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Case Challenge

By Brad Gettleman, D.D.S., M.S.

A 58-year-old Caucasian female presents for evaluation of tooth #30. The patient states, “my hygienist found decay last week during my teeth cleaning”. She is completely asymptomatic and the tooth responds normally to all pulp vitality and periradicular tests. Periodontal probings are all 3 mm or less, and occlusion is not an issue. Her restorative dentist states that all previous periapical radiographs look virtually identical to the one taken at the consultation appointment. Radiographic (PA and CBCT) and clinical assessment reveal (external cervical resorption) ECR.

Historically, clinicians have attempted treatment on many of these cases with limited success, mainly due to not having accurate knowledge of the extent of the defect. However, CBCTs have opened our eyes to the quantity of tooth structure resorbed by these lesions, and the importance of using this technology for diagnosis of root resorption.

Due to the location of this defect and the concerns of either a possibility of bone loss secondary to treatment or periodically following up with clinical and radiographic examination, the decision was made to extract the tooth, as unexpected bone loss could leave the site less predictable for an implant.


Blood Pressure: 134/88

Heart Rate: 68

Poll: Was extraction the best option?

Treatment Options:

Case Challenge November 2019

Dr. Brad Gettleman is board liaison for the AAE’s Resident and New Practitioner Committee.

In the July 2019 Case Challenge, we posted a poll; and now have the results below:

    • What follow-up treatment approach is advisable?
      A. Continue to monitor, have patient return for 12-month recall 14%

      B. Non-surgical retreatment 76%

      C. Apical microsurgery 6%

      D. Referral to oral medicine 1%

      E. It's a cracked tooth; extract. 3%

Best answer: B. The author ended up performing a non-surgical retreatment on no. 15. She found a mid-root split in the M root. She treated the tooth in two appointments just to see if her symptoms subsided. Patient reported all symptoms resolved as soon as she retreated the tooth.