Dentaltown October 2019 - 76

Case 1:
External Resorption
A 25-year-old patient came to the office
requesting that we save her upper left central
incisor, #21. She had visited three other
offices that had recommended a bridge, an
implant and extraction.
A radiograph indicated significant root
caries on the distal of #21, which could have
been caused by external resorption in deeper
parts of the root (Fig. 1). External resorption
is triggered by persistent inflammation of
the tissues in the apical region, tooth trauma,
cysts in dental tissues that put pressure on the
teeth, or overly aggressive orthodontic therapy
and whitening. Inflammatory resorptions
require antiseptic endodontic treatment and
sometimes the intervention of an oral surgeon.
Untreated or insufficiently treated external
resorption can lead to loss of the tooth.

The patient arrived for her fi rst visit
with swollen tissue around teeth #21 and
#22 (Fig. 2). Her tooth was not responding
to thermal stimulus. An examination with a
pulp tester confirmed pulpal necrosis. Many
offices still use ethyl chloride to test pulp
vitality; however, experience has taught us
that ethyl chloride does not always provide
accurate results because periodontosis (the
exposed cervix) of an adjacent tooth can
cause inaccurate readings. A pulp tester is
a practical and more reliable device that
precisely determines the level of pain in a
particular tooth.
An endodontic procedure was performed
on #21 (Fig. 3), and the canal was mechanically and chemically prepared to a length of
24mm. As usual, 5.25% sodium hypochlorite
was used along with chlorhexidine, citric acid,
ethylenediaminetetraacetic acid (EDTA,
Pulpdent) and sodium chloride (NaCl).
Because the pulp was necrotic, the canals

Fig. 1

were filled with TempCanal Enhanced, a
provisional nonsetting, nonhardening calcium
hydroxide paste from Pulpdent that can be
easily removed with file and irrigation at a
later visit. The access cavity was temporarily
closed with HardCore (Pulpdent).
At the two-week follow-up visit, the
patient reported that she had not experienced
any pain or sensitivity. TempCanal Enhanced
was removed with NaCl, chlorhexidine
and citric acid. The canals were filled to a
working depth with AH Plus Root Canal
Sealer (Dentsply) and gutta-percha points,
and the cavity was sealed with a temporary
fi lling, Coltosol F (Coltene), for the next
24 hours (Fig. 4).
The following day, the tooth was reinforced with a fiber post cemented with Activa
Bioactive Cement (Pulpdent). To accomplish
this, the gutta-percha and sealer were removed
from the root canal to two-thirds of the
length of the root (Fig. 5).

Fig. 2

Fig. 1: Preoperative radiograph shows
external resorption.
Fig. 2: Patient presents with swelling
of soft tissues around teeth #21 and
#22. There is no thermal response,
and a pulp tester confirms that #21 is
nonvital.
Fig. 3: Shows diagnostic radiograph to
determine the working length.
Fig. 4: Radiograph shows AH Plus Paste
and gutta-percha points.
Fig. 5: Radiograph with metal matrix
strip cut to size and stabilized with a
wedge (#21 and #22). Two-thirds of the
length of gutta-percha was removed
from the root canal to make space for
the cementation of a fiber post.
Fig. 3

76

OCTOBER 2019 // dentaltown.com

Fig. 4

Fig. 5
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