CBCT - Internal/External Root Resorption!

So good morning. I've got another interesting case for you. This is a patient who presented with kind of non-descript pain, diffuse pain, lower left. She had previously had a history of tooth extraction with some bone graft. You can see residual recrypt indications here. This area was well healed. Nothing internally was visible. You know, probing looked normal. Everything was normal from what I can tell, aside from maybe some recurrent carries. So of course this here appears abnormal. And to me, you know, the first thing that my brain thinks of is this is internal or external resorption of some type because of the way these little stringy things show up. So I asked for a high resolution, small volume, 3D image in that area. And then here is what we have now. So looking, you know, from a different set of angles, we can now see that this is definitely internal, external. I'm not sure if it started as internal or started as external. But when I was probing and measuring, this is below the bone level. And it seems like there's still periodontal attachments here. So I was unable to get into this area. I attempted, but was unable to get in there. So definitely some, you know, internal, external root resorption problems. And as we scroll upward, you can see where the perforation in that tooth happens. Right here, definite clear perforation through the, let's see, that was the lingual cortex of the tooth root there. You can see it a little bit here. Again, this isn't the best angle to capture that resorption. I mean, we can see some opening of that pulp chamber. But definitely an interesting, interesting find, internal, external root resorption. Whereas, you know, the conventional film showed us just a questionable area. It's not super visible on this particular view. You know, I like to use this view to attempt to show the patient that, you know, relatively speaking, where things are in the mouth. But very visible here on the axial slice. And this particular coronal angle is also very visible. So helpful in diagnostics. The other x-ray, you know, was some indication. But based on the interaural exam, I couldn't really, couldn't really feel or see anything. Couldn't get the explorer into this area. You know, periodontal probing was fairly normal because the attachment seemed intact on that lingual surface. So really nothing, nothing out of the ordinary interaurally. It was all radiographically and 3D imaging-wise that allowed us to see what was going on. So thankfully, we have this modality in the office that allows us to do some additional diagnostic work. But the diagnosis was internal or external resorption. Recommended tooth for extraction. Placement of a bone graft and dental implant at the same time, if possible. Again, there's, there didn't seem to be any periapical abscess. So it seems like the surrounding supporting periodontium is healthy enough to, if we get good primary stability with an implant and place some bone graft around it, go ahead and plug in an implant at the same time as the extraction. Which we generally shy away from, if there's active abscess or infection present. So good case. Thanks for watching. Internal, external resorption system diagnosis with the CVCT low volume, high resolution image set.