Multiple External Invasive Root Resorption and Calcification in Systemic Sclerosis-Case Report

There are few reports in the literature of multiple external invasive root resorption (EIRR) lesions in patients with systemic sclerosis (SSc), and an association between root resorption and SSc is not well established. We report the only case that comprehensively illustrates-with the combination of histopathology, cone beam computed tomography (CBCT), orthopantomograms and photography-pulpal and periodontal ligament calcifications, multiple EIRR lesions progressing over time and the sequelae of treatment. Sixteen affected teeth, documented over 14 years, are presented.

A 51-year-old female presented for overall oral management of progressive SSc. Extraction of symptomatic teeth 16 and 26 revealed palatal EIRR. Retrospective dental record review revealed four previously extracted affected teeth. Subsequent CBCT revealed a further 10 affected teeth. Rapid EIRR progression of teeth 25 and 47 ensued and were extracted with tooth 46. Histopathology revealed ankylosis with mature bony infill of EIRR lesions, bone abutting dentine with absent cementum and pulpal and PDL calcifications. The teeth 46-47 extraction site developed stage I medication-related osteonecrosis of the jaw secondary to denosumab use, was managed with conservative measures and resolved.

Patients with SSc may display a higher prevalence of EIRR. Awareness should be raised about this potential association. Dentists treating patients with SSc should conscientiously search for these easily unnoticed, often subgingival lesions, since early management may reduce the risk of teeth succumbing to pathological fracture. However, if multiple progressive lesions present, no intervention may be appropriate due to the aggressive nature of EIRR and potential futile outcome of treatment.