Tooth resorption part II - external resorption: Case series

Abstract

External tooth resorption usually follows trauma to the periodontal ligament. It can be classified into five categories based on its clinical and histological manifestations. Calcium hydroxide has long been used as an intracanal medicament to slow down the resorption process due to its alkaline pH. A combination of both external and internal resorptions can also occur on the same tooth, making the management more complex. Five case reports of external resorption have been presented in this article along with pertinent review of literature. Successful management was possible in two cases, while extractions had to be advised in 3 cases due to advanced nature of the lesions.

Keywords: Calcium hydroxide; external root resorption; osteoclast; resorption; trichloroacetic acid.

Figure 1

(a) External root resorption in teeth #20 and 21 of a 20-year-old female patient, (b-d) Repair of root architecture and healing of periapical radiolucency following placement of calcium hydroxide paste after 1, 2 and 3 months respectively, (e) Complete periapical healing and repair of root architecture after 5 months, (f) 1 year follow-up radiograph shows maintenance of the restored root architecture

Figure 2

External replacement resorption in teeth #7, 8, 9 and 10 of a 19-year-old female patient following orthodontic therapy

Figure 3

(a) A soft tissue mass in a defect on the palatal aspect of tooth #8 of a 12-year-old female patient, (b) A large irregular radiolucency in the coronal region of the tooth extending mesiodistally and slightly into the coronal radicular dentin, (c) A sound dentinal base evident after removal of resorptive tissue, (d) Restoration of cavity with glass ionomer cement

Figure 4

External cervical resorption in teeth #9 and 10 of a 23-year-old female patient following trauma

Figure 5

Tooth #9 of a 16-year-old female patient displaying an immature apex with thin incompletely developed parallel root canal walls. Metaplastic bone like tissue seen obliterating the canal space. An ill-defined radiolucency in the coronal portion of the tooth was diagnosed as external cervical resorption

Figure 6

Computerized tomography (CT) scan slices showing the canal configuration of the tooth #9 at the coronal (a, b, c), middle (d, e) and apical levels (f). (a) Continuous canal walls with a wide pulp space, (b) Break in the continuity of the palatal wall distally, (c) Complete discontinuity of the palatal wall representing the resorptive site, (d) (e) Re-establishment of the canal continuity, (f) Thin distal and mesial canal walls evident which can be correlated with the radiograph