Internal Resorption Research Articles

Portland Cement Use in Dental Root Perforations: A Long Term Followup

Root canal and furcal perforations are causes of endodontic therapy failure and different materials that stimulate tissue mineralization have been proposed for perforation treatment. In the first case, a patient presented tooth 46 with unsatisfactory endodontic treatment and a periapical radiographic lesion. A radiolucent area compatible with a perforating internal resorption cavity was found in the mesial root. The granulation tissue was removed, and root canals were prepared. The intracanal medication was composed of calcium hydroxide and the perforation cavity was filled with Portland cement. The 11-year followup showed radiographic repair of the tissue adjacent to the perforation and absence of clinical signs and symptoms or periapical lesion. In the second case, a patient presented with edema on the buccal surface of tooth 46. The examination showed a radiolucent area in the furcation region compatible with an iatrogenic perforation cavity. The mesial root canals were calcified, and only the distal root canal was prepared. The cavity was filled with a calcium hydroxide-based paste and the distal root canal was obturated. In sequence, the perforation cavity was filled with Portland cement. The 9-year followup showed the tooth in masticatory function with radiographic and clinical aspects compatible with normality.

Quality of different gutta-percha techniques when filling experimental internal resorptive cavities: A micro-computed tomography study

The purpose of this ex vivo study was to determine the quality of root fillings in experimental internal resorptive cavities filled using cold lateral condensation (CLC), vertical condensation and Thermafil techniques. Forty-five extracted maxillary canine teeth were selected. After root canal instrumentation, the roots were sectioned horizontally and experimental internal resorption cavities were prepared. The root sections were re-approximated with a luting agent and randomly assigned to three groups (n = 15) to be filled using CLC, vertical condensation and Thermafil, respectively. Assessment of obturation quality in the internal resorptive cavity was performed using a desktop X-ray micro focus computed tomography scanner, and the percentage of gutta-percha (GP), sealer and voiding was calculated for each specimen. Data were statistically analysed using non-parametric tests, with P < 0.05 denoting a statistically significant difference. Vertical condensation filled 96.25 ± 8.31% of the total artificial cavity, and was superior to CLC (63.20 ± 16.87%) and Thermafil (59.26 ± 18.47%). The mean percentage of voids was 3.75 ± 8.31% in the vertical condensation group, 37.09 ± 17.13% in the CLC group and 41.06 ± 18.60% in the Thermafil group. We conclude that obturation of experimental resorption cavities is significantly better when using vertical condensation than when using other GP-based techniques.

Development of a New In Vitro Methodology to Simulate Internal Root Resorption

IntroductionStudies to evaluate the diagnostic power of imaging examinations to detect root resorption have been based on simulations produced by burs. Standardized, round, and well-outlined access cavities do not reproduce the characteristics of physiological lesions and may facilitate diagnosis, masking the true accuracy of imaging techniques. A methodology to simulate internal root resorption by using acid demineralization was developed. MethodsEleven extracted single-rooted teeth were mesiodistally sectioned into homologous halves. Root canals were labeled to ensure restricted and controlled action of fluids. The protocol was composed of 24-hour cycles (5% nitric acid for 12 hours, rinsing with deionized water, and 8% sodium hypochlorite for 10 minutes). At the end of each cycle 1 tooth was removed from treatment, defining an exposure time that cumulated to the last tooth. Electron microscopy imaging was assessed to determine lesion area and depth. ResultsMinimum and maximum and areas and depths were 3.14 mm² and 10.34 mm² and 0.22 mm and 1.59 mm, respectively. Resorption simulated by the protocol proposed reproduced lesions of different sizes. ConclusionsThe irregular shape and larger diameter:depth ratio suggest that these lesions are more similar to in vivo internal root resorption, compared with bur-induced lesions.

Mineral Trioksid Aggregate'ın Kompozisyonu ve Biyolojik Etkileri: Derleme

Aim: Mineral Trioxide Aggregate (MTA) is widely used in clinical application such as pulp capping, perforation repair, root-end sealing, canal filling at internal and external root resorption and pulpotomies in primary and permanent teeth. In endodontic field when using a material such as MTA the interaction between material and periapical tissue is so important for healing and life time of endodontic therapy. Although it is sealing ability, the interaction with cells or tissues and their replay to this material play major role for endodontic success. Methods: Literature review was performed using electronic and hand-searching methods for the clinical applications, experimental studies and cellular studies of MTA between 2000 and 2010. Results: MTA is a bioactive material when using vital pulpotomies, apical barrier formation for necrotic pulps and open apices. Numerous study and case reports show MTA is more effective material than other materials in these cases. Many studies have shown the effects of MTA on cementoblasts and odontoblasts. Conclusion: This review shows its composition, biologic action when used different endodontic procedure and interaction between cell and tissues

