Dental resorption: The silent killer

Editor's note: Originally published October 1, 2020. Formatting updated January 23, 2023.

So back in the day, when I was in my second year at Louisiana State University Dental School, I remember covering dental resorption in endodontics class. At the time, the common thought was that dental resorption predominantly occurs due to dental trauma. This topic took up about three paragraphs in our textbook, and then we moved on—short and sweet.

Years later, I saw my first case on a 12-year-old female.This was indeed a trauma scenario. It was about seven months posttrauma, involved the central incisor, and had all the textbook signs—major osteoclastic activity all over the clinical root.This case basically looked like a shotgun blast had hit.Of course, there were no reported symptoms that led to the finding, and it wasn’t until a routine periapical film was taken for hygiene that the resorption was seen.If that had not occurred,no one would be the wiser until symptoms started, eventually, as they all do.

Diagnosing what it's cracked up to be: A lesson in endodontics

I almost missed this lesion on the radiograph

One of my referrals and I were discussing resorption one day. My colleague said he felt like he was seeing more and more cases, compared to what he had experienced over the previous 30 years. And truth be told, I have to admit the same after 22 years of practice. Obviously, this may differ from practice to practice.

Referrals have asked me many times over the years, “What do you tell patients, and how do you deal with dental resorption?”

Protocol for dealing with dental resorption

No. 1: I reassure patients that this is nothing they did or didn’t do.

It’s not caries. It’s nothing they ignored to the point of the tooth being unsalvageable. This is important, in my mind, because way too often there’s finger-pointing. But resorption is no one’s fault.

No. 2: Much like in real estate, it’s all about location, location, location.

This actually has a huge bearing on dealing with resorption. External resorption versus internal resorption—when diagnosing, it makes all the difference. In my hands (and heart), I believe the only type that stands any chance whatsoever of treatment success is internal resorption. And even then, it depends on the extent of the damage.

When evaluating and discussing external resorption, I commonly tell my patients, “I cannot make your bones and gingiva stop eating the tooth. I do not have that power.” As we have all seen, external resorption can occur in various places and teeth. However, it almost always seems to be around the area of the alveolar crest, which, in my opinion, makes restoring it almost impossible. At least with internal resorption, one has a chance. You must be aggressive in cleaning the canal way beyond the typical endo and particularly in the areas of the defect. That, my friends, is where the microscope comes in very handy.

No. 3: With resorption, it’s also about timing, timing, timing.

Unless it is caught on the early end, it does not matter. Once the resorptive damage has extended beyond a certain point, the prognosis drops precipitously, regardless of whether it started internally or externally. If communication of the defect occurs from internal to external or vice versa, I find that the prognosis goes from questionable to hopeless.

I have told patients over the years, “Resorption is so random that I have not seen even one commonality consistent in all cases.” Resorption does not care about age, gender, location, health of the individual, or if the area was traumatized or not.In fact, my wife had resorption and now has an implant where that lower molar was. We did not know about it until the fistula decided to show itself at 6:00 a.m. on that dark Wednesday morning. And it surprised both of us. Never had a clue it was coming!

If I were to share any bit of wisdom or advice for dealing with resorption, I would leave you with this: Have a nice, long conversation with your patient about the realities and possible expectations of treating a tooth with resorption. Do not be negative. Be realistic. Let the patient make up his or her own mind. This conversation is not one to skimp on with details.

In the end, it’s about realizing that resorption is ugly, messy, and unpredictable, with an outcome that is not radiographically pleasing to the eye.It’s all about long-term stability of the tooth and trying to retain that if at all possible. And if anyone ever finds that common thread that links resorption, please contact me so I can send you a “Certificate of Awesomeness.”

Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles at this link and subscribe here.