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Case Challenge: December 2017

In an effort to include more interactive clinical content in their communications, the Resident and New Practitioner Committee is introducing the Case Challenge column. This recurring column will give readers the opportunity to review a case and select the correct diagnosis from a multiple-choice question. If you have a Case Challenge you would like to submit for publication, please contact Allison Houle at

By Eshwar Arasu, D.M.D.

A 73-year-old Caucasian male in no apparent distress presented with the chief complaint of spontaneous, remitting pain in the anterior maxilla around teeth #6-8. The patient reports that the pain is long-standing (>12 months) and recalls extraction of tooth #7 over 5 years ago. To his recollection, a fixed partial denture was delivered shortly after the extraction.


  • Blood Pressure: 142/88 mmHg
  • Heart Rate: 76 bpm


  • Lisinopril
  • Metformin

Patient has no known drug allergies. Past medical history is notable for diagnoses of hypertension, Type 2 diabetes, and glaucoma. Past surgical history is unremarkable. Patient has a 10-pack-year history of cigarette smoking and reports drinking between two to five alcoholic beverages per week.

Clinical Photograph of Mucosal Lesion

Intra-oral exam reveals ulceration of labial alveolar and gingival mucosa beneath the pontic of #7. The mucosal lesion can be probed, revealing a 9-mm internal defect and eliciting bleeding. Palpation of the mucosa in this area reproduces the patient’s chief complaint. No response to cold thermal testing was elicited among any teeth in the anterior maxilla.

The following annotated radiographs and cone beam CT images were gathered at the time of examination.

PA radiograph: #6 (yellow arrow), #8 (red arrow)

CBCT Coronal View (#8 noted by yellow arrow)

CBCT Sagittal View of #8

CBCT 3D Reconstruction

CBCT Axial View (#8 noted by yellow arrow)