Follow-up periapical and panoramic radiographs obtained in March 2026 confirmed complete healing of the surgical sites, stable bone levels, and no further progression of root resorption. Figure 4. Panoramic radiograph depicting teeth 37, 38, 47 and 48, demonstrating the extent of root resorption in the mandibular second molars—teeth that were never subjected to direct orthodontic force. Published with patient consent. Figure 5. Post-treatment periapical radiographs showing residual root shortening of the mandibular central incisors and mandibular second molars and healed surgical sites. Figure 6. Follow-up panoramic radiograph in March 2026, confirming complete bone healing at prior surgical sites and no further root resorption. All images published with patient consent. The patient was referred to an oral and maxillofacial surgeon. In March 2024, a CBCT was obtained and reviewed. The surgeon reported that the follicles associated with the developing third molars appeared fluid-filled, forming expansile cysts that had extended to the buccal aspect of the adjacent 47 and 37. The developing follicles of 48 and 38 were directly related to the periradicular radiolucencies around 47 and 37. Crucially, sufficient bone remained around the roots of the second molars, which were non-mobile; the surgeon considered it appropriate to attempt to salvage these teeth. Surgical intervention under general anesthesia was carried out in April 2024, and included extraction of all four third molars, bilateral operculectomies, cyst enucleation and bone regeneration with grafting. The pathology report indicates the 47 specimen showed fibromyxoid connective tissue, bone spicules, light chronic inflammation, and reduced enamel epithelium, consistent with a dental follicle. The 37 specimen demonstrated non-keratinized hyperplastic stratified squamous epithelium overlying inflamed fibrous and granulation tissue, compatible with an inflamed dentigerous cyst. Three-month recall visits confirmed progressive healing of the surgical sites with no further radiolucency expansion. Treatment Conclusion and Outcome Active orthodontic treatment was concluded in December 2024, earlier than the originally planned 36-month course. Given the extent of root resorption, particularly in the unbracketed lower second molars which carried a guarded long-term prognosis, continuing fixed appliances posed a risk that outweighed the benefit of further occlusal refinement. A residual Class II relationship was accepted. Fixed retainers were placed and the patient continues under retention monitoring. 32 | 2026 | Issue 4 Supporting Your Practice
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