treatment options internal resorption

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Jo De Backer
Last seen: 6 months 4 weeks ago
Joined: 11/9/14
treatment options internal resorption

Hello dear collegues,


Some weeks ago, a male patient of 42 years old visited the office concerning the problem of internal resorption on his both upper canines.

The oral surgeon he consulted before should have removed both canines and immediate have placed implants. Because the patient was one of my patients for several years, but moved since two years to another village he wanted my advise.


Personnally I gave him the advise not to remove both canines followed by immediate implantation because of lack of sufficient bone at the apical and buccal region.

What's the treatment planning of my collegues ?

[BrianV - I moved this request here (was in "General").  I felt this was a better place for the question and the answers!)

Brian Volken
Last seen: 6 months 2 weeks ago
Joined: 1/7/15

Dear Single Implant Digital Textbook Authors,

This post came in through the "general" forums - I felt it was more appropriate for this audience of experts, so I moved it here!

It would be most excellent if you could review the case and comment or ask questions!

Thanks, BrianV


both of these teeth have extra-canal invasive cervical root resorption (EICRR) - Heithersay class IV - These class IV EICRR are not treatable especially when they already communicating/cavitating the the external root surface - can be seen on the CT slices.

Best options are to remove and implants.

Jo De Backer
Last seen: 6 months 4 weeks ago
Joined: 11/9/14

That these teeth should be removed is out of discussion. But what's the approach ?


I should do:

1. removing one side the canine

2. rebuilding the bone crest with Bio-Oss or compatible product

3. covering the side with Creos membrane

4. covering the whole side with A-PRF 's

5. closing wound by incisions in periost to obtain enough mobility of the flap

6. cutting the crown of the canine and fixing them in a deep retainer plate

7. after one month the same procedure at the other side.

8. after 6 months placing the implants at both sides using 3D surgical guide


Richard Williamson
Last seen: 2 weeks 4 days ago
Joined: 3/15/15

If the internal resorptive process was still confined to the internal root structure, I would monitor but be prepared to move forward with the extractions very quickly when bone starts to be affected. However, given your observation of palatal and facial bone deficiency, I would extract and osseous graft with delayed implant placement with perhaps additional bone and connective tissue grafting when implants are placed. The palatal bone is important because of the more palatal placement reguired for a screw-retained crown.

Richard A. WIlliamson

Iowa City, Iowa

Richard A. Williamson, DDS, MS, FACP


Victor Granda r...
Last seen: 2 weeks 3 hours ago
Joined: 2/4/16


I would do both sites at same time in a 2 stage approach as Dr Buser claims. Apically i dont see a problem. Facial bone is thin. Careful extraction is needed and final decision will be taken after the extraction.  Fixed temporary prosthesis maryland type. I prefer 2 stages and placement after 8 weeks with the needed grafts ( bone and soft tissue). 

Thanks for providing the case

 Victor Granda