Surface resorption is self-limiting and does not
generally require treatment. Frequent clinical and
radiographic review is necessary, however, to confirm
that inflammatory and replacement resorption are not
occurring in these teeth.
Where resorption has been initiated in traumatized
teeth, replacement resorption cannot be treated
effectively. Nevertheless, as replacement and
inflammatory root resorption can occur together,
endodontic therapy to remove necrotic and infected
pulps from resorbing teeth is warranted. As an interim
measure the teeth can be dressed with a cortico-steroid/
antibiotic paste or calcium hydroxide, or it can
be root filled. Each case has to be treated on its merits.
Treatment of resorbing traumatized ankylosed anterior
teeth often requires multi-specialty treatment planning.
Before extensive endodontic management is
contemplated, the options of extraction, prosthetic
replacement, maintenance of the space for future
prosthetic replacement, orthodontic space closure,
autotransplantation and surgical root submergence
must be contemplated. In younger patients, where
retention of a submerging ankylosed tooth can retard
alveolar growth, root submergence (decoronation)
should be contemplated once evidence of submergence
is noted.
In contrast, in older patients, extraction and
replacement with an osseointegrated implant is an
option.
Inflammatory resorptive defects are treated by
immediate pulp extirpation and the use of cortico-steroid/
antibiotic or calcium hydroxide intracanal
dressings until there is evidence of bone healing. Since
any delay in treatment increases the surface area of the
root that needs repair, urgent and early treatment is
recommended. Root canal disinfection and medication
removes the cause of the resorption. Provided
endodontic treatment is initiated early enough, most
inflammatory resorptive defects can be treated
conservatively.
Treatment of external invasive root resorption is
dependent upon the position and extent of the
resorptive defect. Heithersay
has recently described
treatment options involving the careful application of
trichloracetic acid BP (90% solution) from either an
internal or external approach as a means of managing
some invasive resorptive defects.