Resorption Recall 6 Years
Category: Resorption
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.
Internal Approach
This tooth presented with inter-proximal external crestal resorption according to my resorption classification for clinicians. Usually I like to have an external surgical approach to ensure clean margins, manage the field, and work the appropriate matrix. However, an external approach here would have left one hell of a periodontal problem and lots of bone destruction. So, we worked it out internally. Ultimately, glass ionomer was used as the restorative choice here. On short termish recall, the perio tissues look great- 3mm probings all around and no bleeding on probing. So far so good, no resorptive recurrence.
External Resorption of a Lower Canine
Lower canines seem to exhibit a higher degree of prevalence of external resorption than other teeth. Perhaps it’s the higher forces as they guide the occlusion. Perhaps it’s their position as the corner of the arch which. Perhaps its the periodontal treatments that these teeth undergo. Or maybe it’s something else. 3D imaging helps determine the restorability of these teeth. When the resorption passes two line angles most times I’ll throw in the towel. This was the case with the contralateral tooth. By way of clinical classfication this one was external moderate scooping resorption. As is always the case there is osseous in-growth. It’s important to remember that there is hard tissue replacement when reading the scan or the extent of the resorption may be underestimated. It’s important to remove the osseous ingrowth and resect it back until healthy periodontal ligament can be observed under the microscope. As is typical of these cases, the soft tissue looks good at 48 hours during the suture removal appointment.
Trauma, Resorption, and Decoronation
This little guy caught a fly ball… in the mouth. The lateral was laterally luxated. The central was avulsed and replanted with a dry time of 15 minutes. The lateral was repositioned and splinted. I saw them the day after the injury. We made sure he was on an antibiotic and anti-inflammatory and saw him back in a week to start endodontic therapy as the apex of these teeth were completely deveoloped and the risk of resorption high. After what we thought was a sufficient time in both CaOH and splint therapy, we completed the endodontic therapy and placed fiber posts.
Over the next few years we saw resorption develop. According to the Resorption Classification for Clinicians, this resorption would be considered External Crestal Resorption, moderate scooping. We removed the invasive tissue and restored the root using composite. A custom resin matrix was used for isolation.
Over time, we could see that the central was subject to resorption as well; External Ankylotic Resorption. This was evident by the ankylotic tone when percussed. Radiographically, this was evident my the marked lack of periodontal ligament and lack of tooth root definition. Clinically, this was evident by the infraposition of the clinical crown relative to the other central.
In treatment planning the case, the orthodontist thought some initial leveling and aligning using the ankylosed tooth would be helpful before decoronation. After this was accomplished, the fiber post and root filling was removed and the crown was decoronated using the flapless decoronation approach as outlined by Jared Buck in Best Practices: A Desk Reference
A pontic was added to the orthodontic therapy.
We can see over time that bone developed over the tooth root and the the root is turned over in osseous regeneration. The alveolar ridge is preserved for future restorative replacement.
Here’s the 5 year followup.
Resorption Classification for Clinicians
Historically, classifying systems for resorption have been insufficient to adaquitely guide the treating doctor and inform decision making in the clinical management of resorption . Words like inflammatory and replacement as identifiers are less than ideal as all resorption is inflammatory and all resorption involves replacement. Identifiers using cervical when used to describe ECIR are not really accurate either and are really misleading as the resorption typically stems from the level of the crestal bone. For these reasons, based on more current models, I use a clinical model of classifying resorption, and subsequent management thereof:
The initial identifiers are based first on the derived process location- either external or internal. It’s important to note that the identifiers are derived from imaging, most often CBCT imaging.
Internal Resorption is derived from the pulp. The presentation can be with either a vital or necrotic pulp. Additionally, the resorption can be further classified by extent- namely non-perforating, or perforating. Internal Resorption that is perforating may require surgery to adequately manage the case. Often the process involves a vital pulp, however, occasionally, the pulp may be non-vital. From a prevalence perspective, internal resorption is low; its rare. With internal resorption, since the process is pulpally derived, the replaced tissue is radiolucent. There is not a bone deposition component to internal resorption.
