What's the right treatment for this canine with external resorption?


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I am 38 years old and have a canine (#6) with "a class II cervical invasive root resorption on the distal extending to the osseous level." Images and further context can be found in this endodontics consultation report

I've sought the opinion of an endodontist and oral surgeon in addition to my general dentist. The only consensus among them is that I will need to have the tooth removed at some point in the future. Each of their opinions on what to do now differ. My dentist recommends root canal with crown and crown lengthening, and thinks my tooth will last 5-7 years that way. The endodontist recommends root canal and is confident he can seal with composite filling instead of crown and crown lengthening, but isn't really able to offer any expected timelines. The oral surgeon recommends extraction & implant. Any suggestions on which is the best course of action at this time? Thanks in advance
 
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honestdoc

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I think the need for crown lengthening depends on how accessible it is to restore the distal defect. There is a minimal biologic width requirement of 3 mm from the border of the restoration to the bone level which is 1 mm sulcular depth, 1 mm connective tissue of the gums to the bone and 1 mm epithelial tissue. Composites are not as bio-compatible under the gums so I recommend a strong glass ionomer (Fuji Equia) or bioactive material like Activa. For long term, it is hard to predict the life span of compromised teeth. If you grind and clench, you decrease its life exponentially. I think it is wise to prepare for extraction and possible implant so any problems won't catch you by surprise financially and emotionally.
 
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Thanks for the reply @honestdoc . I interpret your reply as a recommendation to go with the root canal now, and that I should be prepared mentally for extraction at any time after. Is that correct? I'm having trouble understanding the the benefit of going through the hassle and expense of the root canal if the extraction & implant is inevitable. Are you able to explain why it makes sense to preserve the natural tooth as long as possible versus just proceeding with the implant now?

For what it's worth I do grind and clench at night, but I have a nightguard

Thanks again very much.
 

honestdoc

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Are you having pain and or swelling? If your tooth tests vital, then you don't need a root canal. However, you may need it in the future or after the restoration. If the tooth tests vital with no symptoms, do the restoration first. After the restoration is satisfactory, monitor for future root canal. If further damage occurs and you develop symptoms, you may consider extraction instead of root canal and consider implant. Consider the conservative and least traumatic options first.
 

MattKW

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Crown lengthening will also adversely affect the adjacent premolar. Don't take it down with the canine. Do minimal treatment for the canine and prepare for eventual extraction.
 
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Thanks again @honestdoc . I had some pain before my general dentist cleaned out the decay and came across the resorption, at which point she put in a temporary filling. Currently there is no spontaneous pain, but there's is a bit of sensitivity to cold temperatures and it does hurt when I use my electric toothbrush in the rear of that tooth. Do you think that warrants root canal?

If I go the route of restoration, do you think there's a reasonable chance that the tooth could last the rest of my life? If that's the case it makes more sense to me to try the conservative approach first. So far I've gotten the impression that there's pretty much no chance of it lasting my lifetime, but I would like to learn otherwise if that's not true
 
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Thanks @MattKW for weighing in. I appreciate it. So you recommend going with a filling at this point to see if that's successful? Do you think there's a reasonable chance I may be able to keep the tooth the rest of my life? Thanks again
 

MattKW

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I would suggest you only try a glass ionomer. There is no benefit in using a composite. Ultimately, I think that tooth is doomed.
 
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Thanks @MattKW . So do you think the root canal is unnecessary at this point despite the sensitivity to temperature and the pain (albeit quite tolerable) when using my electric toothbrush in the rear of that tooth? Do you have any sense how much time I might be able to buy for the tooth if I end up with a glass ionomer filling? Thanks again
 

MattKW

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Root canal if the pain is intolerable. No idea how long that tooth will last.
 
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@MattKW and @honestdoc , the more I think about it I'm not sure I understand the point of bothering with the restoration if extraction is ultimately inevitable. Seems like I would just be throwing money away on a temporary restoration (not to mention an uncomfortable visit in the dentist chair) as opposed to just getting the extraction and implant done and over with.Are you able to help me understand your reasoning for pursuing the restoration even though it's just temporary? I'm guessing I'm missing something. Thanks again very much
 

honestdoc

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If it was my tooth, I would go for the filling. After the filling, if I have no pain, swelling, or problems functioning, I would just leave it alone. If I develop pain (above 4-5/10 scale), swelling, any difficulties, I would like to re-evaluate with new x-rays and decide to pull it or do a root canal depending on how much damage. Again I prefer the least traumatic option.
 

MattKW

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Very unlikely. But maybe you'll get hit by a falling grand piano tomorrow and all your worries will be over. What I'm trying to say is - just get it filled, and wait and see. There is no definitive timeline to these things.
 
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honestdoc

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Like Dr. MattKW mentioned, it's hard to predict the longevity of things especially teeth subjected to insane amounts of PSI & sheer pressures, mineral degrading acids, bone & gum deterioration, and neglect. I would not lose sleep over it and just keep & maintain your teeth as long as possible. I'll definitely worry about that grand piano falling on me every moment...
 
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