CASE REPORTS
REVERSAL OF EXTERNAL ROOT RESORPTION Joseph H. Burke, DDS, MS, MA, San Dieqo, Cadif
The use of calcium hydroxide paste to induce apexification in the divergent pulpless tooth has become a stan~lard procedure since F r a n k I described this technique in 1966. More recently, the use of intracanal calcium hydroxide pastes has been suggested for treating root perforations caused by internal root resorption, mechanical root perforations, and vertical root fractures. 24 Cvek, 5 in 1973, described the arrest of external root resorption in pulpless permanent incisors by using calcium hydroxide. In the case report that follows, a similar calcium hydroxide paste was used to produce catcific healing of external root resorption.
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Fig 1---Radiograph taken three months after replantation of maxillary lateral incisor.
Fig 2--Radiograph taken thirteen weeks after replantation. Extensive areas of external root resorption present on mesial and distal aspects of root. Calcium hydroxide and camphorated parachlorophenol paste sealed in root canal.
Cavit. The maxillary left lateral incisor was then replaced in its socket. The teeth were stabilized by means of a splint constructed of ligature wire and cold-curing acrylic resin. The patient was then referred to me for further treatment. The splint was removed after three months of stabilization. A radiograph taken at this time revealed areas of external resorption on the mesial and distal aspects of the root of the maxillary left lateral incisor (Fig 1). One week later initial endodontic therapy was begun on the maxillary right and left central incisors. The maxillary left lateral incisor was biomechanically prepared, and a paste
compounded of calcium hydroxide and camphorated parachlorophenol was sealed in the tooth (Fig 2). Two weeks later, the maxillary right and left central incisors were obturated with gutta-percha and Grossman's sealer, using a vertical condensation technique. The patient was seen at monthly intervals during the next six months for clinical and radiographic observation of the maxillary left lateral incisor. All affected teeth were asymptomatic during this period of time. A n acrylic temporary removable partial denture was fabricated to replace the missing maxillary right lateral incisor.
Report of Case A 17-year-old vchite man reported to the dental clinic for treatment of a traumatic injury affecting his maxillary incisors. Thirty minutes earlier the patient had been kicked in the mouth by a horse. The maxillary right lateral incisor had been avulsed and could not be located. The maxillary right .and left central incisors and left lateral incisor had been intruded into the maxilla. The attending dentist was able to realign the maxillary right and left central incisors into normal position. The maxillary left lateral incisor, however, was avulsed during the attempt to realign it. Before replantation, a lingual opening was made in the left lateral incisor, and the pulp was extirpated. The tooth was medicated with Formocresol on a lightly moistened cotton pellet and the lingual access opening sealed with
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JOURNAL OF ENDODONTICS I VOL 2, NO 3, MARCH 1976
Fig 3--Radiograph o/ maxillary le[t lateral incisor alter calcium hydroxide therapy ]or six months and obturation with gutta-percha. External root resorption appears to have undergone calci[ic repair.
Fig 4---One year [ollow-up radiograph shows no evidence o[ renewed external root resorption.
After six months of treatment with the calcium hydroxide and camphorated parachlorophenol paste, the areas of external root resorption appeared to have healed with calcified material. The normal contour of the root was evident, and a distinct periodontal membrane space and lamina dura were present. The apical bony defect produced by the intruded tooth at the time of initial trauma showed evidence of healing. The maxillary left lateral incisor was obturated at this time with gutta-percha and Grossman's sealer, using the vertical condensation technique (Fig 3). A follow-up radiograph of the maxillary left lateral incisor, taken one year after obturation of the canal, shows no evidence of renewed root resorption (Fig 4).
Summary
A replanted maxillary left lateral incisor developed extensive external root resorption three months after traumatic intrusion of the tooth and its accidental avulsion during repositioning. The tooth was treated for six months with an intracanal paste of calcium hydroxide and camphorated parachlorophenol. When the area of root resorption showed radiographic evidence of calcific healing, the root canal was obturated with guttapercha. A one-year follow-up radiograph showed no evidence of renewed external root resorption. The opinions and assertions contained herein are those of the author and are not to be construed as official or as reflecting the views of ,the US Navy or the naval service"at large. The author thanks Cdr. Richard A. Hesby for treating the initial traumatic injury in this case.
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Dr. Burke is a captain (DC) USN. He is head of the endodontics section, Marine Corps Recruit Depot Branch, Naval Regional Dental Center, San Diego, Calif. Requests for reprints should be directed to Capt. J. H. Burke, Dental Dept, Marine Corps Recruit Depot, San Diego, Calif 92140. Reterences
1. Frank, A.L. Therapy for the divergent pulpless tooth by continued apical formation. JADA 72:87 Jan 1966. 2. Frank, A.L., and Weine, F.S. Nonsurgical therapy for the perforative defect of internal resorption. JADA 87: 863 Oct 1973. 3. Frank, A.L. Resorption, perforations, and fractures. Dent Clin North Am 18:465 April 1974. 4. Stewart, G.G. Calcium hydroxideinduced root healing. JADA 90:793 April 1975. 5. Cvek, M. Clinical procedures promoting apical closure and arrest of external root resorption in non-vital permanent incisors. In Grossman L.I., ed. Transactions of the 5th International Conference on Endodontics, 'Philadelphia, Univ of Penn, 1973, p 30.
