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Deciduous teeth: Five-year-old boy having lost his first deciduous teeth.Deciduous teeth, otherwise known as milk teeth, baby teeth, temporary teeth or primary teeth, are the first set of teeth in the growth development of humans and many other mammals. They develop during the embryonic stage of development and erupt that is, they become visible in the mouth during infancy. They are usually lost and replaced by permanent teeth, but in the absence of permanent replacements, they can remain functional for many years.- More from Wikipedia

Replacement Resorption


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 - www.rxroots.com
From: Richard Schwartz Sent: Thursday, April 05, 2001 10:03 PM Subject: Replacement resorption This is a 19 year old college girl who had tooth #9 avulsed about 2 1/2 years ago. They took her to the emergency room where the tooth was replanted. Someone had the presence of mind to put it in some milk, but as best I can tell, it was out of the mouth for at least an hour. She was referred to me about a year ago. It appeared to be undergoing replacement resorption as well as inflammatory resorption. She was swollen and hurting when I saw her. I explained the situation to her and her mom and the poor long term prognosis. She was, of course, a pretty girl with pretty teeth. I did a pulpectomy, placed CaOH,did an I&D and placed her on antibiotics. I saw her again a few days later and she was doing better. My plan was to leave her with CaOH long term and see how long we could keep the tooth. She was in college at Texas Tech, about 7 hours away. I saw her about every three months. Each time the CaOH would be washed out. On one occasion she was slightly symptomatic. Each time I would replace the CaOH. Any suggestions on a better way to manage her? Would anybody place a resorbable obturating material such as ZOE so that washout wouldn't be a problem. As one of my fellow Texans once said, I'm all ears. Rick Schwartz Photos by Richard Schwartz First visit.
Initial canal preparation. Lots of bleeding.

CaOH on place

3 months later. This is representative of how the tooth looked when I saw her on school breaks.
From: Fred Barnett Sent: Friday, April 06, 2001 16 35 Subject:Replacement resorption Rick, This is a tough one. I might try to fill only the coronal part with Ca(OH)2, as you would in a transverse root fracture case....as long as there is no pathosis at the root end. By going through the fracture and stimulating bleeding, inflammation, etc., the CaOH will wash out much more rapidly. The beneficial effects of CaOH are in its controlled release mode of delivery.... continual release of OH-. The infl. resorption will stop when the canal and tubule infection are eliminated. This is more difficult when there is wash out of the CaOH. The replacement resorption will occur at its own pace, and there is nothing we can do about it (yet). I would like to see future recalls if you don't mind, and would be happy to add my $.02 - Fred
Thanks Fred. I'll be seeing her again in the summer when school is out. - Rick
From: M I Pascal, DDS Sent: Friday, April 06, 2001 17 32 Rick - Hi - Michael Pascal from Washington DC - I've a couple of suggestions- first I've found a nice, thick, easily used CaOH paste - it's called MetaPaste ( http://www.ec21.net/co/m/metadental/prod_group.html?grp=1 ) It's easily injected, very radiopaque (sp?), and does not wash out. However, I'd not fool around with this too long. I'd clean the canal, pack collacote/collaplug into the apex,and place MTA, then I'd see her the next day (once the MTA sets) and clean up the apical end surgically. The root will be short, but lots of short roots have lasted a long time.
Hi Michael. A good suggestion. Thanks. - Rick
From: John J. Stropko, D.D.S. Sent: Sunday, April 08, 2001 02 01 Rick, What is the mobility? If Class I, apical surgery would be indicated. As long as the resorption is not stopped, there is less and less root as time goes on. Look at the crown root ratio now as compared to first visit. I've seen ortho cases end up with less root than this and still be OK. Heard a saying once, while playing bridge in dental school, "He who hesitates is lost!" Good luck and see you EOM. - John Stropko
John, There is no mobility. Just the dull thud of an ankylosed tooth. - Rick
From: John J. Stropko, D.D.S. Sent: Sunday, April 08, 2001 02 15 Rick, What about 1) cleaning canal, 2) packing with MTA to level of osseous crest (so no "show through"), no collacote and forget about excess filling material, 3) apical microsurgery after 24-48hrs to remove excess MTA, retained apex and granulation tissue, 4) recontouring MTA fill at apex with a spiral taper bur to minimize vibration (#1171 Brassler), 5) restore access ASAP, and finally 6) Say a prayer of thanks to the tooth god that you had so much help from ROOTS! It will work, I've had a few and they were fine. John Stropko