Where resorption has extended from an internal
inflammatory resorption to involve the external surface
a communicating lesion is created. This can be
recognized radiographically by a radiolucency within
the tooth structure extending to the exterior surface
and the surrounding bone. While treatment is possible,
it is complex and referral to an endodontist is suggested
or implant therapy could be considered.
Endodontic treatment is carried out in the coronal
segment to the level of the resorptive defect where
various materials and medicaments can be used to
induce calcification at or within the resorptive lesion.
Traditionally, calcium hydroxide has been used for this
purpose and an example where this has been employed
is shown in Fig 18 with a 35-year follow-up.
Another approach involves the topical application of
90% aqueous trichloracetic acid to the resorptive tissue
following endodontic preparation to the level of the
resorptive defect. Trichloracetic acid is applied for 1–2
minutes on a mini-applicator or a small cotton pellet
attached to an endodontic file. This will induce a sterile
coagulation necrosis of the resorptive tissue which can
act as a nidus for calcification – a process labelled by
the author as “scaffolding”. An example of such a
treatment of an extensive communicating lesion is
shown in Fig 19 with a 13-year follow-up period.