患者男,32岁,左上颌牙龈反复肿痛溢脓伴左肩关节痛2年余,曾服消炎止痛药,肩敷药膏,疼痛无明缓解,否认有外伤史。检查:26颊侧尖周区牙龈有窦道,有脓液压出,左肩关节区无红肿压痛,活动时疼痛加重,实验室检查未见异常。x线片示:26牙周膜腔增宽,尖固有边界不清的稀疏区。诊断:26慢性尖周炎。开髓过程中因患者疼痛,故给传导阻滞麻醉后进行,探痛(+),开髓后 Patient male, 32 years old, left maxillary gingival recurrent swelling and pain overflow pus with left shoulder joint pain more than 2 years, had served anti-inflammatory painkillers, shoulder dressing ointment, no pain relief, denied a history of trauma. Check: 26 buccal periapical gingival sinus, there pus pressure, left shoulder joint area without swelling and tenderness, pain during activity increased, no abnormal laboratory tests. X-ray film shows: 26 periodontal cavity widened, the sharp boundary of the sparsely populated areas. Diagnosis: 26 chronic periapical disease. Medullary process due to the patient's pain, it was carried out after the conduction block anesthesia, pain (+), after opening the pulp