Dr JT (Koos) Marais

Resorption Revealed: A Case Report

Root resorption is more common than widely believed. It can present as external or internal root resorption with some believing that internal resorption always exists together with external resorption, the one leading to the other.

Resorption is not always visible on radiographs. A case of root canal treatment is presented where the final radiographs reveal the presence of some form of resorption.

History

The medical history was non-contributory. The patient reported no experience of pain and swelling, but mentioned that a colleague had discovered the presence of an abscess on a lower right premolar tooth, adjacent to an implant supported crown. The patient was emphatic in his desire not to have the tooth extracted and replaced by another implant.

Examination

Clinical examination showed the lower left second premolar tooth to be restored with a full gold crown. Vitality testing elicited no response. Radiographic examination showed the presence of a peri-apical translucency and an ill-fitting crown (Figure 1).

Figure 1

Diagnosis and treatment planning

The diagnosis of a necrotic pulp and asymptomatic peri-radicular periodontitis was made and root canal treatment suggested as the treatment of choice. The patient readily accepted this.

Treatment

There was great difficulty in locating the pulp chamber, requiring the taking of a tracking radiograph, taken with an explorer in the cavity (Figure 2).

 Figure 2

This confirmed an erroneous track of exploring. Upon finally accessing the pulp chamber the presence of a necrotic pulp was confirmed. A length determination radiograph (Figure 3) and correction radiograph (Figure 4) established the working length.

 Figure 3      Figure 4

A GP cone was fitted for a trial radiograph (Figure 5)

Figure 5

 and the canal was obturated using multiple waves of condensation and finally thermo-plasticized GP injection (Figure 6).

Figure 6

 The radiograph revealed a void between the apical GP and the coronal GP as well as a mass of GP on the side of the root, a sign of a lesion of root resorption on the lateral side of the root. The coronal GP was removed and the injection of thermo-plasticized GP was redone resulting in an acceptable result (Figure 7).

 Figure 7

Both these radiographs showed signs of filling of multiple portals of exit.

Discussion

The mass of extruded material on the side of the root can only be due to a resorption lesion. Under the circumstances it was a very fortunate result, which may well prove to have a favourable prognosis. The presence of the lesion was only discovered at the end of treatment, leaving one to ponder the significance thereof. Perhaps it has no significance other than that of academic interest. Perhaps it may prove to be a sign of a poor prognosis, despite the very best efforts at treatment.