FAILING CHIN AUGMENTATION OR INFECTED RETENTION SCREW?

FAILING CHIN AUGMENTATION OR INFECTED RETENTION SCREW?

Here is an interesting case with the following presentation…
– 42 yo healthy female
– Chief Complaint: Recent onset pain on the LR chin area
– Hx of facial reconstruction including mandibular surgery to address significant Class II malocclusion
– Chin augmentation also performed at that time; outlined by red arrows
– CBCT shows the location of the chin graft with a radiolucency at the interface of graft and communication with root apices of #26 and #27
– Surgery done in 1989
– Recent onset discomfort associated with #26, 27 area with radiographic evidence of periapical lesions marked in green arrows
– #26 Class III mobility
– #27 Class II mobility
– All pulp vitality testing WNL on #22-31

We were not convinced that endodontic treatment was indicated in this case and the patient was subsequently referred to OMFS for evaluation. To our oral surgeon friends…thoughts?