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The Pink Tooth - An endodontic challenge

This patient was referred to us because their dentist had noted this canine tooth was seen to have a pink discolouration at the gingival margin palatally. The patient had not noticed any pain and had no altered sensation from the tooth.

This pink discolouration is caused by the dentine being replaced internally by soft ('fibro-vascular') tissue with the overlying shell of enamel remaining intact. This process called 'external cervical resorption' can be complex to manage and early detection can be critical in allowing predictable management.

Some teeth are more prone to External Cervical Resorption (ECR) than others as summarised in this paper by Patel et. al. where maxillary canines are the second most likely teeth to present with ECR after maxillary central incisors.

Resorption presentation
Incidence of external cervical resorption taken from Patel et. al 2018

Determining the extent of the resorption defect is key in assessing the restorability of the tooth. On a conventional periapical radiograph, it can be difficult to see how extensive a resorption defect is- I take a CBCT scan in all resorption cases to ensure the defect can be properly assessed.

The periapical radiograph (left image) shows the radiolucency corresponding to the defect. This defect was much more visible on the CBCT scan lateral and axial views. The defect was taking up most of the palatal aspect of the canine tooth and was close to the pulp space. The defect extended sub-gingivally and was below the level of the palatal crestal bone level.

In this case, the patient worked away off-shore and was keen for the most predictable long term treatment option and after discussing the merits o

f repairing the defect, he decided that a dental implant would better suit his needs.

Incidentally in this case, on the CBCT scan, the pulp spaces in UL345 are all visible in the axial slice, however, the UR54321 and UL12 pulp spaces are somewhat reduced in size/ obliterated. One of the causes for ECR can be historical trauma which could also explain this pulp obliteration/ calcification.

The key message here is that early detection is key... the more subtle the pink spot, the smaller the resorption defect will be and the easier it is to treat!

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