External root resorption is an uncommon event, but one that can threaten the long-term viability of a tooth. Its management is greatly affected by the lesion location (apico-coronally and circumferentially), the size of the lesion and a timely diagnosis. Both surgical and non-surgical methods can be utilized in its management. Lesions that are located close to the gingival margin represent a particular challenge due to the need to take periodontal bacterial contamination into account. However, the biggest challenge to the successful management of external root resorption is the limited information on the lesion dimensions during the treatment planning stage.
Modification of the position of the gingival margin around a natural tooth is often necessary to accomplish a variety of goals. These may include a need for restorative access, improvement of aesthetics, creation of a ferrule, or establishment of a healthy periodontal environment in the context of a restorative intervention. Ultimately, apical repositioning of the gingival margin permits predictable restorative procedure to be carried out while restoring and maintaining periodontal health.
The desired positive endpoints of crown lengthening surgery are achieved through a delicate balance between removal of an optimal amount of tissue to allow restorative goals and preservation of an adequate amount of periodontal support to ensure unaltered and continuous function. Alter natives to a crown lengthening procedure include the no-treatment option (i. e., not perform ing the procedure and accepting aesthetic, functional or health compromises), orthodontic extrusion, or removal of the affected tooth.
CASE REPORT
A 70-year-old healthy male presented with an asymptomatic mandibular left canine (33) affected by a large area of suspected external root resorption (Fig. 1). The patient had good oral hygiene and was generally free of periodontal disease. All teeth were present except 34. The most coronal extent of the resorptive lesion was apparent on the root of 33 above the receded buccal gingival margin. It is hypothesized that after the lesion reached its current size, the gingival margin underwent recession which exposed the most coronal aspect of the resorptive defect to the oral cavity. On examination, the tooth 33 was asymptomatic and responded normally to cold application. The coronal aspect of the resorptive lesion could be partially felt with an explorer above the gingival margin revealing a deep non-carious hard rough surface with gingival in-growth occupying the lesion. Probing depth around 33 was normal without overt signs of gingival inflammation. The gingival margin on the buccal appeared irregular (perhaps, torn by tooth brushing) with very limited keratinized gingiva at the apex of the “tear”. Radiographic appearance was remarkable only for a faint radio luscent shadow superimposed over the coronal portion of the canine root (Fig. 2). A provisional diagnosis of external root
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Modification of the position of the gingival margin around a natural tooth is often necessary to accomplish a variety of goals
