By: Victor M. Sternberg, D.M.D. 

June 21, 2024

The metamorphosis of radiographs over the last three decades has been remarkable. However, digital x-rays can often mask pathology, particularly where angulation is critical. 

A patient presented with discomfort on the upper right when she flossed her teeth, and occasionally when she bit down in a certain position. Tooth #3 was asymptomatic to percussion and did not have a deep pocket on the mesial palatal where she was having discomfort. The dentist wanted me to evaluate this situation periodontally. 

I took floss and when I went up to the base of the gingival sulcus she felt a little discomfort. 

Finding no reason on the radiograph, I elected to take a parallel vertical bitewing. Low and behold I saw what looked like a resorptive lesion communicating with mesial surface of the tooth. 

At this point a scan was taken which clearly delineated the internal resorptive lesion which is now communicating in a small area on the mesial aspect of the tooth. When she flosses this area, the floss rubs up against the soft tissue which perforated through the tooth and as a result she has discomfort.

She is off to the endodontist to have the pulp removed as well as much of the granulation tissue that now occupies the mesial third of the pulpal area. 

Hopefully, with some crown lengthening on the mesial, a crown can be created that will cover over the exposed portion of the tooth. 

Interesting enough, I’ve seen more and more resorption lesions of this nature over the course of the last ten years. Some of them were external and some were internal as this one is. I’ve also noticed that these are more common in people who’ve had orthodontic treatment. In this case  the woman’s had orthodontics twice. 

As always, I appreciate your feedback. 

Yours truly, 

Victor M. Sternberg, D.M.D. 

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By Westchester Center for Periodontal & Implant Excellence

December 29, 2023