For Referring Dentists

Refer a patient with complex resorption

Resorption is the diagnosis where 2D imaging fails — internal and external defects look identical on a periapical and have opposite treatments. This guide is the CBCT-based classification protocol, the AAE/Heithersay staging we use for prognosis, and the report-back communication you'll receive.

Medically reviewed by Dr. Jason Kung, DDS, MS · Specialist Endodontist · UCLA DDS · OHSU MS ·
Submit a referral Call (669) 234-2354

When to refer

  • Incidental radiolucency in the crown or root of a tooth on a routine bitewing or periapical — particularly a pink-tinged crown noted clinically.
  • Patient with a history of dental trauma, orthodontic treatment, or internal bleaching presenting with a new radiolucency on the affected tooth.
  • Cervical (neck-of-tooth) defect that does not look like decay and probes asymmetrically.
  • A previously root-canal-treated tooth with a new lateral or apical radiolucency that does not have the morphology of a typical periapical lesion.
  • Ankylosis suspected after avulsion-and-replant, with progressive replacement resorption visible on serial radiographs.
  • Any tooth where the 2D radiograph cannot distinguish internal from external resorption — and the treatment paths are opposite.

Our workup

1

CBCT in Endo Mode for 3D classification

Internal and external resorption look almost identical on a 2D X-ray and have opposite treatments. CBCT is the only reliable way to classify the defect (internal vs. external cervical vs. external apical vs. replacement) and to stage its extent — circumferential involvement, communication with the periodontal ligament, and remaining sound tooth structure.

2

AAE / Heithersay classification for external cervical resorption

We stage external cervical resorption per the AAE classification system (which adapted Heithersay) — Class 1 (small supraosseous), Class 2 (defined near the coronal pulp), Class 3 (extending to the coronal third of root), Class 4 (extending beyond the coronal third). The class drives the treatment decision.

3

Treatability assessment

Internal resorption with intact root canal walls: typically treatable by non-surgical root canal treatment. External cervical resorption Class 1–2: usually treatable with surgical access and restoration. Class 3–4 or extensive replacement resorption: prognosis often unfavorable; extraction with site preservation may be the honest recommendation.

4

Prognosis communicated in the AAE 2014 framework

Favorable / questionable / unfavorable — the same language you use when discussing the implant alternative. The patient leaves understanding what is being saved and what is at risk.

What you get back

  • Same-day written diagnostic report with the resorption type, Heithersay/AAE class, and the specific 3D CBCT findings that support the classification.
  • Annotated CBCT slices (axial, coronal, sagittal) showing the defect; DICOM on request.
  • Treatment recommendation: non-surgical RCT, surgical access and restoration, observation, or extraction with site preservation — with the reasoning for each option.
  • Direct phone call within 24 hours on any borderline (Class 3) case where the restorative plan may pivot between save-the-tooth and extract-and-implant.

Related: tooth resorption (patient page) · CBCT 3D imaging · For Referring Dentists hub.

Ready to refer?

Online referral form Call (669) 234-2354