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External Resorption? - Courtesy ROOTS

From: Daniel Shalkey
To: ROOTS
Sent: Wednesday, June 27, 2007 9:09 PM
Subject: [roots] External Resorption?

With attachments this time.  Do you think this is external resorption on the distal of #3
on this healthy 17 year old female and what treatment do you advise? - DanS



Dan, This is ECIR for sure. Prognosis is poor. I would inform the patient, and monitor for a while.
Maybe she can keep the tooth for some time. I would recommend extraction when she gets symptoms,
or when the lesion spreads fast. - Marga

Marga, That is exactly my question, to treat or not to treat.  My results in such cases hae been
very unpredictable.  It would be difficult to gain access to this lesion without involving the pulp
and the alveolar crest.   A restorative margin that deep is problematic.

I had the cruel thought to refer this to the endodontic specialty practice I compete with, but I fear
they would automatically do an endodontic procedure and I am not sure that would be in the best interest
of the patient.

I did not want to treat this, so I really like your suggestion, and especially appreciate the consultation
from someone I respect so much - DanS

Screw the guy down the street dan.  Your responsibility is to the patient.  Do what is in their best interest.
And if marga says it is ecir,  you know your diagnostic phase is over.  Even Khademi says, and I quote,
"she walks on water"  I’ve never seen her do it, but I have no reason to doubt it is true. - Gary

Dan,

This is the classic picture of ECIR with the defect "worming" its way
in from the distal cervical area and leaving the relatively
uncalcified, but radiographically visable, region of the predentin
intact.  Note the bitewing, where there seems to be a wall that is
unaffected on the distal side of the pulp chamber with what appears
to be an enveloping of the pulp chamber by the defect.

Sadly, treatment of the defect will require a lot of tooth loss.
Perhaps forced eruption and crown lengthening would allow for a
biologically friendly crown margin once the resorption and
endodontics is addressed - Grant