Periodontitis and root resorption: Two case reports

Background/Aim: Root resorption (RR) refers to a cellular response resulting in loss of hard and soft dental tissue due to injury, irritation of the periodontal ligament, and/or tooth pulp. Typically, it is considered a physiologic response; however, in permanent dentition, it is associated with the presence of active pathology, and the basis of it has two main aspects: injury and stimulus. This is a presentation of two cases that show evidence of external apical resorption with concurrent periodontal bone loss of the involved teeth as the only evident stimulus in the history of the patient, clinically and radiographically. Case Report: The first case was that of a 43-year-old patient who presented himself with mild generalized pain in the second quadrant. The medical history revealed no underlying condition, and the patient provided informed consent. The clinical examination included periodontal charting of the dentition, which confirmed the presence of pockets in various locations, measuring between 4 mm and 6 mm. The initial panoramic radiograph (orthopantomogram: OPG) at the day of the appointment revealed a diffuse pattern of root resorption on the tooth #26 in contrast to the distinct and clear, although asymptomatic, root resorption of #47. The second case involved a 73-year-old patient who presented himself with mild generalized pain in the first quadrant, mostly while eating. Medical history revealed only the administration of furosemide as anti-hypertensive treatment, and the patient provided informed consent. Clinical examination included periodontal charting that confirmed deep pockets, more prominently in the posterior teeth of the maxilla, and specifically the first quadrant. The orthopantomogram examination on the day of the appointment confirmed the presence of the pockets radiographically. #16 did not respond to cold and therefore the patient was referred to an endodontist, who initiated the root canal treatment and suggested an exploratory flap, which in turn revealed the root resorption of the palatal root. Conclusions: Historically, intraoral periapical radiographs (PAs) were the first tool that was used to diagnose RR. However, over the years, the development of panoramic radiograph (OPG) and the later development of Cone Beam Computed Tomography (CBCT) has incrementally altered our ability to visualize and diagnose dental pathosis. Root resorption involves shortening or blunting of the root concomitant with loss of cementum and/or dentin. Physiological root resorption involves exclusively deciduous teeth and thus is considered pathological when affecting the permanent dentition. The periodontal status acts as a precursor since periodontal disease-related root resorption is reportedly found about three times more frequently. Root resorption presents with significant variation in the affected teeth and, with no guidelines in place correlating a specific class of root resorption with a singular treatment, a case-by-case approach is the gold-standard.