This patient presented with spontaneous discomfort on the upper right.
A review of the periapicals reveals some suspicious interproximal activity. Upon clinical evaluation, there were no significant periodontal probings and only an isolated Class V lesion on #3. While there was an elevated response to cold in tooth #3, this presented much like a classic irreversible pulpitis. The etiology of the patients condition was not clear at first.
But the bitewing changed everything…
Welcome to the world of external resorption. For reasons that are sometimes unclear or idiopathic, a resorptive process is initiated on the tooth. This is often the result of damage or injury to the periodontal ligament. In my experience it proceeds in an episodic fashion, meaning that significant activity appears to happen in bursts, rather than at one consistent rate.
Treatment of external resorption involves the physical removal of the lesion through physical and chemical means. Thankfully, the lesions can be stained and this further assists the clinician in differentiating diseased from healthy tissue.
After multiple visits and some creative restorative dentistry, this was the final outcome.
As is often the case in endodontics, the recalls will tell the story…
