From: "Winfried Zeppenfeld"
To: "ROOTS"
Sent: Monday, December 08, 2008 2:42 AM
Subject: [roots] Distal translucency?

In 1994 I prepped a bridge in the right mandible of this pt. I was quite surprised I opened the pulp of 45 (#29 US),
way more coronally than I  ever expected. I did rct (steel files , AH26 and lateral condensation)
and cemented a cast post. In 1994, I concluded it was some kind of  internal resorption but didn't take a closer
look at the mid root area  due to lack of knowledge. When I look at these pics today, it sure looks
like internal rsorption. May also be an extra canal, although the recent mesial excentric X-ray gives no hint of a
sencond pdl.   Yesterday, the  pt came with a swelling that corresponds with the lateral lesion visible
on the X-ray. There must be a connection between the lesion and the  marginal gingiva, although I could not probe it.
But when I blew air at  the margin, my fingertip placed above the lesion felt the  mucosa  blow  up like a little
balloon. What should I do now? 46 and 47 are missing, and 45 is quite a weak abutment for such a long bridge.
So my idea is to take 45 out and place two implants in the location of 45 and 47. The crown on 48 can stay there.
Would anyone of you recommend retreatment of 45 and dare to place a new bridge? Any other ideas? - Winfried



Win, This is invasive cervical resorption, no internal resorption. Prognosis is  very poor in this case - Marga

Hi Winfried, for a internal resorption, you got to have a vital pulp. So even if there would have been a
second canal, I am not shure, if the pulp would have survived for so long - Jörg

Winfried....this is ECIR, unfortunately.- Fred

I agree with Marga, this is an external resorption, meaning the resorptive cells are from the pdl.
Internal resorption is rare in comparison, and the resorptive cells are from the pulp, so even if a canal
was missed, the pulp would have had to remain vital to cause this defect---not so likely.  Also, the external
variety seems to be more 'malignant", and this prognosis looks quite poor, as Marga said, perhaps a
Heithersay III or IV already.  This is commonly called cervical resorption, although this terminology is not
so precise, since the process does not always present at the cervical, as we see here - Kendel

Thanks Marga (and Fred, Jörg, Kendel)
At least I didn't srew up the prognostic evaluation of the tooth. Anyway, I'm surprised it lasted that long.
Thanks for your help! - Winfried

Here is another one from 1984. Any objections that it is internal?