From: Terry Pannkuk
To: ROOTS
Sent: Saturday, August 28, 2010 6:11 AM
Subject: [roots] Surgical Resorption Repair

Here’s an 83 year old guy I treated only internally for the ECIR in 1997.  I’d call it a Type 3 Heithersay because
it has tentacles extending apically but seems to be limited to the lingual aspect.  I’ve had limited success with
Type 3 and Type 4’s and usually start out only treating them internally if there is no detectable crater communicating
periodontally.  If a crater is detected I do the surgery in addition to the endo, treating it internally and externally
trying to cauterize and eliminate as many circulatory feeders as possible.  -  Terry



These are what I view to be very key management steps in these cases:

1. CBCT mapping to determine whether there is surgical access and the amount of osseous access required.
   The transverse sections are invaluable.  If the resorption wraps around the mesial and distal surfaces
   forget it; the root will be too weakened after the prep and too much bone required for tissue support
   will end up being removed.  An implant is a better plan.



2. Make a long sulcular incision at least a full tooth away from the tooth to be treated (if necessary for
   limited jaw opening go 2 teeth over).  Avoid release incisions on the lingual, you don’t need them anteriorly.



3.Indentify the entire margins of the defect and free them of invading bone/granulation tissue.  If you can’t
  clear the margins of invading bone or granulation tissue treatment is going to fail.  I use a surgical length
  flame tip diamond for the gross bone removal creating at least 1 mm of clean smoothed attachment free dentin
  around the entire prep margin.  I perform the final smoothing/dentin clearing with a surgical length flame
  tip composite finishing bur.



4.The prep is treated with trichloracetic acid, rinsed with Peridex, then etched with Citric Acid, then rinsed
  again with Peridex.



5.If necessary you can isolate the prep with Dycal, but in this case I didn’t need to because the hemostasis
was excellent.  I then mix Geristore in a needle tip Centrix tube and inject into the prep, in layers if possible
to prevent shrinkage away from the margins.



6.I contour the restoration with a flame tip diamond and cut way the excess flash.



7.Standard interrupted suturing.  If you don’t use release incisions suturing is simple, the healing is predictable,
and you can predictably see re-attachment (junctional epithelial) within a month.   I typically schedule a one month
post-surgical appt. to see how the site heals and will lightly probe to see if attachment is forming.