Internal and External Resorption – Case Presentations
Dr. Paul Belzycki
General Dentist, Toronto
Root resorption, both internal and external, is an uncommon clinical finding. Management of these lesions requires periodontal surgery, endodontics and restorative dentistry. Presumably, we are aware that one must not violate the Biologic Width of Attached Gingiva with restorative materials. However, these lesions are often located in the complex of tissues, comprising the Biologic Width, forcing us to manage this delicate soft tissue barrier against the ingress of micro-organisms that promote periodontal breakdown. This presentation reviews several cases in the hopes of providing guidance to achieve predictably successful outcomes.
Post referenced in the presentation: View from the Chairside: Nosce Te Ipsum, Know Your Limitations
Until next time!
CDA Oasis Team
Thank you very much Dr. Belzycki for your great case presentations! Great use of periodontal surgery to complete the treatment. Nice flap design on the second case!
Dr. Belzycki, thanks for the presentation, it was very informative. I would like to clarify one aspect. When removing the resorbed area, is it sufficient to use a spoon excavator or do you introduce the round bur to clean the area out?
Joseph, thanks for the comment. As with all questions regarding technique…depends on clinical findings. I would like to go into a defect with a rotary instrument to clean up the surface and idealize a retentive prep design. If sufficient bulk of tooth structure remains and access is favorable, then this is done. I will use a slow-speed round bur…as this allows me to “feel” if the dentine is of sound structure. There are also chemicals that some have suggested to treat the remaining tooth structure to “kill off” hidden odontoclasts/osteoclasts. I have never done this for fear of injury to surrounding hard and soft tissues. I often use a tetracycline slurry to condition root surfaces during periodontal surgery. It is my hope that this may eliminate unwanted cells, but I have no scientific evidence for this. My warning is to be careful with high-speed rotary instruments when the cavity prep is close to bone. Too easy to remove too much tooth structure.
Hope this helps.