis of history, clinical, and radiographic examination.\nInitial periodontal treatment consisted of oral hygiene instructions and generalized scaling. Completion of phase I therapy led to an incidental finding of enamel pearl on the lingual surface of mandibular right central incisor at a distance of approx. 2.5 mm from the CEJ and about 2 mm × 3 mm in diameter []. Subsequently, root canal treatment was done in mandibular right central incisor [] and the flap was raised in mandibular incisor region []. The area was completely debrided and odontoplasty was performed in mandibular right central incisor to remove the enamel pearl []. The flap was re-approximated and sutured []. The patient was recalled after 1 week for suture removal and showed uneventful healing []. Six month recall of the patient showed complete resolution of gingival inflammation [], reduction in mobility and significant resolution of periapical lesion [].