Upper anterior: Resorption case
This is a preview. To watch the full video please Sign up
Integrated Management of a Complex Resorptive Lesion
Overview
In this video we look at a diagnostic challenge involving a buccal sinus tract in the upper anterior region. We demonstrate how vitality testing and 3D imaging are essential for identifying the tooth of origin when clinical signs, such as gutta-percha (GP) tracing, may be misleading.
The Case & History
A patient presented with a buccal sinus tract located between the upper left central (UL1) and lateral (UL2) incisors. Initial radiographic tracing with a GP cone pointed towards the UL2, suggesting it was the source of the infection. However, clinical testing provided a different picture: the UL2 responded normally to thermal stimulus, while the UL1 was non-responsive. Detailed CBCT imaging confirmed that the UL1 had a complex resorptive lesion, despite its intact periapical periodontal ligament (PDL) on 2D radiographs.
The Clinical Problem
The primary challenge was managing an irregular, perforated resorptive defect from an internal approach. The UL1 exhibited both internal and external resorptive changes, necessitating a wider-than-usual access cavity to facilitate cleaning. The treatment required a specialised combination of tungsten carbide EndoTracer burs and ultrasonic Piezoson tips to debride the defect. Obturation was particularly complex, involving a hybrid approach: warm vertical condensation for the apical portion of the canal, followed by the placement of a bioceramic putty (Biodentine) to seal the irregular resorptive area and provide internal reinforcement for the compromised tooth structure.