Replacement Resorption





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 Richard Schwartz - www.rxroots.com

From: Richard Schwartz
Sent: Thursday, April 05, 2001 10:03 PM
Subject: Replacement resorption

This is a 19 year old college girl who had tooth #9 avulsed about 2 1/2 years ago.
They took her to the emergency room where the tooth was replanted.  Someone had the
presence of mind to put it in some milk, but as best I can tell, it was out of the mouth
for at least an hour.  She was referred to me about a year ago.  It appeared to be
undergoing replacement resorption as well as inflammatory resorption.  She was swollen
and hurting when I saw her.  I explained the situation to her and her mom and the poor
long term prognosis.  She was, of course, a pretty girl with pretty teeth. I did a
pulpectomy, placed CaOH,did an I&D and placed her on antibiotics.  I saw her again a
few days later and she was doing better.  My plan was to leave her with CaOH long
term and see how long we could keep the tooth.  She was in college at Texas Tech,
about 7 hours away.  I saw her about every three months.  Each time the CaOH would
be washed out.  On one occasion she was slightly symptomatic.  Each time I would
replace the CaOH.  Any suggestions on a better way to manage her?  Would anybody
place a resorbable obturating material such as ZOE so that washout wouldn't be a
problem.  As one of my fellow Texans once said, I'm all ears.

Rick Schwartz

Photos by Richard Schwartz 

First visit.



Initial canal preparation.  Lots of bleeding.  




CaOH on place




3 months later.  This is representative of how the tooth looked when I saw her on
school breaks.



From: Fred Barnett
Sent: Friday, April 06, 2001 16 35
Subject:Replacement resorption

Rick,

This is a tough one.  I might try to fill only the coronal part with Ca(OH)2, as you
would in a transverse root fracture case....as long as there is no pathosis at the
root end.  By going through the fracture and stimulating bleeding, inflammation, etc.,
the CaOH will wash out much more rapidly.

The beneficial effects of CaOH are in its controlled release mode of delivery....
continual release of OH-.  The infl. resorption will stop when the canal and tubule
infection are eliminated.  This is more difficult when there is wash out of the CaOH.
The replacement resorption will occur at its own pace, and there is nothing we can do
about it  (yet).

I would like to see future recalls if you don't mind, and would be happy to add my
$.02 - Fred


Thanks Fred.  I'll be seeing her again in the summer when school is out. - Rick

From: M I Pascal, DDS
Sent: Friday, April 06, 2001 17 32

Rick -
Hi - Michael Pascal from Washington DC - I've a couple of suggestions-
first I've found a nice, thick, easily used CaOH paste - it's called MetaPaste
( http://www.ec21.net/co/m/metadental/prod_group.html?grp=1 ) It's easily
injected, very radiopaque (sp?), and does not wash out.  However, I'd not
fool around with this too long.  I'd clean the canal, pack collacote/collaplug
into the apex,and place MTA, then I'd see her the next day (once the MTA sets)
and clean up the apical end surgically.  The root will be short, but lots of
short roots have lasted a long time.

Hi Michael. A good suggestion.  Thanks. - Rick

From: John J. Stropko, D.D.S.
Sent: Sunday, April 08, 2001 02 01

Rick,
What is the mobility?  If Class I, apical surgery would be indicated.  As long
as the resorption is not stopped, there is less and less root as time goes on.
Look at the crown root ratio now as compared to first visit.  I've seen ortho
cases end up with less root than this and still be OK.  Heard a saying once,
while playing bridge in dental school, "He who hesitates is lost!"  Good luck
and see you EOM. - John Stropko



John, There is no mobility.  Just the dull thud of an ankylosed tooth. -  Rick



From: John J. Stropko, D.D.S.
Sent: Sunday, April 08, 2001 02 15

Rick, What about

1) cleaning canal,
2) packing with MTA to level of osseous crest (so no "show through"), no collacote
   and forget about excess filling material,
3) apical microsurgery after 24-48hrs to remove excess MTA, retained apex and
   granulation tissue,
4) recontouring MTA fill at apex with a spiral taper bur to minimize vibration
   (#1171 Brassler),
5) restore access ASAP, and finally 6) Say a prayer of thanks to the tooth god that
   you had so much help from ROOTS! It will work, I've had a few and they were fine.

John Stropko