From: Arturo Garcia
To: ROOTS
Sent: Thursday, March 24, 2005 6:27 PM
Subject: [roots] extreme external resorption case

This is from a friend on another mostly restorative forum.  The diagnosis seems to be straightforward.  What is confusing
is the treatment plan and prognosis. Also:

Here is some background from the visit with my friend:

42 y/o female.  Medical History: Non contributory.  Good health.  No meds.  No sure when last physical was though.  Seeing
dentists on a regular basis for routine cleanings and exams.  Orthodontics in high school for at least one year.  Tray
tooth whitening 2 years ago, for two to three weeks.  Last BWX taken 6 months prior, no pathology seen at that time.  So
the resorption occurred in a 6 month period.  All lesions are subgingival.  She has seen at least 2 to 3 other general
dentist, a periodontist, prostodontist, and endodontist.  All coming to the same dx of idiopathic external resorption, but
very different treatment plans.  That's why she is so confused and unsure what to do and I think mentally not ready to
extract 10 plus teeth and consider implants or dentures.  She does not want to do restorative and then in a year or two be
back in the same situation meaning other teeth present with external resorption or restored teeth have it recur.

Also:

New patient presented to my practice for consult on external resorption -- I am the 8th or 9th consult.  She has been
getting treatment plans all over the board.  Has anyone treated a patient with severe external idiopathic resorption?  23
teeth involved.  Some teeth will need to be extracted.  I have a set of digital x-rays, if needed, did not want to create
a large email.  What is the likelihood of the resorption reoccurring once teeth are restored? Experience with having full
mouth periodontal surgery to expose defects and follow up by restoring teeth?  Should I take a more aggressive approach
and extract all involved teeth and restore with implants or partials?  Anyone have articles on this subject, I have done a
web search but not much out there.  Any suggestion on how to proceed with treatment is greatly appreciated?

Any ideas? Thanks, - Arturo



Makes one wonder if HIGH concentrations of H2 O2 were used? With some recession maybe this could cause from the out as
well as it would from the inside. ?

AND some of it really looks more like caries than any resorbsion I have seen. I don't see the 'tentacle's of expansion as
in MOST cervical resorbsion I have seen. ? In any case, looks bad for the patient and HOPE the recare X rays really are
clear and just not 'missed and ignored'. - Alan Cady

Arturo, I agree with Alan. Looks more like caries to me. I had a similar case 3 years ago. Patient stopped smoking and
started using sugar containing candy instead of smoking. He had this in his mouth all day long! Within 8 month he
developed huge defects especially apical of the enamel-cementum-junction. Like in the case your friend is showing the
defects did not occure on all teeth an there has been more destruction on teeth in the lower jaw. he should ask the
patient if there are any sugar "abusing" habbits. - Jörg Schröder