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Root resorption after bone graft: cause?

Last Updated: Mar 05, 2017

I have treatment planned this 56 year old male with a noncontributory medical history to replace his missing maxillary teeth with implants.

His pre-surgical CBVT was taken on 3/23/16.

On 6/17/16 I performed a lateral sinus augmentation utilizing 50/50 mix of NuOss cancellous bovine bone (ACE) and allograft (50/50 cancellous / mineralized bone). I also placed the bone graft material on the buccal bone of teeth #’5 and 6 and covered the window with Mem-Lock pericardium membrane (BioHorizon). Please see post – surgical CT. That was my usual protocol.

On 12/16/16 I saw the patient for a re-evaluation and a CBVT was taken. Sinus graft seemed to be well mineralized and I proceeded with implants placement.

On 1/25/17 I opened the area for implants placement and noted severe roots resorption of #5 and 6 (Please see clinical photographs). Sinus graft density was within normal limits so I placed an implant in #3 site.

I have never come across root resorption after bone grafting procedures and never saw anything in the literature. Now I am planning to extract #5 and 6, re-graft the area and eventually place implants in the target sites #5 and 6. Can anybody help me identify the cause of the resorption?

![]Exam 3/23/16](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2017/03/b35ad2b8812396d7441257c64c82b99e-e1488732352170.jpg)Exam 3/23/16
![]Exam 6/17/16](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2017/03/d6da12d0388a3bf4ef1046a609a40812-e1488732484222.jpg)Exam 6/17/16
![]Exam 12/16/16](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2017/03/d58840fc8fc61db4f7e974ca4005196a-e1488732577399.jpg)Exam 12/16/16
![]Exam 1/25/17](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2017/03/6c647def3ffa62c22ce41759525a7e86-e1488732666463.jpg)Exam 1/25/17

6 Comments on Root resorption after bone graft: cause?

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Francis

3/7/2017

Traumatic , iatrogenic, injury to tooth surface may cause surface resorption. Just a thought Francis

Vladimir

3/7/2017

There was no trauma to the teeth. Bread-and-butter sinus augmentation. I did not touch the roots, just placed some extra bone grafting material over the buccal plate.

Saad Boji

3/7/2017

I was treated many defects with Allograft, specially after Apicectomies, and unfortunately, I had root resorptions after few years, I discovered it by chance, and of course not in all cases. Allograft which I used has bone morphogenetic proteins which I believe that they have the effect on root resorption. So during the bone remodelling process with the allograft you used, may have the root resorption. I prefer to use a synthetic bone graft like a tri-calcium phosphate and other derivatives which would be replaced by new bone quickly and without any damage to the root surface. I you would like to use allograft, so use that one which is completely demineralised and have no any organic substances. Also you are not in need to remove the teeth #5 and #6. I prefer to try with MTA or Biodentin on the resorbed part of the root firstly, after treat them with RCT if they are in need. Dr. Saad Boji BDS. MSc. PhD.

Dr. Sofia

3/8/2017

Thank you Dr. Boji, very insightful comment. Props also to the Dr. who posted this. Unfortunately we are afraid to post mishaps many times due to what our colleagues might say about us.

Vladimir

3/9/2017

Thank you very much Dr. Boji. Will keep this in mind in the future.

Francis

3/9/2017

Could it be that different brands of xenograft have different processing procedures, one of them ( used in case of bioss and nuoss) use chemical (NaOH) to make it porous after deprotienaisation ? could it be traces of alkaline make the graft material more irritant to the biological tissue? Regards

root tip implants path root canal obturation material should i remove this before placing implants