Resorption Recall 6 Years
Author: admin
External Resorption Recalls as of 5/2026
Decision making under uncertainty is undoubtedly strained to the max when managing external crestal resorption. The literature is all but useless in guiding our decision making with regards to risks, benefits, and alternatives. An honest approach for the truth requires meaningful follow-ups of actual cases. Only then can we really answer the question “when should we attempt to fix it?”, which is a good one and worth the effort.
What will follow is an ongoing presentation of recalls at meaningful timeframes. I’ve treated over 60 teeth over the years. I will endeavor to recall all 60 and take new imaging when possible. There are over 20 that have 1-4 years. It may very well be that the inferences change with incoming data and that’s ok. We will stare unblinkingly at our failures when they present and do our best to learn from them. Here they are: the good, the bad, and the ugly. In blue is noted the number of years after treatment. Click on the image to see the case.
The Failures
So here’s where things get kinda interesting. I’ve got one endo failure where I missed a canal and one that developed significant periodontal disease in the 5 year period after treatment. Neither failed due to recurrence.
I have 20 more follows that range from 1-4 years.
Embrasure Space Recapture
The embrasure. I don’t think most clinicians give enough thought to the embrasure. It’s the contact in three dimensions. It is dictated often by tooth position and or restorative. As long as there is sufficient embrasure space, the contact can be elongated, broadened, and shifted bucco-lingually. In order for both teeth to have convex curvatures an embrasure space of 2-3mm is necessary. In some instances root proximity sets the tooth up for failure as a proper embrasure is almost naturally impossible. In many instances the embrasures provided by implants are dangerous for adjacent teeth.
The bottom line is that good embrasures are important for proper function and longevity. And in some instances the space required for a proper embrasure has been lost.
Here’s a recent case where the embrasure space is negative, probably negative 1-2mm. Gingival ingrowth can be seen.
The caries was removed and a band placed. From the occlusal, we can seet the proximal convexity of the distal tooth was over the distal cavosurface. Fuji core is great in this indication. It sets completely and immediately, and comes in a blue color that’s clearly visible but not ridiculous. The canals were instrumented medicated and the access closed with cavit. Then an orthodontic spacer was flossed into place.
After 3-4 weeks, the patient returned. We had recaptured 2-3mm of space, which is typical. The endodontics was finished, an amalgam core was placed, and after it had set we placed another spacer to recapture another couple of mm’s.
I think this really stacks the deck for the restorative dentist, and as such exemplifies Restoratively Driven Endodontics.
Here was an early case from 14 years ago. We used Luxacore blue back then. I think the Fuji core is an upgrade. Might be the first one performed, at least by me.
Here’s another embrasure space recapture from almost 10 years ago. You can see in the upper right picture how much space was regained from the spacer.
It may not get a lot of play, but I think it’s a nice one to have in the bag of tricks.
Decompression of a Dens in Dente Central Incisor
This was was an interesting tooth. It had a large talon on the palatal leading to a c shaped dens in dente or tooth within a tooth. There was a very large apical finding. Symptoms didn’t resolve after the first round of calcium hydroxide. So we added a decompression. The main goal of a decompression is to shrink the “lesion” and decrease the likelihood of collateral damage. In this case, surgery would have almost certainly devitalized the adjacent lateral incisor.
Decompression or true marsupialization works on the theory that creating a drain makes the epithelium creep inward along the bone pushing the cyst or granuloma outwardly. Otherwise it works by traumatically disrupting things allowing for subsequent healing. Marsupialization is a pretty slow process. We created a flange on a piece of surgical tubing, then sutured into place. The patient had instructions to irrigate a couple times a day with chlorhexidine. In this case we kept it in for over 3 months. This was a longer term calcium hydroxide case. We root-filled at about a year. Complete radiographic clearing was realized over time.
Horizontal Root Fracture
This seems to be fairly predictable of this case type. Stabilize it. Monitor it. Watch it pulp canal obliterate (PCO). And the root tip kinda sails off into the sunset. Based on those that I’ve seen, a horizontal root fracture like this doesn’t have a terrible prognosis as long as it’s managed correctly. Meaning the doc keeps his handpiece holstered.
Here’s a couple other older cases with the same progression. The increased density caused by PCO can cause some color changes, not to be confused with a necrotic tooth. No intervention is necessary. If desired, internal bleaching without endodontic therapy can be offered, which of course carries it’s own risks, benefits, and alternatives.
Some of these can be observed in the wild 30 years after the fact.
Max Molar Video- Access from 2014.
