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Invasive cervical resorption - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. - Photos courtesy of Winfried - www.rxroots.com
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 
sure, 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?


Toughest root canal

Retricted mouth opening

Deep decay

Upper second molar

Open sinus lift

Implant after extraction

Implant # 20

Implant # 30

Irreversible pulpitis

2 step necrotic case

Fracture

Lesion on MB

Endo perio case

Surgery or implant

Silver point removal

Series of cases

SS reamers and files

Single visit RCT

Ortho resorption

Apico retreatment

Apical perforation

Funky canine

Crown preparation

Two tough molars

Epiphany recall

To squirt or not

Core distal end

MTA miracles

Pain with LR

Instrument removal

3 canals upper Bi

Acute pain

Dental decay

Calcified chamber

Mandibular first molar

Ultrasonic activation

Fluorosis

TF and patency

Interim dressing

Huge lesion

Tough distal canal

Debris in pulp chamber

Access and success

Restricted mouth opening

Broken drill fragment

MB2 or lateral

Gutta percha cases

Another calcified

Big Perf

Canals and exit

Dam abuse

Amalgam replacement

Simple MTA case

MTA barrier

Restoration with simile

Immediate implant

Traumatic accident

Lesion on D root

Extract / Implant

Carious exposure