Repair of a perforating internal resorption: two case reports

Internal resorption is a rare condition in permanent teeth, and may result from trauma, caries, or restorative procedures. Internal resorption is usually asymptomatic and is first identified as a round-shaped enlargement of a root-canal space on routine radiographs. Large resorption defects may result in penetration of the tooth into the periodontium through the cementum. The gold-standard treatment consists of debridement and obturation of the pulp space, sealing of the external communication, and restoration of the normal function of the tooth through a nonsurgical or surgical method. In this case presentation, we report on two methods for repair of internal resorption with perforation. The first method consisted of treating the lower right second premolar by conventional endodontic therapy under a microscope, followed by repair with mineral trioxide aggregate. The second method consisted of surgical treatment of the upper right central incisor. The choice of treatment depends on the size of the perforation, its location, and the ability to approach it for repair.

Clinical, radiographic and histologic analysis of the effects of pulp capping materials used in pulpotomies of human primary teeth

To compare the clinical, radiographic and histological responses of the pulp to mineral trioxide aggregate (MTA), calcium hydroxide (CH) and Portland cement (PC) when used as a pulpotomy agent in human primary teeth. Forty-five mandibular primary molar teeth were randomly assigned to CH, MTA or PC groups and treated by pulpotomy technique. The teeth were treated by conventional pulpotomy technique, differing only in the capping material for each group. Clinical and radiographic evaluations were recorded at 6-, 12- and 24-month follow-up. Teeth in the regular exfoliation period were further processed for histologic analysis. Data were tested using parametric tests at a significance level of 5%. The histological results were expressed descriptively. Clinically and radiographically, the MTA and PC groups showed 100% success rates at 6, 12 and 24months. In CH group, several teeth presented clinical and radiographic failures detected throughout the follow-up period, and internal resorption was a frequent radiographic finding. Histologic analysis revealed the presence of dentine-like mineralised material deposition obliterating the root canal in the PC and MTA groups. CH group presented, in most of the sections, necrotic areas in the root canals. MTA and PC may serve as effective materials for pulpotomies of primary teeth as compared to CH. Although our results are very encouraging, further studies and longer follow-up assessments are needed in order to determine the safe clinical indication of Portland cement.

Clareamento de dentes tratados endodonticamente: uma revisão da literatura

Na Odontologia contemporânea, a estética sofreu uma valorização significativa, ganhando destaque e importância. Nesse contexto, a beleza é influenciada pelo contorno, forma, simetria, alinhamento e, principalmente, pela cor dos dentes. O clareamento de dentes anteriores desvitalizados escurecidos tem se tornado uma terapia muito requisitada, uma vez que o escurecimento dos dentes é motivo de grande insatisfação por parte dos pacientes. Esta revisão de literatura tem como objetivo analisar os dados disponíveis na literatura sobre este assunto, uma vez que a associação entre o clareamento interno e a reabsorção radicular externa cervical é uma questão que ainda gera dúvidas na prática odontológica. O clareamento interno apresenta resultados esteticamente satisfatórios, no entanto, apresenta como possível efeito colateral a reabsorção radicular cervical externa, que prejudica ou até mesmo inviabiliza a permanência do elemento dental na cavidade bucal. A etiologia da reabsorção radicular externa relacionada ao clareamento é complexa, no entanto acredita-se que o agente clareador alcance os tecidos periodontais através dos túbulos dentinários, desnature a dentina, que passa a ser considerada um tecido imunologicamente diferente, sendo reconhecida como um corpo estranho e inicia uma reação inflamatória que resulta na perda localizada de tecido dental. Outra limitação do clareamento de dentes tratados endodonticamente é a recidiva da cor, ainda pouco compreendida. Apesar do clareamento de dentes desvitalizados ter um alto índice de sucesso e de sua natureza minimamente invasiva, os possíveis efeitos colaterais, tais como a reabsorção cervical externa e a recidiva de cor devem ser levados em consideração no momento de sua indicação.

Internal and external root resorption: aetiology, diagnosis and treatment options

Root resorption is a pathological process that may occur after surgical, mechanical, chemical or thermal insult. Generally, it can be classified as internal and external root resorption. Depending on the diagnosis, an orthograde, surgical or a combined approach is used in management of these cases. General dental practitioners can face difficulties in diagnosis and treatment planning for cases with root resorption. An understanding of the aetiology and pathogenesis of root resorption is critical for diagnosis, effective management and improves outcome.

