Extra canal invasive resorption - Case 1 Case 2
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- Photos courtesy of Richard Schwartz - www.rxroots.com
From: Richard Schwartz
Sent: Sunday, April 15, 2001 4:48 PM
Subject:Extra canal invasive resorption
Here is a case I treated in conjunction with one of my restorative friends
(probably the best restorative dentist in San Antonio). It was his mother.
He noticed that one of her central incisors looked kind of pink in the cervical
area and took an xray. You can see what he found. The tooth was asymptomatic
and the pulp was vital. There was no evidence of resorption on an xray taken
2 years earlier. When I entered the tooth the resorption had a honeycombed
appearance. I only removed enough of the resorption to do the root canal get
good isolation. He then reflected a flap, did crown lengthening on the lingual,
debrided the lesion and restored it with a tooth colored post and one of the
resin-ionomers. The crown was just a shell once the resorption was removed.
The last photo is a recent recall. As you can see, he was able to do the surgery
entirely from the lingual without compromising the esthetics. I see now that
I got the small, scanned xray flipped around in photoshop. #9 was the tooth
After reading Fred's post this morning about the Heithersay articles on this topic,
I stopped by the dental school library and made copies. It is a very good series and
beautifully documented. Thanks Fred. You are such a great source of information.
While at the library, I ran into one of the 3rd year perio residents and showed
him one of the Heithersay articles. He was unfamiliar with the process and said
they had not discussed it in his residency. It is largely an unknown phenomenon
in the dental community, at least around here.
Sent: Monday, April 16, 2001 5:39 PM
Hi Richard: I am also treating a case like this (will post the pix), and it is the
third I see in recent times. Doesn't Heithersay recommend application of Chloroacetic
acid on the remaining dentin after debridement? I cannot find his article but
I remember this fact. Am I right? (it is in the quintessence 1999 article,
if memory serves). Best regards and congratulations on the nice case. P.S.Gut feeling?
the resorption will reccur eventually.
From: Uziel Blumenkranz
Sent: Monday, April 16, 2001 6:32 AM
Dear Rick: Beautiful case. My feelings are however, that we are daling with a different
type of resorption. this simply is a question of semantics, the problem remains the same,
how to cope with it? I ried to duplicate Hiethersay's technique with the trichloroacetic
acid but was not successufl in removing the resorbed tisuue, so the periodontist had to
go in, do crown kengthening procedure and then the case was restores with geristore,
It may be still around in roots where I psoted it several months ago. the present case is
challenging becuse of the size of the lesion, so my thoughts are to try to do the endo,
and if that is achieved, possibly raise a flap to mor or less restore the defect and ask the
orthodontist to do forced eruptiona and then if everything goes the right way have the tooth
In any case I will keep all around posted on the happenings.
Thanks once again. - UZi
From: Richard Schwartz
Sent: Tuesday, April 17, 2001 8:18 AM
Rick Schwartz, I just read his articles for the first time this weekend. I believe he uses
trichloroacetic acid. He said that it eliminates any tissue tracts to the PDL that
can not be removed during debridement. He also said that he was able to avoid endo
about 30% of the time. He had 100% success with smaller lesions, and progressively
less as the lesions increased in size. We have tried to debride some of the small
lesions without doing endo, but most of those patients needed endo later. Some returned
in acute pain. He probably was less agressive in debridement and relied on the acid.
I plan to try it. Does anyone know where to obtain tricloroacetic acid? Does anyone
know about it's properties? - Rick
From: Uziel Blumenkranz
Sent: Tuesday, April 17, 2001 3:31 PM
Hello: Yes, According to Hiethersay, February 1999 Quintessence, If I am not wrong,
thricloroacetic acid. I bought mine in a drug store, (Not equivalent to american drug stores),
company that manufactues medicaments and so on.
As mentioned before I was not able to remove the "coagulated tisues - Üziel
From: Fred Barnett
Sent: Tuesday, April 17, 2001 4:10 PM
Rick, You can get the acid from your pharmacist; special order or a medical supply house,
or possibly Fisher Scientific. Dermatologists use it a lot to remove small skin lesions,
warts, papillomas, etc. I have never used it, but how can you argue with his results?
I wondered if the TCA might setup the stage for further root resorption as there can be
a collateral damage to intact areas of the root surface (as in intra-coronal bleaching).
But there is no evidence for this. I worry too much sometimes. - Fred