Dense Bone Island with External Root Resorption on Mandibular Evaluation

A 27-year-old female was referred by a general dentist for evaluation of a radiopacity on the distal root of tooth #30, with no reported symptoms. The radiographic and clinical features were suggestive of a dense bone island, a common finding with no clinical significance, though moderate to severe apical external root resorption of the distal root was also present. The radiologist noted that while the severe apical resorption can appear alarming, it is sometimes seen with this condition and does not necessarily indicate cause for concern on its own. However, external cervical resorption was also identified on the same tooth, which means periapical sclerosing osteitis should be considered in the differential. The radiologist noted that the radiographic density, borders, and extension of the apical lesion, along with the absence of symptoms, are more characteristic of dense bone island, but action may still be needed to address the resorptive process.