Resorption
I have an interesting case that involves a 35 year old black female who has internal resorption on tooth #9. (Resorption is a common type of dental injury or irritation that causes a loss of a part or parts of a tooth.) She has been a patient for almost 6 years, and had a full series of x-rays taken on her first visit. The full mouth x-ray was totally normal at that time.
Teeth Moving
Impressed by TV commercials and promises of great looking teeth, she signed up for tooth straightening about three years ago. This company does not require guidance by traditional orthodontics. And, to my knowledge, during those three years, no additional x-rays were taken to detect any changes on the anterior teeth.
Damage from Tooth Moving
Four months ago this patient returned to our office. She reported that she was not doing well with the tooth moving she had paid for. So, she requested a referral to an orthodontist. We updated her full mouth x-rays and found the resorption of significant size. Subsequently she was referred to the root canal specialist who is quite talented in this specialty. He gave it his best attempt by doing the root canal and cleaning all of the affected tooth structure. Unfortunately the affected tooth perforated outside the root outline. He proceeded to use biocompatible materials to finish the task and stabilize the tooth. Within less than 2 months there was swelling and inflammation on the palate, indicating that the treatment had failed. The tooth would have to be extracted. All involved were quite disappointed.
Treatment for Resorption
The next phase of treatment involves a trip to the orthodontist and the surgeon. The plan is to first get the braces placed. Then at some appropriate time, the tooth will be extracted. The orthodontist is going to extrude the tooth (let it drop down) which will take some of the bone around the tooth with it. We can’t let a patient walk around without a front tooth. So, frequently we have patients wear a removable tooth while everything heals. Fortunately with braces, a missing tooth can be placed inside the brace. This approach is much easier for the patient.
After the tooth is removed and the bone heals the implant will be placed. Once that heals sufficiently, the patient will be ready for an impression for the final crown. This process will take several months before the crown is delivered to the patient. The orthodontist will tweek the bite and place the patient in retainers.
It is really wonderful that the dentists communicate with each other to make life just a little easier for the patient. Her final result will be superb.