Internal root resorption: a review.

Jacobovitz M, de Lima RKP. Treatment of inflammatory internal root resorption with mineral trioxide aggregate: a case report. International Endodontic Journal, 41, 905‐912, 2008. Aim To report the treatment and follow-up of a maxillary central incisor with internal resorption managed by root canal treatment, white mineral trioxide aggregate (MTA) repair and a fibre-glass post for reinforcement. Summary This study presents a case of extensive internal root resorption affecting tooth 11 (FDI) in a 28-year-old male patient, with a history of trauma in that region. The substantial loss of tooth structure, including cementum, and a perforation with lateral periodontal communication were complicating factors. Despite a guarded prognosis but encouraged by a healthy periodontal condition, treatment based on reconstructing the tooth with white MTA and a fibre-glass core was carried out. Follow-up radiographs over 20 months demonstrated the maintenance of a functional tooth. The tooth did, however, discolour after MTA treatment. Key learning points • Because of its insidious pathology, internal root resorption can extend to significant dimensions before being recognized. • MTA plus the fitting of a fibre-glass post provided adequate, functional rehabilitation of a compromised tooth for 20 months. • Despite the favourable biological and mechanical properties of white MTA, considerable tooth discolouration may occur.

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Treatment of inflammatory internal root resorption with mineral trioxide aggregate: a case report

Internal inflammatory root resorption is a relatively rare resorption that begins in the root canal and destroys surrounding dental hard tissues. Odontoclastic multinuclear cells are responsible for the resorption, which can grow to perforate the root if untreated. The initiating factor in internal root resorption is thought to be trauma or chronic pulpal inflammation, but other etiological factors have also been suggested. Active, expanding resorption requires vital pulp tissue and continuous microbiological irritation, likely from the necrotic coronal part of the root canal. In its classical form, internal root resorption is easy to diagnose. However, in many instances advanced diagnostic methods may be required for a definitive diagnosis. Internal root resorption is usually symptom free, but in cases of perforation, a sinus tract usually forms. The prognosis for treatment of small lesions of internal root resorption is very good. If, however, the tooth structure is greatly weakened and perforation has occurred, the prognosis is poor and tooth extraction must be considered. Sodium hypochlorite, ultrasonic instrumentation and calcium hydroxide are the cornerstones of treatment of internal inflammatory root resorption. Mineral trioxide aggregate is being increasingly used as a root canal filling material, particularly in cases of perforation.

Internal inflammatory root resorption: the unknown resorption of the tooth

Kamburoglu K, Kursun S. A comparison of the diagnostic accuracy of CBCT images of different voxel resolutions used to detect simulated small internal resorption cavities. International Endodontic Journal, 43, 798–807, 2010.



Abstract

Aim  To assess ex vivo the use of two different cone-beam computerized tomography (CBCT) units at different voxel resolutions for the detection of simulated small internal resorption cavities.



Methodology  A total of 60 single-rooted mandibular incisors and canines were split mesiodistally along the coronal plane into labial and lingual sections. Artificial internal root resorption was simulated by drilling with a 0.5-mm-diameter round bur to its full depth at either the cervical or apical portion of the labial wall. In total, 60 cavities were created (30 cervical and 30 apical), and 60 locations (30 cervical and 30 apical) were left without cavities. The sections were rejoined and placed in dry human mandibles in groups of 6 and imaged using two different CBCT units at different resolutions to obtain five image sets as follows: Iluma, ultra-resolution (0.1 mm3); Iluma, high-resolution (0.2 mm3); Iluma, low-resolution (0.3 mm3); 3D Accuitomo 170, 6 × 6 cm FOV (0.125 mm3); 3D Accuitomo 170, 8 × 8 cm FOV (0.160 mm3). Each image set was viewed by two observers and evaluated using a 5-point scale for detection of internal resorption cavities. Kappa coefficients were calculated to assess intra- and inter-observer agreement. Az values were calculated and compared, with a significance level of α = 0.05.



Results  Kappa values were fair-to-moderate for the low-resolution Iluma images and good to excellent for all other image sets. Both intra- and inter-observer agreement values were higher for the Accuitomo images than for the Iluma images. The highest Az values were obtained with the Accuitomo 0.125 mm3 images and the lowest with the Iluma 0.3 mm3 images. The Az values for the Accuitomo and Iluma ultra- and high-resolution images were higher than those of the low-resolution Iluma images. No differences (P > 0.05) for internal resorption detection were found between the Az values of the Accuitomo 0.125 mm3, Accuitomo 0.160 mm3, ultra-resolution Iluma and high-resolution Iluma images.



Conclusion  Ultra-and high-resolution Iluma and Accuitomo 0.125 and 0.160 mm3 CBCT images performed similarly and better than low-resolution Iluma images in the detection of simulated internal resorption ex vivo.

A comparison of the diagnostic accuracy of CBCT images of different voxel resolutions used to detect simulated small internal resorption cavities

Observer Ability to Detect Ex Vivo Simulated Internal or External Cervical Root Resorption

– Aim and methology: Two cases of internal tooth resorption were examined. A mandibular premolar and a mandibular canine were studied after they were extracted using radiographs, a stereomicroscope (SM) and a scanning electron microscope (SEM). Lastly, 3D images of the sectioned teeth were obtained(3D).



Results: Radiographically, internal root resorption was shown as a uniform radiolucency. By SM examination, an extensive destruction of dentin was seen, while, by SEM examination, a disappearance of dentinal tubules was clear. The 3D reconstructive method revealed a circumscribed, oval-shaped defect that did not perforate the cemental layer.



Conclusions: Internal root resorption is a rare remodeling process that can be studied using different experimental methods.

Vasiliki I Dourou

Papers

Internal root resorption studied by radiography, stereomicroscope, scanning electron microscope and computerized 3D reconstructive method.