” Something rare to be seen” 

 This is what it has flashed in our mind  few days ago at Dr. Fabrizio Antenucci’s office,  reason way we decided document the case to shoot some pictures,and here we are,talking about External Resorption, in this specific case…

– bilateral resorption,affecting 4 elements in a single (unlucky) patient –

But what does the scientific bibliography says about Internal and *External Resorption?

Resorption is both cases if it is *external or *Internal is a physiological and pathological process which results in loss of hard tissues of the tooth , cement and dentine and the surrounding bone are tricked by this degenerating process.

As you will see in the following case pictures, the patient tooth seems health and in a good general state, before going on reading, take your time and think about it…and try to answer!

what it can cause a tooth degeneration without any visible damage? (1)









If yo have answered ”ALL THE PREVIUS” You were right! in fact is seems that external Resorption incidence is more common in patients who has this kind of parafunctional activity,vitamin loss or habits:

  • Vitamine D loss
  • orthodontic treatment made with the application of  excessive forces
  • Bruxism
  • Maxillary iatrogenic trauma
  • Repeated Bleaching
  • Trauma to the periodontal ligament
  • Surgical periodontal therapies

The first External Resorption classification was made  in the yr 1999,  by Dr. Heithersay :

He divided them in 4 classifications :

  • Class 1 provides a small cervical resorption in the area with a shallow penetration into dentin;
  • Class 2 has a well-defined resorption penetrating near the room throb with little or no extension in the root dentin;
  • Class 3 affection od the coronal third of the root resorption extend;
  • Class 4 identifies resorption extended and obtrusive that extend beyond the coronal third of the root

The approach to this kind of cases is different and it depends on how much the ”tooth pathology” is evolved.

In this unlucky case in particular there was not so much to do, except for surgical extraction of the affected elements (2 of 4).

When it’s possible,you can perform a minimal invasive approach,using Biodentine or MTA  to fill the resorption (after removing all the granulation tissue) and performing a normal endo treatment. (2) – (3)

I would like to share a video taken from http://www.formazioneodontoiatrica.it by Dr.Federico Tirone and Dr. Stefano Salzano, my personal  invitation is  to read them article about minimally invasive treatment of resorption at this link ( we have already provided a translated link for you) unfortunately it’s not possible to translate also the video,but it’s quite clear anyway!

Now lest’s go to Dr. Antenucci’s case :


Patient : Male ♂

Age : 50 y/o

Health : Good General Health State,No vitamin loss,no health pathology,Bruxism.

Symptomatology : The patient came to the office for idiopathic pain in the upper and lower jaw – elements 1.6 and 3.6

After taking an Rx ,the symptomatology is explained by external resorption,the first approach is surgical,but as written some lines before in this case the ”lesion” was too evolved to be treated with an endo  treatment.

After performing  a inter – pappillary flap,the maxillary and mandibular bone was exposed,and here it is what we found.


Lesione Molare 1.6



Lesione Molare inferiore

Elements 1.6 And 4.6 were extracted, Elements 2.6 and 3.6 are currently under control,endo treatment of the other two elements is under evaluationnight guard has been given to the patient dissipate the clamping forces derived from bruxism, we supposed that this cause can be the only one possible to justification this harmful situation.

(*) Case By Dr. Fabrizio Antenucci    (*) Artecle written By Dr. Mattia Di Girolamo 



(1) Correlation of Vitamin D status and orthodontic-induced external apical root resorption.Tehranchi A1, Sadighnia A2, Younessian F3, Abdi AH4, Shirvani A5.

(2)Management of extensive external apical root resorption leading to root perforation. Ghafoor R1, Tabassum S1, Hameed MH1.

(3) formazioneodontoiatrica.it by Dr. F. Tirone / Dr. S. Salzano

(4) Tooth resorption part II – external resorption: Case series Marina Fernandes, Ida de Ataide, and Rahul Wagle1



About the Author Dr. Mattia Di Girolamo

Dr.Mattia Di Girolamo (DDS) Founder and Admin of Universal Dentists Founder and Admin of Share The Dental Congress

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