Internal Inflammatory Root Resorption Research Articles

Internal root resorption: case report and literature review

Abstract: Internal inflammatory root resorption (IIRR) is a rare, but significant consequence of dental trauma. Previous cases often focus on two-dimensional imaging. More widespread use of cone beam computed tomography (CBCT) has seen improved diagnostic accuracy of these defects leading to more appropriate management. In this case report, an adolescent male patient complained of a missing front tooth (UR1). Dental history revealed intrusive trauma to the predecessor as a child. The UR1 was impacted with a dilacerated root. CBCT imaging revealed severe internal root resorption, and due to its extensive nature, extraction was advised. CPD/Clinical Relevance: Readers should be aware of the consequences of internal inflammatory root resorption and understand the importance of early detection with appropriate special investigations.

An unusual repair of perforating internal inflammatory root resorption; a case report of endodontic treatment

Internal inflammatory root resorption (IIRR) can occur as a serious complication of dental trauma which leads to progressive loss of the root structure. An early diagnosis could influence the therapeutic approach, but endodontic treatment becomes a challenge with a doubtful prognosis. The present report described an unusual clinical presentation of an IIRR with perforation resulting from a trauma four years previous. A 15-year-old female patient was presented to our service with pain in the maxillary incisor region. Intraoral radiography revealed a large radioloucent area compatible with IIRR, communicating with the periodontium in the middle third on the distal root face of the right central incisor. The root canal of the right central incisor was chemo-mechanically prepared. The calcium hydroxide (CH) intracanal medication was used and renewed periodically four times. The root canal was filled only in the cervical region to the level of resorption by the inverted gutta-percha cone technique. Clinically and radiographically, all follow-up examinations revealed an asymptomatic tooth, evidencing periapical tissue repair and new bone formation. The tooth remained asymptomatic 3 years afterwards. The present case report supports the idea of executing satisfactory intracanal decontamination by chemo-mechanical preparation, thus creating a favourable environment for tissue repair.

Management of Root Perforation : A Case Report

Background : Root perforation results in the communication between root canal walls and periodontal space (external tooth surface). It is commonly caused by an operative procedural accident or pathological alteration (such as extensive dental caries, and external or internal inflammatory root resorption). The diagnosis of dental pulp and/or periapical tissue previous to root perforation is an important predictor of prognosis. Case : A female patient came to Dental Conservative University of Airlangga with complaints of perforated lower left molars. On the objective examination obtained negative vitality test, positive on bite test. On radiographic examination, a radiolucent on bifurcation was performed Case management : The tooth was treated by hemisection. Root canal treatment was carried out in the distal canals. Afterwards, the tooth was split mesio-distally. The mesial root was extracted, and the distal root was retained and restored with PFM Crown. Discussion : Hemisection is a useful alternative treatment to extraction to save the multi-rooted teeth by endodontic approach, which includes the root canal treatment of the remaining roots and restoring them with suitable restorative material to splinting it with the adjacent tooth to decrease the risk of displacement followed by a fixed prosthodontic prosthesis to maintain the occlusal balance. Conclusion : Hemisection with subsequent prosthetic rehabilitation can be a viable alternative to retain severely decayed mandibular molar.

Endodontic management of perforating internal resorption in a mandibular molar using sandwich technique

Internal inflammatory root resorption is an uncommon pathology that can progress to the periradicular vicinity. It is frequently asymptomatic and only discovered during a radiological screening. Appropriate and timely diagnosis is extremely crucial in tackling these cases. A perforating internal resorptive cavity in the distal root of the mandibular first molar was successfully managed using a sandwich concept of sectional apical obturation with gutta-percha and Bioceramic sealer followed by the placement of mineral trioxide aggregate in the resorptive cavity.

Management of Unusual Pattern of Internal Inflammatory Tooth Resorption and Periapical Cystic Lesion - A Unique Case Report

Dental trauma is a challenge for dental integrity and can lead to various consequences, among which internal inflammatory root resorption can also be the fate of anterior teeth as they are commonly involved in traumatic events. The internal inflammatory root resorption occurs as a result of damage to the predentin due to trauma, plus root canal system becoming infected with bacteria. Trauma generates chronic inflammation, which leads to periapical inflammation and necrosis of epithelial cells, resulting in the formation of a cyst. The aim of the treatment approaches should be to assure complete biological healing and functional integration. This case report presents the unique characterization of traumatic consequences, including large periapical lesion and unique pattern of internal tooth resorption with intact apical barrier which was diagnosed by cone-beam computed tomography imaging and well managed by surgical intervention using mineral trioxide aggregate – both as a retrograde filling and tooth reinforcement material and sticky bone (platelet-rich fibrin + Bio-Oss) as a regenerative approach. The follow-up showed good results both clinically and radiographically. Thus, it can be concluded that endodontic reinforcement of thin roots due to internal resorption with intact apical barrier and surgical microendodontic procedure with regeneration is a potential therapeutic option in cases of traumatic injuries.

