Dr. Victor M. Sternberg 

August 16, 2023 

A patient came in complaining of discomfort when she used the water irrigator on the upper right. An x ray was sent by her dentist who saw no pathology. 

The tooth was not sensitive to percussion and was not sensitive to hot or cold. She had about 1 degree  of mobility in the tooth. One would assume, standing alone, that this would probably be not unusual. 

However, a decision was made to take a 3D scan  

The scan demonstrated clearly that the entire lingual plate of bone was gone beyond the apex and  perhaps even communicating with the sinus. Upon probing the patient palatally the probe was lost into  the apex of this tooth. 

3D scans are particularly valuable in picking up periapical pathology that doesn't show up on a dental x ray and the extent of periodontal bone loss that may be occluded by the palatal or buccal to a root  which obviate the image. 

The patient was a heavy smoker which is often associated with palatal bone loss. Although I'd never  seen this patient before I did urge her to stop smoking before I attempted to treat this tooth. Most  likely the prognosis for this tooth is poor to hopeless.  

It is interesting to note that the tooth communicates with the sinus at least on the film and the right  sinus is cloudy right above the apex of the tooth while the left sinus is completely clear. 

As always I appreciate your viewpoints. 

Yours truly, 

Victor M. Sternberg, D.M.D.

By Westchester Center for Periodontal & Implant Excellence

August 18, 2023