Cat teeth with resorptive lesions and periodontitis may have a distinctly different clinical and radiographic appearance compared with teeth that have focal, lesion-associated gingivitis. A retrospective, case-controlled study was performed to determine the occurrence of root replacement in cats with resorptive lesions and associated periodontitis. Of 543 teeth evaluated with resorptive lesions, radiographic and/or clinical signs of periodontitis were identified in 236 (43.5%) teeth. Periodontitis was present in 43 of 275 (15.6%) teeth with root replacement and 193 of 268 (72.0%) teeth that had normal radiodensity and maintenance of the periodontal ligament. There was a significantly lower occurrence of root replacement in cat teeth with resorptive lesions and periodontitis.