External Resorption: Tooth #26. What Are My Best Options?

Question

I was recently rold by my dentist that I have External Resorption on tooth #26 and will have to have it removed. I am dreading the fact that I'll have a missing tooth in the front. My dentist sent me for a consultation with a orthodontist and I am waiting to consult with him before the extraction. I was wondering what is the best solution? Should I have the toothed pulled?If I do how long will it take for the gap to close up and what is the fastest way in closing the gap? Is there any other way?

Scott Young, DDS · Answer

More than likely your best option is going to be extracting the tooth and placing a dental implant. The have small diameter implants now that should fit nicely and after the crown is placed give you a great result. Orthodontics may be an option, but I worry about how much movement would need to take place and where your midline would be following treatment. Good luck.

Norman Huefner, DDS · Answer

If you have external resorption and your dentist feels it is not savable by means of root canal and periodontal surgery, then it is best to remove it.

	If your lower teeth are crowded, then after the tooth has been extracted your orthodontist may just unravel the crowded teeth, which in turn should close the space.  If your teeth are only slightly crowded, then after the braces or invisalign orthodontics, you might need a little composite bonding to finish closing the space.  If you don't have any crowding, then orthodontics may not be the best way for you to go.

	You ask about other alternative treatments?  There are at least two that immediately come to my mind.  One is a dental implant and the other is a dental fixed bridge. 

	Regarding the dental implant, oftentimes the implant can be placed at the same time that the tooth is extracted.  However, you may have to wait a number of weeks wearing a temporary tooth substitute (usually called "a flipper") until the implant has bonded to the bone and ready to accept a crown on top of it.

	The bridge approach would mean you first have the tooth extracted, wear the temporary as mentioned above for 4-6 weeks to allow for the bone and gum at the extraction site to heal and mature.  Then the two teeth adjacent to the space can be prepared, a temporary bridge placed, and two weeks later the permanent fixed bridge placed.  So, beginning to end, your entire treatment using the bridge approach may only take around two months, but you would never have to go out with some kind of tooth in the space where the failed tooth was removed.

	If you have dental insurance, you may NOT get any coverage for the orthodontics, the implant or any cosmetic bonding.  However, most dental insurance companies will pay for the fixed bridge treatment.

Brian Dorfman, MD, DMD · Answer

Without photos and radiographs it is difficult to give any definite advice, but generally the best treatment for external root resorption would be extraction and a dental with or without a bone graft (depends ofn individual situation) Orthodontics is an option, but that would make your dental midlines uneven and in turn will not be very esthetic. a bridge is an option, but you have to cut down healthy teeth and bridges only last 5-7 yrs. Seek out the advice of a Board Certified Oral and Maxillofacial surgeon for the best treatment for you, He/ She will have the greatest amount of training and knowledge to discuss your particular case.

Madeleinne Zapantis, DMD · Answer

I'm glad you are getting your consultations before you extract your tooth. Orthodontics might be an option, but only if you have crowded lower teeth. If you have somewhat normal spacing ortho likely will NOT give you nice cosmetic results. This of course depends on your smile and lip height (how much tooth you show). Unfortunately your options are few. They include; implant (get that consultation before you extract as well- you may not have enough room - the lower anterior can be tricky), bridge of one sort or another, removable partial denture. Since you asked the best option is the one that will give you the results you are looking for (speed, cosmetics, cost?). If ortho, the time frame varies but expect at least 9 months. Good Luck!

Donald L. Wilcox, DDS · Answer

Most times when a tooth has resorption it is eventually lost. However, depending on the location and the severity of the resorption, I have seen a few cases treated successfully with endodontic thereapy (root canal). If your teeth are very crowded, orthodontics could be a possiblity or if you have other bite, cosmetic issues you want changed. If not, an implant would be an option if adequate bone and space is present. In that area normally a bridge can be done that bonds to the back of the adjacent teeth and restores the missing tooth without any preparation of the adjacent teeth being required.

Scott LeSueur, DDS · Answer

If you have external resorption, it depends on the speed at which it is occurring as to when the tooth may need to be removed. Unfortunately, non removal will result in the result of the tooth breaking off with a more difficult extraction senario. Implants are usually the choice of option iof there is no crowding whereby the space can be closed by uncrowding other teeth with orthodontics. Definitely consider all your options and ask lots of questions. With an implant or othodontics, temporaries can be constructed while corrections are taking place.

Leonard Tau, DMD · Answer

I am sorry that you have to have a tooth removed. From the information you have provided it is hard to give you an exact recommendation but while orthodontics may certainly be on option you may also be a candidate for a dental implant which would replace the tooth that you would be missing.

Zola A Makrauer, DMD · Answer

Most of the time teeth need to be extracted as a result of external resorption. Orthodontics is an option if a crowded condition exists. You have to be careful because you could end up with a space or not enough gum tissue in between the teeth that will result in a black space. Ask the orthodontist about the possibility of this. The alternative is an implant to replace the tooth or a permanent fixed bridge.

Soheyla Marzvaan, DDS (retired) · Answer

From  your explanation, it is hard to say whether Orthodontic is your best option. If you close the gap via braces, the alignment and the balance of  bite forces, the midline will change and not for the better. If you have enough spacing in your jaw, your best option will be to extract the tooth and place implant and a crown.

	Good luck.

Gary Nack, DDS (retired) · Answer

In most cases, teeth that have external resorption will fail in time.  The resorption is caused by cells in the ligament that surround the tooth, attacking and destroying it.  Late stage resorption can cause the tooth to become ankylosed, or joined with the bone, causing a difficult extraction.  My best recommendation would be to visit a periodontist to have it extracted with the possiblity of placing an implant at the same visit.  By doing this, you combine two surgeries into one procedure making it less stressful for you and shortening the overall treatment time.

	Good Luck!!

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