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Resorption due to ortho

From: Marga Ree
Sent: Friday, April 10, 2009 12:49 AM
Subject: [roots] ortho= controlled trauma..

I see more and more resorption due to ortho. This 45 year old
male was referred to retreat 11. He had a sinus tract at the
buccal aspect of 11. Tooth was calcified.

I probably made my own canal, filled with CaOH and after some
time MTA, did an internal belaching, but the sinus tract never
went away.

Surgery revealed a missing buccal bone plate....and there was
calculus on the root tip. Funnely enough, I see this frequently
when there is a long standing sinus tract.

I covered the resection surface with composite, and gave him a
poor prognosis, given the extremely poor root/crown ratio and
missing buccal bone plate.

Today he returned after 6 months, the sinus tract was gone,
and there are even signs of healing, the lesion is filling in.
Patient is symptomfree, his dentist splinted all front teeth
with a retention wire - Marga

Dear Marga, Your patients are definitely lucky to stay in your hands. There is a right scar from #7 to #9 over the mucogingival line at the starting. It suggest to me a previous trauma or surgery in the area. Was there any antecedent of this type? Even in this case it seems root resorption that happens from #7 to #10. Do you have details on the Ortho treatment: speed, lasting, technique? Have you arrived to any conclusion about which ortho procedures or patient conditions could lead to resorption? On the other hand, I have a multidisciplinary patient, who is finishing the orthodontic stage and she is referred to make RCT from #6 to #11 in sound pulps previous to prosthetic rehabilitation. I am concerned on the risk of external resorption due that periodontal ligament is enlarged for recent ortho movement. Do you know any experience or advice on this cases? Do you wait some time to start RCTs? - Nuria Campo Hi Nuria, Patient mentioned a previous surgery some years ago. I assume an oral surgeon did an attempt to control the infection, without success. Ortho was initiated some years ago, with catastrophic root resorption in all teeth, in particular upper and lower front teeth. Do you have any radiographs from this patient of yours? Why should all these teeth be root canal treated, since you are mentioning the presence of healthy pulps?? - Marga Hi Marga, Am I correct that you see the root tip calculus often when doing surgery on long-standing lesions? If so, I remember John Stropko describing the same thing. I would imagine the apexum device would have little effect, no? - Kendel Yes, Kendel, you are correct, that's my experience as well, in particular in the presence of long standing sinus tracts. Extraradicular biofilms do exist....:-)) No apexum device for me here! - Marga

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