Gingival fistulas are not completely eradicated, mainly because local irritation is not eliminated and surgical excision is not complete, resulting in infected lesions remaining. The underlying lesion is not removed and the gingival fistula can still make a comeback. For example, periapical fistulas usually present as a chronic condition and are particularly easy to ignore as the patient is mostly painless, but the periapical area is in fact always inflamed.