In 2009 a dear friend and colleague came to see me about a problem with tooth #8. I captured a couple images and cringed as they popped up on my monitor. Resorption….and not just a little. 2009 pre-dates my CBCT scanner and because I could not identify an external component, EICR was ruled out. Tooth #8 was diagnosed with significant internal resorption. As dental professionals we value all teeth. Truth be told, there is generally more weighed value for those teeth in the esthetic zone. This greater weighted value generally prompts patients to take more risk. During the consultation I gave this tooth an unfavorable prognosis and advised implant replacement. My advise was quickly trumped and I was persuaded to attempt treatment. It is challenging enough to treat a resorptive defect of this magnitude, but the added pressure of treating a referring doc (and friend) was felt. I am always willing to attempt heroics as long as I do no harm and all risks are well understood. Due to the resorption, I treated this case in 2 steps in order to take advantage of Ca2OH. At visit 1, I established WL and shaped the canal. Warm GP was placed in the canal (apical to the defect) so that I would not block the canal while removing the resorptive defect. I cleaned the defect with a series of Munce Discover Burs until sound dentin could be felt. Fortunately no perforations. Using a GP cone as a scaffold, the resorptive defect was repaired by injecting Geristore around the GP cone. Once set, the GP cone was easily removed and Ca2OH was placed. At the visit 2, my standard treatment protocols were followed and the canal was obturated and restored with Geristore and a bonded fiber post. Whether the post was necessary could be questioned, but it sure made me feel better. I had the opportunity to capture a 5 year follow image and CBCT scan this past Tuesday. I am happy to say the tooth is asymptomatic and is surviving for now. Who knows how long this tooth will survive, but it never would have had a chance if my original advise was followed. Sometimes we have to try things knowing that the odds are against us, clinging to the hope that everything is treatable until proven otherwise! Bill
Posted on: Sat, 11 Oct 2014 01:44:44 +0000
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