A complication of orthodontic treatment
This patient presented to her normal dentist with a pink spot on her upper right lateral incisor tooth. A diagnosis was made of external cervical root resorption (ECR). The patient in her early teens had recently been undertaking a course of orthodontic treatment and the maxillary brace was removed when the discolouration was noted- Mavridou et al (2017) report orthodontic treatment as the most common predisposing factor in ECR with the maxillary central incisor the most commonly affected tooth (followed by the maxillary canine and then maxillary lateral incisor).
Interestingly, on the CBCT scan, there is an area of external replacement resorption where there is bone replacing the root surface and a separate area where there is soft tissue replacing the lost tooth structure (causing the pink appearance of the tooth) The patient had been told the prognosis for treatment was hopeless and that the tooth would need to be extracted and she would have to wear a partial denture until old enough to consider a dental implant so attended for a second opinion. We agreed to at least try and defer the loss of the tooth so the defect was cleaned by a surgical approach. After cleaning, the defect was restored with composite. As the defect was very closely associated with the large pulp space in this tooth the tooth was also endodontically treated. Endodontic treatment is not always required as the pulp can often remain vital if the defect is detected early enough. In this case, we decided to endodontically treat the tooth as I could not be sure there was no microbial ingress into the pulp space and also because it would allow placement of a fibre post in the pulp space. The fibre post was placed without removing any remaining dentine but extended below the level of the defect which will hopefully reduce the risk of the tooth snapping.
On review, the soft tissues were healing well with good papilla formation. Oral hygiene instruction was re-enforced and the patient will be reviewed in 12 months.