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Idiopathic root resorption?
IDIOPATHIC
ROOT RESORPTION?
H. BERGER, DR. MED. DENT., TEL-AVIV,
PALESTINE
F A DISTURBANCE or a disease is called “idiopathic, ” we have to see in such a name nothing but the confession of our ignorance as to the underlying causes. It is the same with the term, ‘(spontaneous.” This ignorance may be only a tempprary one, and future investigations will lead perhaps to a better understanding of conditions which-at present-have to be called “idiopathic” or “spontaneous.” On the other hand, before resigning ourselves to such a nomenclature, we should have exhausted all other possible explanations at present at our disposal. In a recent article, “Root Resorption, ” by Dr. Samuel Fastlicht a case of “idiopathic root resorption” has been reported. This case might possibly be explained-I expressly state, possibly only-by being brought into relation to a known causative process. In this case the two maxillary lateral incisors are Some time ago, the patient, shown in Fig. I, came to me for treatinvolved. ment. The right maxillary permanent cuspid was erupting some millimeters above the permanent, lateral incisor. X-ray pictures failed to reveal the extent of the resorption, since it was impossible to find any projection where the crown of the cuspid did not cover the root of the lateral incisor. The tooth had to be extracted anyway on account of its mobility, and Fig. 2 shows how far resorption had progressed.
I
Fig. 1.
This instance was the first time that I encountered root resorption in a permanent tooth caused by an ectopic bud. Yet skimming through our literature, I found two cases of resorbed maxillary permanent. lateral incisors reported by Klatzky and by Buchner. Now, I cannot but connect these three cases with that reported by Fastlicht. Here, too, the maxillary lateral incisors are concerned, and I think 548
IDIOPATHIC
549
ROOT RESORPTION?
it quite possible that the resorptions have been caused by ectopic cuspids which, afterward, have straightened and, eventually, found their normal place. This explanation is, of course, conjectural, but has, in my opinion, a high degree of probability and should, if offered to the parents, go far in reassuring them about the future of the other teeth.
Fig. 2.
In all these cases, the resorptions had nothing to do with orthodont,ic treatment, and it fell only to the orthodontist to diagnose them and break the news to the patients or their parents. There are, however, other cases where ectopic cuspids do not cause resorption but displacement of lateral incisors, i.e., by pressing against the root of the lateral they are tipping the crown outward. In the case reported by Buchner, we even find this condition on one side while on the other the tooth, by not evadin g the pressure and remaining straight, has fallen prey to resorption. It is perhaps not superfluous to warn once more, in this connection, never to start treatment of tipped lateral incisors before the cuspids have erupted unless one has made absolutely sure by x-ray pictures that the roots of the lateral incisors will not possibly contact the cuspids during their movement. Otherwise, resorptions of the above-described kin’d might be caused by pressing the roots against abnormally situated cuspids. In such cases,widening of the arch in the premolar” region and early extraction of the deciduous cuspid are advisable as precautionary measures. REFERENCES Buchner:
Root Resorption
Caused by Ectopie
Eruption
of Maxillary
Cuspid, INT.
J. ORTHO-
DONTIA AND ORAL SURG. 22: 1236,1936.
Fastlicht : Root Resorption, AM.J.ORTHODONTICS ANDORAL SURG.~~: 548,1942. Klatzky : Report of an Unusual Case of Root Resorption in the Mixed Denture (The Forum), INT. J. ORTHODONTIA AND ORAL SURG. 22: 192,1936. 69 BOULEVARD ROTHSCHILD
ROOT RESORPTION?
H. BERGER, DR. MED. DENT., TEL-AVIV,
PALESTINE
F A DISTURBANCE or a disease is called “idiopathic, ” we have to see in such a name nothing but the confession of our ignorance as to the underlying causes. It is the same with the term, ‘(spontaneous.” This ignorance may be only a tempprary one, and future investigations will lead perhaps to a better understanding of conditions which-at present-have to be called “idiopathic” or “spontaneous.” On the other hand, before resigning ourselves to such a nomenclature, we should have exhausted all other possible explanations at present at our disposal. In a recent article, “Root Resorption, ” by Dr. Samuel Fastlicht a case of “idiopathic root resorption” has been reported. This case might possibly be explained-I expressly state, possibly only-by being brought into relation to a known causative process. In this case the two maxillary lateral incisors are Some time ago, the patient, shown in Fig. I, came to me for treatinvolved. ment. The right maxillary permanent cuspid was erupting some millimeters above the permanent, lateral incisor. X-ray pictures failed to reveal the extent of the resorption, since it was impossible to find any projection where the crown of the cuspid did not cover the root of the lateral incisor. The tooth had to be extracted anyway on account of its mobility, and Fig. 2 shows how far resorption had progressed.
I
Fig. 1.
This instance was the first time that I encountered root resorption in a permanent tooth caused by an ectopic bud. Yet skimming through our literature, I found two cases of resorbed maxillary permanent. lateral incisors reported by Klatzky and by Buchner. Now, I cannot but connect these three cases with that reported by Fastlicht. Here, too, the maxillary lateral incisors are concerned, and I think 548
IDIOPATHIC
549
ROOT RESORPTION?
it quite possible that the resorptions have been caused by ectopic cuspids which, afterward, have straightened and, eventually, found their normal place. This explanation is, of course, conjectural, but has, in my opinion, a high degree of probability and should, if offered to the parents, go far in reassuring them about the future of the other teeth.
Fig. 2.
In all these cases, the resorptions had nothing to do with orthodont,ic treatment, and it fell only to the orthodontist to diagnose them and break the news to the patients or their parents. There are, however, other cases where ectopic cuspids do not cause resorption but displacement of lateral incisors, i.e., by pressing against the root of the lateral they are tipping the crown outward. In the case reported by Buchner, we even find this condition on one side while on the other the tooth, by not evadin g the pressure and remaining straight, has fallen prey to resorption. It is perhaps not superfluous to warn once more, in this connection, never to start treatment of tipped lateral incisors before the cuspids have erupted unless one has made absolutely sure by x-ray pictures that the roots of the lateral incisors will not possibly contact the cuspids during their movement. Otherwise, resorptions of the above-described kin’d might be caused by pressing the roots against abnormally situated cuspids. In such cases,widening of the arch in the premolar” region and early extraction of the deciduous cuspid are advisable as precautionary measures. REFERENCES Buchner:
Root Resorption
Caused by Ectopie
Eruption
of Maxillary
Cuspid, INT.
J. ORTHO-
DONTIA AND ORAL SURG. 22: 1236,1936.
Fastlicht : Root Resorption, AM.J.ORTHODONTICS ANDORAL SURG.~~: 548,1942. Klatzky : Report of an Unusual Case of Root Resorption in the Mixed Denture (The Forum), INT. J. ORTHODONTIA AND ORAL SURG. 22: 192,1936. 69 BOULEVARD ROTHSCHILD