The resorption case that Doug recently posted made me think of a case that I treated a couple years ago....

His case was difficult because there is the question of:

Should it be treated now?
Can you arrest the resorption with endo?

This case is a bit different because the resorption was perforating and symptomatic, so it had to be treated.

Here is how the patient presented in hygiene:

Tooth #10 symptomatic (aching) with clear resorption on the PAX. Cold testing showed that the tooth was necrosed:

[image:651637862c35a_Untitled_001.jpg]

After seeing this initial xray, I decided to take a CBCT to see the extent of the defect and saw this:

[image:651637b8b2b43_Untitled_002.jpg]

We decided that the tooth needed to be removed. Because of the necrosis and defect, I decided NOT to place an immediate implant. The plan was the following:

Extract tooth #10 and graft the site
Provisionalize the site with a 1-wing Maryland bridge. He had an anterior open bite so the decision was easy to do a "fixed" provisional
Let the site heal for 5 months
Place an implant and immediate provisional in the site
After 4 month healing, restore the implant

Since I don't like to spend time making a provisional the day of surgery, I like to "pre-make" them before. Especially with Maryland Bridges. The first step is to take intraoral scans of the case (we did this on day 1 in hygiene).

[image:651638c9e67fb_Untitled_003.jpg]

We then 3D printed the upper model and did the following:

Scanned the preop of #10 (as a copy for the shape) on the 3D printed model
Manually cut out tooth #10 with a carbide bur and scanned that model (for me easier and more accurate than virtual extraction)
Designed and milled a provisional maryland bridge and fit it on the model. All this is done before appt. 2 and extraction

[image:651639463e8d8_Untitled_004.jpg]

[image:6516394cb98c7_Untitled_005.jpg]

The next appt we extracted tooth #10, grafted and sutured, and relined the cervical portion of the maryland bridge with flowable composite.

One tip is to use teflon tape to cover the site for a better "dry" field for bonding

[image:651639b06b102_Untitled_006.jpg]

Here is the healed maryland bridge provisional at 5 months:

[image:651639cb7c25d_Untitled_007.jpg]

We then planned a guided implant and placed the implant in the site. We immediately provisionalized the case with a milled resin screw retained crown

[image:65163a08ac9d8_Untitled_008.jpg]

Here is the final restoration (cement retained solutions with zirconia hybrid abutment and e.max crown)

[image:65163a283fdb6_Untitled_009.jpg]

Hopefully this is helpful as one way to go about resorption cases that HAVE to be treated. I'm sure there are many other ways also.

Mike