0099-2399/90/1607-0339/$02.00/0 JOURNAL OF ENDODONTtCS Copyright 9 1990 by The American Association of Endodontists

Printed in U.S.A. VOL. 16, NO. 7, JULY 1990

CASE REPORTS Inflammatory Resorption Caused by an Adjacent Necrotic Tooth Alfred L. Frank, DDS

It was deemed advisable to request previous radiographs and a dental history to assist in the diagnosis and treatment planning.The bicuspid pretreatment radiograph with a "large lesion" as recorded by the treating dentist was not located. However, a 4-yr recall radiograph taken after the endodontic therapy was available (Fig. 1). There was no radiolucency remaining, implying endodontic success. This assisted in the conclusion that the radiolucency and resorption demonstrated 6 yr later was probably related to the necrotic cuspid. Note the anatomical defect on the distal aspect of the cuspid (arrow). It was not possible to determine whether this was a preexisting anatomical anomaly or a result of prior inflammatory resorption. Nonsurgical endodontic therapy was per-

A case history is presented with a large periapical lesion and a perforating resorption defect on a cuspid. Endodontic therapy was performed, presuming that the necrotic cuspid caused the inflammatory response. No radiographic healing was evident 18 months after endodontic therapy. Considerable healing was demonstrated 6 months later, following the extraction of an adjacent tooth with prior root canal therapy. It was concluded that the failing root canal therapy of the extracted tooth was the primary factor leading to the inflammatory lesion, the resorptive perforation of the adjacent tooth, and its pulpal necrosis. It has not been reported prior that inflammatory resorption can result from the puIpal necrosis of an adjacent tooth.

It has been well established that a necrotic pulp can develop an inflammatory process that can have a resorptive affect on the cementum and dentin of the tooth involved (1-3). This resorptive affect has been defined as inflammatory resorption. It has not been reported that this inflammatory process can affect the dentin and cementum of an adjacent tooth. CASE H I S T O R Y A 35-yr-old male presented with a large periapical radiolucency superimposed over the apices of the mandibular lateral incisor, cuspid, and first bicuspid (Figs. 1 and 2). The bicuspid was endodontically treated 10 yr previously and restored with a porcelain veneered crown and a cast post, which served as the mesial abutment of a multiunit bridge. The apex of the cuspid appeared to be totally encompassed by the radiolucency and the tooth was nonresponsive to vitality testing. A large resorptive defect was present on the disto-apical aspect. No history of trauma was reported nor were restorations apparent. The lateral incisor responded within normal limits to all vitality tests modalities.

FIG 1. No radiolucency is apparent on a 4-yr recall radiograph following endodontic therapy on the bicuspid. Note the anatomical defect

(arrow). 339

340

Frank

Journal of Endodontics

:ore }::

.....

:

= "

FIG 2. Radiograph taken 6 yr after Fig. 1. A radiolucency is superimposed on the apices of the mandibular lateral incisor, cuspid, and first bicuspid.

formed on the cuspid at this time (Fig. 3). The expression of root canal sealer into the distal aspect demonstrated a perforative defect. The patient returned 18 months later for a recall radiograph. No appreciable radiographic healing was evident (Fig. 4). The patient was to be appointed for periapical surgery on the cuspid since the gutta-percha seal was considered to be inadequate. Instead, a loose crown and the questionable restorability of the bicuspid prompted the referring dentist to extract it, preempting the corrective surgery of the cuspid. No curettage or debridement of the alveolar socket was performed. Six months later, the patient returned for the preplanned surgical correction. A new radiograph, taken at that time, demonstrated substantial repair (Fig. 5). Rather than perform a possibly unnecessary surgical procedure, a 6-month reexamination was scheduled, at which time complete radiographic healing had taken place (Fig. 6). It was concluded that the failing root canal effort on the bicuspid was, in fact, the primary factor leading to the inflammatory lesion, the resorption perforation of the cuspid, and its necrosis. DISCUSSION The cuspid in this case certainly presented valid indications for its endodontic treatment. At the same time, it was not unreasonable to presume that the reSorptive defect on the cuspid was probably associated with its pulpal necrosis. The fact that the bicuspid demonstrated good osseous repair 6 yr

" , % ,;7*

F=G 3. Nonsurgical endodontic therapy was completed on the cuspid. Note the expression of sealer at a perforative defect.

FIG 4. NO appreciable radiographic change was seen on an 18-month posttreatment recall.

earlier tended to rule out consideration of the bicuspid as a factor contributing to the resorption on the cuspid. However, failure of the endodontic therapy on the cuspid to initiate any appreciable repair until the adjacent bicuspid was extracted 18 months later leads to the conclusion that the bicuspid was indeed involved and was in fact the primary issue in this case. It has not been reported that an inflammatory lesion can result in the resorption on an adjacent tooth. And yet, when one considers the possibility, it is not, in fact, an unlikely result of an inflammatory process. This case is presented to

Vol. 16, No. 7, July 1990

Inflammatory Resorption--Adjacent Tooth

341

FiG 5. Radiograph taken 6 months after Fig. 4 demonstrating osseous repair.

FIG 6. Radiograph taken 6 months after Fig. 5. Further radiographic healing is apparent.

alert the dentist that this possibility should be considered in the diagnosis, treatment planning, and evaluation of endodontic failure cases.

References

Dr. Frank is professor of endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA.

1. Andreasen JO. Traumatic injuries of the teeth. 2nd ed. Philadelphia:WB Saunders, 1981:359. 2. Frank AL, Simon JHS, Abou-Rass M, Click DH. Clinical and surgical endodontics, concepts in practice. Philadelphia:JB Lippincott, 1983:139. 3. Walton RE, Torabinejad M. Principles and practice of endodontics. Philadelphia: WB Saunders, 1989:429.

Inflammatory resorption caused by an adjacent necrotic tooth.

A case history is presented with a large periapical lesion and a perforating resorption defect on a cuspid. Endodontic therapy was performed, presumin...
673KB Sizes 0 Downloads 0 Views