Internal treatment of external resorption is predictable with the right tools and materials

Patient: 62 year-old female in excellent health

Chief Complaint: asymptomatic

Dental History: The patient reported a history of external bleaching and prior orthodontics. Her dentist referred her to the author after noticing a root radiolucency (tooth #22) on a routine dental radiographic examination

Significant Findings: A root radiolucency was confirmed with additional radiographs suggestive or root resorption (tooth #22). Teeth #’s 22 and 23 failed to respond to cold thermal stimulation, yet tooth #22 responded unequivocally to the electric pulp test. Tooth #23 did not respond to the electric pulp test and the crown was slightly discolored. Periodontal findings were within normal limits without bleeding upon probing of all the teeth in the lower left anterior sextant. A CBCT scan verified that the root radiolucency involved the labial cervical area of the #22 root not involving the pulp with a small channel communicating with the root surface toward the labial. Tooth #23 demonstrated some cratering/blunting of the root apex with periodontal ligament space widening.

Pulp and Periradicular Diagnosis:

Tooth #22: Class 2 Heithersay resorption (ECIR) Tooth #23: Necrotic Pulp with External Inflammatory Resorption