Internal resorption with a necrotic pulp:
Internal Resorption with Perforation:
External resorption refers to the process of tooth structure being removed and replaced from the outside. Additional identifiers depict distinctions based on a mix of location, cause, and extent. External Crestal Resorption is by far the most common type of resorption. It originates at the level of the crestal bone. A mix of soft granulomatous tissue and hard boney tissue invade and replace the tooth. Additional identifiers include scooping or tunneling. Scooping refers to the pattern of extension by which it progresses in a relatively bowled out fashion as if the tooth removal was performed with a small ice cream scoop. Tunneling refers to a thin fingerlike progression, often many of them progressing axially. Finally, the extent of the External Crestal Resorption may be described. Mild refers to external resorption that doesn’t involve the pulpal space. Moderate is likely to involve the pulp space and will require endodontic therapy. Severe resorption is the extent whereby the tooth is usually no longer restorable. The determination of restorability is made via CBCT. One thing to keep in mind when determining the extent of the resorption is the hard tissue component invading the tooth. It’s easy to mistake tooth schema for invading bone or bone schema. Additionally, the pdl is not present in this area making the distinction more difficult. Sometimes, changing the scale of the imaging during viewing can help. that’s because the process of interpreting schemata is itself dependent on scale. For example, we understand that mouth is part of face, and lips are part of mouth, and vermilian border part of lips. Changing the scale helps with understanding features at all levels.
External Crestal Resorption, Moderate Scooping:
External Crestal Resorption, Severe, Tunneling:
Tunneling Resorption presents challenges as the osseous tissue embeds itself axially. Aggressive removal weakens the tooth, however, leaving bone behind allows for resorptive progression.
External Apical Resorption:
External Apical Resorption can be a result of orthodontic force, root canal infection, or in some cases, unknown causal relation.
External Pressure Resorption:
Teeth and expansile growths such as cysts can cause pressure resorption. Depending on the restorability the extent may be mild, moderate, or severe.
External Axial Resorption:
External Axial Resorption is identifiable by the radiolucent areas adjacent to root structures. Often this is sequela of trauma and accompanied by an infected tooth. This resorption may be arrested by endodontic therapy and medication with calcium hydroxide. The extent of the injury and development of the tooth determines the prognosis. Often injuries to these teeth include avulsion, lateral luxation, intrusion or extrusion. Depending on the extent of External Axial Resorption, External Ankylotic Resorption may follow over time.
External Ankylotic Resorption:
External Ankylotic Resorption may follow after External Axial Resorption. The difference is the lack of radiolucent areas adjacent to the root. As with other external resorption where bone deposition is involved, distinguishing between root and bone schemas can be difficult. The appropriate interpretive response is increased uncertainty. In the developing adolescent, when facial development is not complete, the management of External Ankylotic Resorption is decoronation. An alternative might include autotransplantation if there is a knowledgeable and skilled surgeon.
Resorption Retreatment
This patient presented with pain associated with failing endo. The endodontic therapy was revised, and the tooth restored with a fiber post and palatal composite. The resorption would be classified as External Crestal Resorption, moderate/scooped. The resorption was removed, and restored with flowable composite. The almost 8 year followup shows healthy gingiva free of recession, and no black triangle formation. There was no bleeding on probing evident.
Resorption Repair
6 year followup on this case. CBCT imaging was used for determination of restorability. This type of resorption is crestal resorption. The resorption was determined to be less than two line angles by way of extent and located on the palatal. The endodontics was performed and a fiber post placed well below the level of the resorption. In this case we performed a burectomy to remove the ginigiva and visualize the cavosurvace once the the resorptive soft and hard tissues were removed A matrix band with a little Dycal was used for isiolation. A bulk fill of glass ionomer was placed and then vaneered with flowable composite. The restorative material approached the bone in the area of resorption, however, on followup there is no recession, and no bleeding on probing. We’re cautiously optimistic about a favorable long term outcome.
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