Expert: Frederick R. Liewehr DDS, MS, FICD - 4/9/2007

Question
My tooth #23 had an area of external resorption (now cleaned out and filled with a temporary filling) near the pulp in the root area, but the pulp is healthy.  I was told by an endodontist the tooth needs extraction.  Is there a way to repair and restore the tooth instead? I DON'T WANT TO LOSE THIS TOOTH AND WOULD GO THROUGH A LOT TO TRY TO SAVE IT!  Or, do I need to ask a different type of expert this question?  

Answer
There is a poorly understood entity called, "invasive cervical resorption", which sounds like what you have experienced. Something, but it is unclear what, causes presumably osteoclasts to eat away at the outside of your tooth. Trauma, bacteria, and other etiologies have been blamed, but we are not yet sure exactly what stops this process. Interestingly, it rarely involves the pulp; the resorptive process will often "eat" around the pulp space, leaving it intact.

To treat this resorption, one needs to stop the process and then restore the tooth. There is no need to remove additional tooth structure, as there is no bacteria to remove, as is the case with caries. The dentist merely gently removes the softened tooth material, places trichloroacetic acid on the tooth for a few minutes to get rid of any residual osteoclasts, and places a bonded resin or compomer restoration or MTA to restore it.

If your dentist is unaware of this condition, have him consult PubMed for pertinent articles on it. Good luck!

Dr. Liewehr