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  Invasive cervical resorption case extracted after treatment

The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. - photograph courtesy: Marga
This patient was referred for retreatment of teeth 21 and 22, which went well, and consisted of removal of silver points, apical plugs of MTA, fiber posts and composite build-ups, nothing special.  
Tooth 11 was treatment planned for extraction, because of the severe invasive cervical resorption. As you can see on the clinical pic, there was an asymmetry between the 2 central incisors, 11 was located in supraposition. Because 11 was to be extracted and replaced by an implant, the prosthetic dentist decided to do orthodontic extrusion of 11, to gain some extra bone and try to restore the asymmetrical gum line.
After the ortho was almost completed, the defect was fairly good accessible, and he asked me if I thought the resorption defect was restorable, and we could save the tooth. The patient was also in favour of changing the treatment plan. I said I would give it a try, flapped it, used TCA, restored it with composite, and took a rad. I thought I restored the defect completely, and went on the remove the silver cone in a next session. After placing an apical plug of MTA, I made another rad...............and was shocked to see that the defect was not completely filled...............because of the vertical angulation of the rad that I took immediately after the surgery, the defect had been partly hidden..............
To make a long story short, the tooth had to be extracted yet. I took some pictures after extracting it, which makes you very humble........The defect is far more extended than you think by looking at the radiographs.   -  Marga


Marga,Great documatation though! It is very sad that sometimes despite our best efforts the tx fails. I have a similar case, in which I re implanted two anterior teeth after in vitro Endo tx. One of which is showing external root resorption. I am expecting it to be extracted someday. don;t know why it appeared in only one of the 2?? - Ananya

Marga,, How do you remove the apical plug of MTA?  Yours was an interesting case. - Charles

Hi Charles, I didn't remove an apical plug of MTA in this case, but if I had to remove MTA, I'd use ultrasonics. - Marga

Hi Marga , very interesting case. How much time was there between the composite restauration and the silver cone removal in the next session? Do yo u think it's poossible that the resorption continued despite the TCA and everything? Did you use caries detector when you cleaned out the defect? Thanks for sharing! - Winfried

Hi Winfried,

I did the removal of the silver cone a couple of weeks after restoring the resorption defect, so it is very unlikely that the unfilled part of the resorption arose over the course of a few weeks, but of course I cannot fully exclude this. I think there is another explanation:
I didn't manage to access the resorption defect completely, because it was partly covered with bone. Because of the vertical angulation of the radiograph which I took immedialtely after surgery, it escaped my attention, it just looked if the defect was completely filled. This was also my clinical impression, I did the whole procedure with the aid of the microscope. These defects are usually more extensive than they appear on rads, and this has been confirmed by several papers on this topic. - Marga

What a great teaching case Marga.  I am going to be doing an implant on a lower incisor with the same problem.  To difficult to save the tooth given the location (lingual) and the short roots.

What wonderful documentation, and please remember folks.......IF MARGA CANT SAVE IT......ITS UNLIKELY ANY ONE ELSE COULD!

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A fun case