Management of internal inflammatory root resorption using injectable platelet-rich fibrin revascularization technique: a clinical study with cone-beam computed tomography evaluation.

The current study evaluated clinically and radiographically the management of internal inflammatory root resorption (IIRR) in permanent anterior teeth with or without periapical lesions using injectable platelet-rich fibrin (i-PRF) regenerative approach. Ten systemically healthy patients, with thirteen anterior mature teeth diagnosed with IIRR were selected for the study. At the first visit, the tooth was anesthetized, access cavity opened, root canals were mechanically prepared then medicated with calcium hydroxide and temporarily sealed. After 2-4weeks, regenerative endodontic procedures were performed by preparing and applying i-PRF inside the canal, then a freshly prepared PRF membrane was placed over it. White mineral trioxide aggregate was placed over the PRF matrix, and the tooth was restored with a glass ionomer cement base and resin composite restoration. The patients were recalled for clinical and radiographic evaluation and follow-up every 3months for 12months. Cone-beam computed tomography (CBCT) imaging was performed preoperatively and after 12months. Clinical evaluation results showed resolution of signs and symptoms through the follow-up period in all of the cases. Both CBCT imaging readings of IIRR lesions and periapical lesions revealed a volumetric significant difference (p = 0.00) between the preoperative and the 12-month follow-up period. Usage of i-PRF could arrest and allow for healing of IIRR in permanent mature teeth and allow for periapical healing with successful clinical results. i-PRF revascularization technique proved to be a successful REP in the treatment of the IIRR, reducing the number of appointments and increasing patient compliance.

Management of internal root resorption in primary mandibular right first molar: A case report with four-year follow-up

Internal inflammatory root resorption in primary teeth is a well-known entity with unknown prevalence. The diagnosis and conservative treatment of such a lesion has perplexed practitioners for decades. The management of a non-perforating internal root resorption is long been debated by general dentists and paediatric dentists alike. This case presentation describes the case of a 4-year old boy with non-perforating internal root resorption in a primary molar treated successfully with endodontic procedure and monitored routinely for four years. The objective here was to suggest a minimally-invasive treatment alternative to conventional treatment practices.

Reparative Endodontic Treatment of a Perforating Internal Inflammatory Root Resorption: A Case Report

The aim of this case report was to present a reparative treatment approach of an extensive internal inflammatory resorption with a lateral perforation and apical and lateral inflammatory lesions. Only the necrotic coronal part of the pulp was removed, and the vital pulp tissue within the resorption cavity and the apical part of the root canal was left uninstrumented. Bleeding was induced, and the blood clot was covered with mineral trioxide aggregate. Hard tissue repair and healing of the apical lesion could be observed in the 3-year recall.

Management of internal inflammatory root resorption - an endodontic challenge: Case series

Root resorption of the tooth is defined as a pathologic or physiologic process resulting in loss of hard tissue such as root dentin, cementum and bone. Root resorption is of two types external and internal root resorption. Management of internal root resorption has always been a challenge to the endodontists. It may occur in cases with chronic pulpal inflammation, following caries or due to traumatic injuries. Prevalence of internal root resorption is more in anterior teeth, because of their susceptibility to trauma. For successful treatment outcome early diagnosis, removal of the cause, proper treatment of the resorbed root is mandatory. This paper summarizes the management of internal root resorption through two cases of non-perforating and perforating internal resorption, which were successfully managed and showed good healing after a follow up of 6 months to 1 year.

Management of internal inflammatory root resorption with the aid of cone beam computed tomography: A case report

Managing a case of internal root resorption is a tedious task.Mostly it is detected in anterior teeth where trauma is mainly responsible for its occurrence. It is a chronic pulpal inflammation condition where signs and symptoms are elicited in due course of time. Successful treatment can be rendered only after proper diagnosis and elimination of etiological factors. In this article a case report of internal root resorption is presented where treatment was instituted after thorough analysis of CBCT sections. Keywords: Internal root resorption, Composite, CBCT.

