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Endo tips    Better Endo    Endo abstracts    Endo discussions

Extra canal invasive resorption - Case 1 Case 2

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 -
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
we treated.

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.

Deep trough case 
Cracked tooth 
Simple surgery 
Safety needles
Second canal
Magnification factors 
Microscope photos
Best Microscope
Replacement resorption 
Disposal of plastic bladders
RCT and amalgam care 
opening sterile packages
Dental Questions/Answers
Importance of floss in perio
Antibiotic Prophylaxis 
Extra-oral fistula  
Safe enough to drink? 
Patient education tools
My first middle mesial 
Taming Destructive Forces  
invasive resorption 
Ideal root filling material 
Intracanal placing of MTA

From: PBery 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 restored. 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
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