Page 23 - GP Spring 2025

were offered to the patient, but the patient denied any treatment un- tion, shown in Figure 8, of
less it became symptomatic. A panoramic radiograph of the patient external inflammatory root
can be seen in Figure 5. resorption. Osteoclasts and
macrophages are the prin-
cipal cells attracted to the
initial site of injury to re-
move the damaged tissue.
A breach in the integrity of
the protective precementum
permits odontoclasts to bind
to and resorb the underlying
mineralized cementum and
dentin.
4
The long-standing resorp-
tion has caused inflamma-
tion to degrade and oblit-
Figure 5. Panoramic taken in 2023 showing complete root erate both cementum and
resorption of tooth #31 with silver points remaining in bone. dentin, while bone replaced Figure 8. A histopathological
the resorbed space as seen examination of external
Conclusion: by the sturdy standing silver inflammatory root resorption. 4
According to the the “Resorption Triad” explained in Figure 6, we points. Pathological progres-
speculate that root resorption was caused by a long-standing failed sion is noted in the radiographs from 2011 to 2023. The periapical
root canal, allowing for bacteria to infect the PDL and cementum, radiograph in 2011 (Figure 4) shows mild periapical radiolucen-
along with chronic occlusal force from the upper porcelain implant cy on both mesial and distal roots. Significant mesial bone loss is
crowns, and viable blood supply to maintain osteoclastic, odonto- noticed in the 2016 periapical radiograph (Figure 5). Finally, the
clastic, and dentinoclastic activity. periapical radiograph taken in 2023 (Figure 6) shows the total deg-
radation of all roots up to the cervical portion of the tooth. Progres-
sion is most likely external surface resorption, followed by external
inflammatory resorption, which ended up with external replace-
ment resorption. Due to the infected root canal, the bacteria is the
source that caused the inflammation. The injury to this resorption
was chronic occlusal force trauma, which caused the resorption to
progress until this stage.

References:
1. Liu, Huimin SMMa; Peng, Xiaoxing MBb; Sun, Hongchen
PhDa; Li, Xiangwei PhDa,*. Clinical and histopathological char-
acterization of root resorption in replanted teeth: Two case re-
ports. Medicine 99(3):p e18869, January 2020. | DOI: 10.1097/
MD.0000000000018869.
2. Ahangari Z, Nasser M, Mahdian M, Fedorowicz Z, Marchesan
MA. Interventions for the management of external root resorption.
Cochrane Database Syst Rev. 2015 Nov. 24;2015(11):CD008003.
doi: 10.1002/14651858.CD008003.pub3. PMID: 26599212; PM-
Figure 6. Three general requirements must be present for CID: PMC7185846.
root resorption to occur, and this has been once termed the “ 3. Fernandes, Marina, et al. “Tooth Resorption Part II - External
Resorption Triad:” a breakdown of the natural barriers in Resorption: Case Series.” Journal of Conservative Dentistry : JCD,
the tissues, a continuous stimulating factor, and a viable U.S. National Library of Medicine, Mar. 2013, pmc.ncbi.nlm.nih.
blood supply for the clastic cells. gov/articles/PMC3659868/.
4
4. Abbott PV, Lin S. Tooth resorption—Part 2: A clinical classi-
Although no premature contact fication. Dental Traumatology. 2022; 38: 267–285. https://doi.
was noted in the area of #31, the org/10.1111/edt.12762
chronic occlusal trauma may be 5. Fuss Z, Tsesis I, Lin S. Root resorption--diagnosis, classification
due to the parafunctional habit of and treatment choices based on stimulation factors. Dent Traumatol.
bruxism in that region. External 2003 Aug;19(4):175-82. doi: 10.1034/j.1600-9657.2003.00192.x.
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replacement resorption, which PMID: 12848710.
followed ankylosis, may be con- 6. Hargreaves, Kenneth M., and Louis H. Berman. Cohen’s Path-
sidered as a possible explana- ways of the Pulp Expert Consult, Elsevier, 2015. ProQuest Ebook
tion as to why the silver points Central, http://ebookcentral.proquest.com/lib/nyulibrary-ebooks/
appear integrated into bone, as detail.action?docID=4187366.
seen in Figure 7. An example
of a histopathological examina- Figure 7. Schematic Diagram of
external replacement resorption. www.nysagd.org l Spring 2025 l GP 23
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