My Day Today
I would like to share the first three patients I saw today.
All were cases with Invasive Cervical Resorption. The first patient was a one year follow-up, the second was a consultation and the third was a treatment.
Case 1
This one year follow-up is of a case treated via an internal as well as a surgical approach
The tooth was functional and asymptomatic. CBCT showed no sign of continued resorption.
The internal treatment utilized Laser management (Er.Cr:YSGG Laser) of the invading tissue in both a wet mode (with 6% NaOCl) to dissolve the tissue and a dry mode to ablate the tissue. Surgical repair was performed with Geristore and the surgery was performed via a sulcular incision utilizing the laser to make the incisions, perform osseous removal as well as degranulation of the defect.
Prognosis is good.
Case 2
This case was a consultation of an asymptomatic lower right first molar tooth with Class 4 ICR. CBCT showed osseous replacement of tooth structure. My recommendation was observation with no treatment intervention, hoping that the resorption was in remission. There was no history of trauma or orthodontic therapy.
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Prognosis is guarded.
Case 3
This case of ICR involved the lower central incisor teeth. Both teeth were vital and asymptomatic. There was a history of adult orthodontics. Treatment plan was to manage both teeth via an internal approach with surgical repair of the lingual defect in #25. Prognosis is good for both teeth.
The internal approach utilized the Er.Cr:YSGG Laser to remove the invading tissue by tissue dissolution with activated 6% NaOCl, and tissue ablation utilizing the laser in the dry mode where the laser energy was absorbed by the water in the invading tissue. Specialty side-firing laser tips (SFT8) were used to direct the laser energy. Calcium hydroxide was used as the interim dressing. Treatment will be completed in two weeks time.
What a way to start off my day!
MDS, Ph.D* Research Scholar & Reader, Department of Conservative Dentistry & Endodontics, Sibar Institute of Dental Sciences
4 个月Nice management of cases sir, In CASE:2: The sagittal section of Molar teeth shows radiolucency surrounding the radiopaque tissue (possibly bone-like tissue), which may suggest the presence of granulation tissue. If left untreated, there could be complete dentin loss or the occurrence of replacement resorption, both of which are challenging to manage, sir.
Owner @ North Raleigh Endodontics | Improving Quality of Life By Saving Teeth
5 个月Nice management Justin. Suggestion: Check out the Glossary of Endodontic Terms as it relates to prognosis…
Endodontist at Clifton Endodontics
5 个月Beautifully managed cases Justin. I do have one question regarding #30 and the continued monitoring of that tooth. This has always been a dilemma when making the final call on these cases. If the resorption progresses, how much more difficult will it be in the future to (1) remove this tooth, if and when it has to come out and (2) to graft this site after an extraction, especially if the root fragments are difficult to remove?
Associate @ Leading Edge Endodontics | DDS
5 个月The etiology is idiopathic. The predisposing factors are widely recognized and described in the literature. Bisphosphonates do not seem to be involved.
Director of FIFSCM
5 个月With regard to the etiology, were the patients using biphosphonates or was there any viral charge re. the clastic cells? In general, what factors are you seeing that underly such resorptions? Anecdotal evidence suggests that there is a sharp upward trend, which is extremely worrying.