Case Study: Severe Bone Loss Due to Untreated Root Canal

 

I have been practicing dentistry for over 35 years. On occasion I will see an interesting case who disappears after treatment for a long time , and then out of nowhere, shows up again.

Such was the case, with a healthy male white patient, 28 years old, who came for a routine examination and cleaning. The x-rays revealled that an accident had affected his upper anterior teeth (upper front teeth). Root canals were started but never completed, on 4 teeth. There were also large lesions on the ends of the roots (this indicates that bone has been lost around these teeth, and the bone loss can get larger and more extensive). I recommended seeing an endodontist (root canal specialist), but being a bit obstinate and in no pain, the patoemt didn’t do anything then. The time frame is around 1994.

Moving forward 3 years, the lesions at the ends of the roots have grown so much that there is a no bone in the area from the bone on the front of the teeth to the palate (the gum tissue is covering this, so you can’t see it without an x-ray). At this point I got his attention, referred him to an oral surgeon, at which point he had a surgical procedure done to remove the infection. The surgeon recommended that he have all his front teeth crowned and splinted. But, being the same person that he was, he did nothing further.

A year goes by, and lo and behold, all of the bone has filled back in! The surgeon has achieved a fantastic result! Keep in mind the time frame here is around 1998.

Many years go by and finally, in 2013, he showed up from out of the blue. Absolutely nothing had been done to his front teeth in all of this time. However, his right lateral incisor is showing signs of external resorption (the end of the root starts to dissolve) and there is very little root structure remaining to support the crown of the tooth. I have referred him to a root canal specialist to see if there is anything that can be done to save the tooth, but my guess is the tooth will need to be extracted and restored with any acceptable method (implant, fixed bridge or removable partial denture).