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Case of the Month

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December 2002 Classic Internal Resorption of a Maxillary Lateral Incisor

Fig. 1 - Pre Op

December's case of the month involves a case that had been previously accessed and left open. This 45 year old female's maxillary left lateral incisor had a history of deep composite restorations on both mesial and distal sides. She was Hepatitis B positive and also had a history of orthodontic treatment later in her mid 30s.. The apical third showed a fairly large area of internal canal resorption. The apex shows a classic lesion of endodontic origin associated with a necrotic tooth. The patient was asymptomatic with the exception of a draining sinus on the labial aspect.(Fig.1 )

Fig. 2- WL

A working length was established used a K file (Size #40). The canal was cleaned and shaped using standard irrigation protocols ( NaOCL 5.25%)) taking care not to enlarge the apical foramen that appeared to have been resorbed as well. ( It is unknown whether the resorption occurred as the result of pathology or Orthododontics) (Fig.2 ) This case was done in a single appointment, without placement of medication such as CaOH. A coarse paper point was used to gauge the foramen size and point of termination.

Fig. 3 - Cone Fit with Sealer

A medium gutta percha point was fit slightly short and a thin layer of sealer was placed on the entire length of the gutta percha cone. You will note that at this stage there is a void in the are of the resorption - prior to application of heat and vertical forces. It is also important to note the excellent control of the gutta percha that can be obtained, even in cases where the foramen is larger than optimal.

Fig. 4 - Immediate Post Op

The case was filled with Warm Vertical compaction technique. Post op fill shows good adaptation to the resorbed area and no excess out of the canal space. The case shows good apical control while at the same time filling a large space close to the foramen.

Fig. 5 - 4 Yr. Recall

A 4 year recall film shows complete bone fill and healing.

There are many clinicians that insist that treatment of necrotic teeth can ONLY be reliably performed with multiple appointment procedures to allow for placement of CaOH intracanal medicaments. A maxillary lateral incisor is presented here that was treated - from open - to conclusion using standard endodontic techniques and obtaining good canal seal. A 4 year recall shows complete healing.