Diagnosis

Patient has had several phases of orthodontic treatment that commenced when he was seven years old. He also had a history of a labially positioned and impacted maxillary cuspid that was surgically exposed and orthodontically moved into position. He had a traumatic injury to his face that resulted in a broken nose. As a part of this evaluation, periapical radiographs and a CBCT scan was taken by an oral and maxillofacial surgeon. These radiographs disclosed extensive external root resorption of tooth #10. Tooth #10 was asymptomatic, vital and exhibited moderate clinical mobility.

Challenge

The distal aspect of tooth #10 had extensive root resorption and the tooth structure overlying the pulp is very thin. Extreme care must be exercised to avoid root perforation.

Treatment

The treatment plan for tooth #10 consisted of removing the orthodontic forces on tooth #10, initiating endodontic treatment and placing calcium hydroxide for several months (to attempt to arrest resorptive process) and completing endodontic therapy. Due to the extensive amount of root resorption, the prognosis will be guarded.