* Apical resorption may be associated with a systemic disease or of an idiopathic origin. It may also occur in association with orthodontic treatment or with pathoses such as tumours, cysts, etc. * In the absence of signs or symptoms of pulpal and/or periapical disease, endodontic treatment is not indicated. * Long-term monitoring of affected patients is essential.

Wegener's granulomatosis is a systemic disease characterized by a granulomatous lesion that can affect any organ throughout the body. This case-report illustrates the problem posed by a patient presenting with bilateral serous otitis media with marked sensorineural hearing loss, facial nerve paralysis and an atypical serological picture. The importance of early diagnosis and the protocol for the management of a patient with an uncertain diagnosis is discussed. Due to atypical presentations, only a high index of suspicion will ensure an early diagnosis.

Parry Romberg Syndrome (PRS) is a rare disorder of progressive hemifacial atrophy, involving soft tissues, fat and occasionally bone. It can co‐exist with presentations of Morphea. We describe an unusual case of persistent periodontal and alveolar destruction associated with PRS. A 56‐year‐old African female initially presented with persistent periodontal destruction, which showed minimal response to conventional periodontal treatment. After non‐surgical treatment, surgical debridement followed by extraction of the two right maxillary incisor teeth was required to halt the periodontal destruction. Atrophy was not limited to the periodontal tissues. Multidisciplinary care and extensive investigations were required to diagnose PRS. Once the PRS has stabilised, adipose tissue transplants will be required to improve the facial appearance. We highlight the need for extensive investigations and a multidisciplinary approach to diagnose rare systemic causes for recalcitrant periodontal disease.

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