Acute pulpal-alveolar cellulitis syndrome. IV. Exacerbations during endodontic treatment. Part 3. A case report.

An asymptomatic abscessed maxillary premolar, which had undergone previous endodontic treatment, was retreated. The initial attempt to remove the silver cone seal was unsuccessful. Early the next morning, the patient appeared with a severe cellulitis exacerbation. The silver cone was now loose: a lateral "blowout." Specific cultures of the silver cone and exudate revealed three aerobic microbes: a Streptococcus sp and two obligate Pseudomonas spp. Anaerobes were shown to be absent with anaerobic subcultures. This case would appear to substantiate the alteration of the tissue oxidation-reduction potential as the major factor in endodontic cellulitis exacerbations, as previously reported.