Recently I wrote about the importance of paying close attention to the pulpal spaces on radiographs. While the prognosis of the tooth discussed last time was hopeless, I would like to share another example from the same patient and fortunately this time the prognosis is much better. As you can see from the initial PA above the pulpal space for #20 does not appear normal. Just as with the tooth mentioned in my previous article, I could have taken off-angle radiographs to further evaluate; however, again the patient and I came to the consensus that a CT scan would give us the clearest picture of what was going on and that was the way to go.

 

As you can see in the screen shot from the CT this tooth has suffered invasive cervical resorption. Fortunately in this case we have a fighting chance to save the tooth through crown lengthening to expose the resorptive defect, followed by removal and restoration (which may not require endodontic treatment) of the resorptive area.   Having the chance to save a tooth like this is the reward for paying close attention to those pulpal spaces! John R. Carson, DDS, PC, Spear Visiting Faculty. [ www.johnrcarsondds.com ]

Comments

Commenter's Profile Image Brien Harvey
May 21st, 2013
Since this seems to be a case of external resorption, am I correct in assuming that the decision concerning whether or not to do endodontic therapy will be based upon the clinical finding of whether or not the resorptive tissue communicates with the pulp? That is, if there seems to be a sound layer of dentin between the resorptive cavity and the pulp, no endodontic therapy will be planned, right?
Commenter's Profile Image John Carson
May 21st, 2013
Brien, you are correct, endo may or may not be needed, but in this case there is a good chance of avoiding it!