From: Yosef Nahmias
Sent: Tuesday, April 24, 2001 1:25 PM

Please look at this case!

Patient was referred to me for assessment of tooth #41 (FDI). He is 27 years old.No
symptoms at all. No history of trauma (although he plays hockey!). Had extensive
ortho done some time ago! Medical OK!  Distal Buccal pocketing 4 mm. Bleeding upon
probing. Tooth appears to be testing vital (cold and Vitalometer!). No palpation,
mobility and no percussion sensitivity!

So now WHAT?

You know guys, it is incredible. One of you mentions that they saw a broken
instrument, next day I get one! Next day, someone talks about a perforation, next
day, I get one. Is like the bad spirits are against me!

Yosi



Photos courtesy of Yosef Nahmias - www.rxroots.com



From: John J. Stropko, D.D.S.
Sent: Wednesday, April 25, 2001 9:23 PM

Yosi,

Looks like a classic radiographic appearance of Extra-Canal Invasive Resorption.  Get
together with the top perio guy in your area and discuss.  I am guessing that you
will lose the tooth in spite of all attempts.  Heard a talk by some "flakey"
periodontist Dr Eric Rindler)----just kidding Rick---he was great!---last night at
our local study club meetingt  He also is seeing more of this.  A Dr Heathersay (sp?)
from Australia is supposedly THE expert on this.  Any other ideas?

John Stropko

From: PBery
Sent: Wednesday, April 25, 2001 10:25 AM

Invasive cervical resorption. Tx: eventual extraction, as proper restoration will be
tough! Otherwise, if judged restorable, endo, cleaning of lesion w. trichloroacetic
acid, MTA or bonding, and prayers galore.

From: Fred Barnett
Sent: Wednesday, April 25, 2001 3:59 PM

I have a crazy idea for this type of resorption:  how about flap surgery, debridement
of defects, EMDOGAIN, resorbable membrane, flap replacement.

I thought Emdogain wasnt very predictable, no? - Jerry Avillion

From: Uziel Blumenkranz
Sent: Thursday, April 26, 2001 6:17 AM

    Dear Yosi: If that is not an oblique crwon root fracture it is a scaratch in your
digital x ray? Invasive cervical resorption, possibly post ortho. I saw some arrested
cases shown by Gerald Harrington, and I have a couple of cases that seemed to have
healed, however, how much are you willing to gamble? Use  Hiethersay's technique now
that the resorption has not advanced too much unless you can get some previous
X rays. let me know what happens. -    Uzi


Yosef Nahmias wrote:

Thank you guys for the quick response! This case just showed me AGAIN
how important it is to be part of this group!!

THANKS A MILLION!