REVERSAL OF EXTERNAL ROOT RESORPTION Joseph H. Burke, DDS, MS, MA, San Dieqo, Cadif
The use of calcium hydroxide paste to induce apexification in the divergent pulpless tooth has become a stan~lard procedure since F r a n k I described this technique in 1966. More recently, the use of intracanal calcium hydroxide pastes has been suggested for treating root perforations caused by internal root resorption, mechanical root perforations, and vertical root fractures. 24 Cvek, 5 in 1973, described the arrest of external root resorption in pulpless permanent incisors by using calcium hydroxide. In the case report that follows, a similar calcium hydroxide paste was used to produce catcific healing of external root resorption.
)
,,?
N
Fig 1---Radiograph taken three months after replantation of maxillary lateral incisor.
Fig 2--Radiograph taken thirteen weeks after replantation. Extensive areas of external root resorption present on mesial and distal aspects of root. Calcium hydroxide and camphorated parachlorophenol paste sealed in root canal.
Cavit. The maxillary left lateral incisor was then replaced in its socket. The teeth were stabilized by means of a splint constructed of ligature wire and cold-curing acrylic resin. The patient was then referred to me for further treatment. The splint was removed after three months of stabilization. A radiograph taken at this time revealed areas of external resorption on the mesial and distal aspects of the root of the maxillary left lateral incisor (Fig 1). One week later initial endodontic therapy was begun on the maxillary right and left central incisors. The maxillary left lateral incisor was biomechanically prepared, and a paste
compounded of calcium hydroxide and camphorated parachlorophenol was sealed in the tooth (Fig 2). Two weeks later, the maxillary right and left central incisors were obturated with gutta-percha and Grossman's sealer, using a vertical condensation technique. The patient was seen at monthly intervals during the next six months for clinical and radiographic observation of the maxillary left lateral incisor. All affected teeth were asymptomatic during this period of time. A n acrylic temporary removable partial denture was fabricated to replace the missing maxillary right lateral incisor.
Report of Case A 17-year-old vchite man reported to the dental clinic for treatment of a traumatic injury affecting his maxillary incisors. Thirty minutes earlier the patient had been kicked in the mouth by a horse. The maxillary right lateral incisor had been avulsed and could not be located. The maxillary right .and left central incisors and left lateral incisor had been intruded into the maxilla. The attending dentist was able to realign the maxillary right and left central incisors into normal position. The maxillary left lateral incisor, however, was avulsed during the attempt to realign it. Before replantation, a lingual opening was made in the left lateral incisor, and the pulp was extirpated. The tooth was medicated with Formocresol on a lightly moistened cotton pellet and the lingual access opening sealed with
87
JOURNAL OF ENDODONTICS I VOL 2, NO 3, MARCH 1976
Fig 3--Radiograph o/ maxillary le[t lateral incisor alter calcium hydroxide therapy ]or six months and obturation with gutta-percha. External root resorption appears to have undergone calci[ic repair.
Fig 4---One year [ollow-up radiograph shows no evidence o[ renewed external root resorption.
After six months of treatment with the calcium hydroxide and camphorated parachlorophenol paste, the areas of external root resorption appeared to have healed with calcified material. The normal contour of the root was evident, and a distinct periodontal membrane space and lamina dura were present. The apical bony defect produced by the intruded tooth at the time of initial trauma showed evidence of healing. The maxillary left lateral incisor was obturated at this time with gutta-percha and Grossman's sealer, using the vertical condensation technique (Fig 3). A follow-up radiograph of the maxillary left lateral incisor, taken one year after obturation of the canal, shows no evidence of renewed root resorption (Fig 4).
Summary
A replanted maxillary left lateral incisor developed extensive external root resorption three months after traumatic intrusion of the tooth and its accidental avulsion during repositioning. The tooth was treated for six months with an intracanal paste of calcium hydroxide and camphorated parachlorophenol. When the area of root resorption showed radiographic evidence of calcific healing, the root canal was obturated with guttapercha. A one-year follow-up radiograph showed no evidence of renewed external root resorption. The opinions and assertions contained herein are those of the author and are not to be construed as official or as reflecting the views of ,the US Navy or the naval service"at large. The author thanks Cdr. Richard A. Hesby for treating the initial traumatic injury in this case.
88
Dr. Burke is a captain (DC) USN. He is head of the endodontics section, Marine Corps Recruit Depot Branch, Naval Regional Dental Center, San Diego, Calif. Requests for reprints should be directed to Capt. J. H. Burke, Dental Dept, Marine Corps Recruit Depot, San Diego, Calif 92140. Reterences
1. Frank, A.L. Therapy for the divergent pulpless tooth by continued apical formation. JADA 72:87 Jan 1966. 2. Frank, A.L., and Weine, F.S. Nonsurgical therapy for the perforative defect of internal resorption. JADA 87: 863 Oct 1973. 3. Frank, A.L. Resorption, perforations, and fractures. Dent Clin North Am 18:465 April 1974. 4. Stewart, G.G. Calcium hydroxideinduced root healing. JADA 90:793 April 1975. 5. Cvek, M. Clinical procedures promoting apical closure and arrest of external root resorption in non-vital permanent incisors. In Grossman L.I., ed. Transactions of the 5th International Conference on Endodontics, 'Philadelphia, Univ of Penn, 1973, p 30.