Root perforations: a review of diagnosis, prognosis and materials.

Root perforation results in the communication between root canal walls and periodontal space (external tooth surface). It is commonly caused by an operative procedural accident or pathological alteration (such as extensive dental caries, and external or internal inflammatory root resorption). Different factors may predispose to this communication, such as the presence of pulp stones, calcification, resorptions, tooth malposition (unusual inclination in the arch, tipping or rotation), an extra-coronal restoration or intracanal posts. The diagnosis of dental pulp and/or periapical tissue previous to root perforation is an important predictor of prognosis (including such issues as clinically healthy pulp, inflamed or infected pulp, primary or secondary infection, and presence or absence of intracanal post). Clinical and imaging exams are necessary to identify root perforation. Cone-beam computed tomography constitutes an important resource for the diagnosis and prognosis of this clinical condition. Clinical factors influencing the prognosis and healing of root perforations include its treatment timeline, extent and location. A small root perforation, sealed immediately and apical to the crest bone and epithelial attachment, presents with a better prognosis. The three most widely recommended materials to seal root perforations have been calcium hydroxide, mineral trioxide aggregate and calcium silicate cements. This review aimed to discuss contemporary therapeutic alternatives to treat root canal perforations. Accordingly, the essential aspects for repairing this deleterious tissue injury will be addressed, including its diagnosis, prognosis, and a discussion about the materials actually suggested to seal root canal perforation.

Internal Inflammatory Root Resorption. Management with Mineral Trioxide Aggregate and Gutta-Percha

Internal Inflammatory Root Resorption. Management with Mineral Trioxide Aggregate and Gutta-Percha

Prevalence of Internal Inflammatory Root Resorption

Introduction Internal inflammatory root resorption is regarded as rare because it is only occasionally detected in clinical or radiographic examination of teeth. However, inflammation is supposedly an important etiologic factor of internal resorption. Therefore, we tested the hypothesis that there is no difference in the presence of internal resorption between teeth with vital, healthy pulp and teeth with a history of pulp inflammation. Methods Thirty teeth with no previous root canal treatment that were to be sequentially extracted from adult patients were diagnosed for their pulpal status (ie, healthy, pulpitis, or necrosis). After extraction, the teeth were split buccolingually, and both halves were exposed to 6% sodium hypochlorite for 10 minutes under constant shaking to remove all organic debris covering the root canal walls. The specimens were washed in water and prepared for scanning electron microscopy to examine the root canals for the presence of internal resorption. Results The null hypothesis of this study was rejected. None of the 9 teeth with healthy pulps revealed signs of internal resorption. Four of the 8 teeth with pulpitis (50%) and 10 of the 13 teeth with necrotic pulps (77%) had internal resorption ( P < .01). The average number of resorptive lesions in the affected necrotic teeth was 2.4, whereas in teeth with pulpitis and internal resorption, the average number of lesions was 1.25. The amount of resorption was always <100-μm deep; the length of the lesions varied from 200 μm to >1 mm. Most lesions (15) were detected in the middle third of the root, followed by the apical third (13). Only 1 internal resorptive lesion was detected in the coronal third of the root canal. Conclusions Internal resorption was a frequent finding in teeth with pulp inflammation or necrosis.

Green discoloration of the crown after internal root resorption treatment with grey mineral trioxide aggregate (MTA)

Root resorption (RR) is the loss of dental hard tissues as a result of clastic activities. Internal inflammatory root resorption (IRR) is a type of RR characterized by progressive loss of tooth substance starting from the root canal wall. IRR is usually asymptomatic, slowly progressing, and detectable upon routine radiographic examination or by the clinical sign of a ‘pink spot’ when the IRR involves the crown or the coronal third of the root canal. Mineral trioxide aggregate (MTA) is a biocompatible cement that has been used successfully in pulp capping, pulpotomy, treatment of traumatized teeth with immature apices, and for treatment of root resorption. The treatment and follow-up of a maxillary central incisor with perforating IRR managed by root canal treatment and grey MTA repair is reported. IRR affected tooth 11 (FDI World Dental Federation) in a 29-year-old female patient, with a history of previous trauma. Follow-up radiographs over 24 months demonstrated the maintenance of a functional tooth. However, the tooth showed a green discoloration of the crown after MTA treatment.

Internal inflammatory root resorption: the unknown resorption of the tooth

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.