Healing of External Inflammatory Root Resorptions and Periapical Lesions without Surgical Treatment in an Operated Oblique Facial Cleft Case

Abstract

This paper describes an operated oblique facial cleft case with external inflammatory root resorption (EIRR) of the permanent maxillary left incisors and canine in a 12-year old patient. Due to the facial oblique cleft, the plastic surgery department operated on the patient five times and placed her on fixed orthodontic therapy. EIRR treatment of the maxillary left incisors and canine was performed using long-term calcium hydroxide therapy. The permanent root canal fillings of the lateral incisor and canine were performed using conventional gutta percha fillings. Because no sufficient apical barrier stop of the central incisor occurred, it was filled with Mineral Trioxide Aggregate (MTA); the canine crown fracture was restored using a carbon-covered fiberglass post and a light-cured composite resin. Examination after 42 months revealed good esthetics and no periapical pathology.

Keywords: External inflammatory root resorption; Oblique facial cleft; Tessier classification.

Figure 1.

The extraoral view of the patient.

Figure 2.

The periapical radiograph of the patient at referral time.

Figure 3.

The panoramic radiograph taken 1 year before Le Fort 1 osteotomy operation.

Figure 4.

The periapical radiograph after 15 months from the Le Fort 1 operation demonstrating loss of lamina dura and an oblique resorption at the apical portion of the left central incisor.

Figure 5.

The occlusal radiograph after 27 months from Le Fort 1 operation shows a periapical radiolucency associated with the maxillary lateral incisor tooth and the loss of lamina dura at the distal aspect of the root of the central incisor (arrow). The extensive root resorption of the central incisor and slight root resorption of the lateral incisor can be seen.

Figure 6.

Periapical radiograph taken nine months after commencement of endodontic treatment which included long term calcium hydroxide therapy shows evidence of periapical repair and resorption control.

Figure 7.

Periapical radiograph taken following the completion of the root filling the maxillary central incisor with MTA and the lateral incisor and canine teeth with gutta percha and AH28. The canine tooth has been restored with a fiber glass post and composite resin.

Figure 8.

The intraoral view of the patient after the completion of the restorations.

Figure 9.

Periapical radiograph taken 42 months after completion of endodontic therapy shows evidence of favourable peri-apical healing and resorption control.