I found this old video looking for some other things. Access from 10 years ago. View in split screens. 2 Appointment case. Part 1 and 1b are meant to be played at the same time. Then 2 and 2b are meant to be played at the same time.
Blue Light Special
The intersection of scopes, filters, composite, and light can lead to some confusion and possibly unsafe clinical habits. So lets get the whole story straight and make sure our working habits are healthy as well as productive.
Light cure composites set when they are exposed to a light energy at a set wavelength of light. The composite has a photo-initiator called camphorquinone and an accelerator. The activator present in light activated composite is diethyl-amino-ethyl-methacrylate (amine) or diketone. They interact when exposed to light at wavelength of 400-500 nm, i.e, blue region of the visible light spectrum and cause the composite to set.
Sunlight, ambient light, and all other white light have the entire spectrum. So in the operatory, the ambient light will have enough blue light to make composite eventually cure. And your scope light with all its fabulous power will totally cook your composite. Additionally, the blue light with its low wavelength and high energy has the potential to cause harm to your eyes. Macular degeneration, retinal problems, and possibly cataracts are on the table eye damage wise. In addition, blue light is believed to affect mood and sleep among other things. Fortunately, there are filters that filter out the blue light.
Looking at the color wheel which represents the colors (ROYGBIV) and their opposites, you can see the opposite of blue is orange. So these orange filters will filter out the blue light.
Which comes in super handy when working under the scope doing composite work:
We do all our bonding using the orange filter in the scope. And here’s where some people get bamboozled.
Awash in orange light it’s easy to think that your scope filter is protecting you during the cure process.
Oh contraire monfraire!
If you were to remove the light from the back of the scope, and hit a cure, you’ll notice there is no difference whether the filter is applied or not.
The filter isn’t in the column at all. Its where the fiberoptic/liquid cable enters the back of the scope.
It’s this little guy here…
So when it’s time to cure, either look away out of the scope or don some protective eye wear.
In the case of performing a custom resin matrix, its eye wear for the both of us. Routine composite work, I usually just close my eyes till I hear the beep.
Decoronation of an Ankylosed Tooth
Decisions…decisions. A very young looking 10 year old girl presented after an avulsion of tooth number 9 with a very short extra-oral dry time, immediately replanted and subsequently splinted. The decision of whether to initiate endo on the central is dictated by the time out of the mouth and the development of the tooth. I made the call that the apex looked wide open and the tooth hadn’t completely developed. So we decided to wait and see if the tooth would revascularize. My first follow-up time of trauma is typically 3 weeks. I saw her inside of 4 and resorption was already full on; progressive and aggressive. Classification wise this would be external axial resorption. We initiated endo immediately, but the damage was done. Additionally, the concussed lateral wasn’t responding to cold, so we started endo on that one as well.
We kept the tooth in medication for 5 months changing it out monthly. Over that period of time there was ankylotic tone and no mobility under the scope using 2 mirror handles to evaluate. Ugh. We placed Vitapex in the canal which lasts longer than many other CaOH preparations, and restored. Over time, washing out of the medication could be observed; a common finding in a resorbing root. We waited until we measured 3mm infra-occlusion and set her up for a flapless decoronation like my buddy Buck came up with circa 2008.
If you can, preserve the pulp. If you can’t; save the root and tooth. If you can’t do that, at least save the bone. That’s where decoronation comes in.
We clamped the other central and split dam to the distal of the lateral and used a rubber dam triangle to wedge the dam distally. Then we cut the crown off using a an 014 tapered diamond. Then a surgical length 556 on end, we cut the tooth flat to 1-2mm below the bone. It’s critical to remove all the enamel as it won’t resorb. We observed granulomatous soft tissue extending from the canal space. A good clot was evident before dismissing the patient.
Hindsight being 20/20 I woulda medicated the tooth at a week. Similar patient representing the same way? That’s tougher. I’m thinking if the tooth looks most of the way developed, regardless of the apex developement, I might jump in. It’s a tough call.
Dens Invaginatus
Sometimes the development of the tooth goes a little haywire and another tooth begins to develop within a tooth, but not completely. So we end up with this invagination leading to the pulp and sometimes it doesn’t completely close off. Such a situation set the pulp up for an early death as can be seen here by the lack of root development and divergent open apices. Here we have a a pretty large finding imaging wise and a swelling. We changed the calcium hydroxide medicine out over 5 months and ultimately filled the apical 5mm with MTA and then reinforced the rooth with a fiber post. At 4 years post op there appears to be complete radiographic clearing and retained radio-opacity from the calcium hydroxide.
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