Gutta percha points to track into abscesses

Some clinicians advocate the use of a small gutta percha point inserted into a draining or non draining sinus to track to the apex of a tooth then taking a PA radiograph. In my opinion this makes for a nice photograph but isn't always necessary. It is true that the abscess may not always be located directly next to the infected tooth (especially in kids whose bones are much less dense) but often the signs should be there along with a radiolucency on the PA to allow sufficient diagnosis without the addition of the GP point.

Situations where a radiolucency may not be apparent may be where the root apex is fenestrated or closely situation to the buccal bone so little to no bone loss has occuredto allow the pus to drain through the soft tissues. The apical formamen may also be located a few mm from the anatomical apex on the buccal aspect so no apical bone is required to be resorbed to drain the abscess. There may also be overlapping of other structures e.g maxillary sinus that may hinder the visualisation of a periapical radiolucency.

Despite these special cases I still don't believe that the possible added diagnostic benefit of adding a GP point outweighs the possibility of false positives and negatives. The GP point may move before exposure of the radiograph and point to a different tooth or a non apical area, you may not put the GP point in deep enough and if it tracks laterally you may point to the wrong tooth. Often the radiographs that people are proud of are a GP point sticking into an incisor that is so obviously infected that any layperson would notice the radiolucency.

A situation that I think it may be beneficial are when there are multiple teeth that require treatment and you are trying to figure out which is producing the abscess. In this case I would argue that you should just treat multiple teeth however in an emergency situation this may not always be possible. Another situation where it may be useful is when there is a very large radiolucency and a few teeth may be the possible culprits as it extends to seemingly contact them. In this case a GP point may point to the correct tooth and provide diagnostic value but it may also point to the incorrect tooth. I would suggest that you check the coronal structure and periodontium to check for a cause before proceeding with treatment.