Management of Perforating Internal Root Resorption with Periodontal Surgery and Mineral Trioxide Aggregate: A Case Report with 5-Year Follow-Up

Internal root resorption (IRR) is characterized by progressive loss of tooth substance initiating at the root canal wall as a result of clastic activity. The use of periodontal surgery and mineral trioxide aggregate is a good approach to repair lesions with periodontal communication (perforating IRR). This case describes the treatment and follow-up of a maxillary central incisor with perforating IRR in a 56-year-old male patient where root canal treatment, periodontal surgery, and white mineral trioxide aggregate were employed to achieve complete repair and to restore function. Clinical findings and periapical radiographs indicated success after a 5-year follow-up.

2883 Ma commencement of BIF deposition at the northern edge of Congo craton, southern Cameroon: New zircon SHRIMP data constraint from metavolcanics

New SHRIMP data for zircons separated from a metadacite interbedded with banded iron formation (BIF) in the Mbalam region of southern Cameroon provide a 2883±20Ma age for the commencement of BIF deposition in the Congo craton. Separated zircons from the associated metadacite are brown and euhedral to subheral in form with distinct oscillatory zoning typical of magmatic signatures. These zircons lack internal resorption features and serrated zone boundaries as should be expected of zircons inherited from the surrounding basement rocks or multiple magmatic plumbing events. However, zircons from a surface BIF sample collected ∼ 60km west of the sequence from which the metavolcanics were sampled show a different age spectrum (Palaeoproterozoic, 1.0-2.0 Ga) suggesting a latter stage of BIF formation in the region which is not the focus of this work. Geochemical features of the metavolcanic samples analyzed identify the rocks to be rhyolitic, dacitic to andesitic in composition and possibly formed from a single magma by simple fractional crystallization. Trace element plots show negative Nb, Ta, Ti and Ho peaks that are characteristic of arc magmas. The study shows that initial BIF deposition in the Congo Craton was associated with early arc magmatism in the Archean. These ages correlate reasonably with early BIF deposition across the Atlantic in Brazil which was once linked to the Congo craton prior to the breakup of Gondwana.

Prosthetic Rehabilitation and Management of an MTA‐Treated Maxillary Central Incisor with Root Perforation and Severe Internal Resorption

Root canal perforation and root resorption are challenging clinical conditions to correctly diagnose and treat, especially when they occur in anterior teeth. This clinical report describes the computed tomography findings, endodontic treatment, prosthetic rehabilitation, and clinical outcome of an iatrogenic root perforation and internal resorption in a maxillary central incisor. The case management consisted of endodontic retreatment, periodontal surgery, and prosthetic rehabilitation. Gray mineral trioxide aggregate (MTA) was used to fill the resorption space and seal the perforation. The prosthetic treatment was performed with glass fiber-reinforced dowels and all-ceramic crowns. No signs or symptoms, including discomfort, pain, or esthetic defects were observed in 30 months of follow-up.

Leaf Nutrient Resorption of Seagrass &lt;i&gt;Zostera japonica&lt;/i&gt; Aschers. et Graebn. in Beihai, Guangxi, China

Resorption of nutrients (C, N, P, Ca, Mg, Fe and Mn) from senescent leaves of Zostera japonica and the concentration of nutrients (C, N, P, Ca, Mg, Fe and Mn) in the sediment from three subtropical seagrass meadows (Guchenling, Zhulin and Ronggenshan) in Beihai, Guangxi, China were studied. Resorption efficiencies were quantitatively assessed by comparing nutrient content between the leaf with the highest content and the senescent leaves. In addition, the relationship between nutrient resorption efficiencies and nutrient sources (the sediment and the adult leaf) were evaluated. During the course of leaf development in Z. japonica (young leaf – adult leaf – senescent leaf), C content first rose and then declined; N and P contents gradually declined; but Ca, Mg, Fe and Mn gradually rose. During leaf senescence, resorption efficiencies of C, N, P, Ca, Mg, Fe and Mn were 2.1%, 19.5%, 45.1%, −61.1%, −12.0%, −27.1% and −72.3%, respectively. For Z. japonica, C, N and P contributed to new leaf growth, whereas Ca, Mg, Fe and Mn was not. The nutrient contents of the sediment and adult leaf were not significantly correlated to leaf nutrient resorption efficiencies. It was calculated that for Z. japonica approximately 13.8% of total N demand and 31% of total P demand could be met by internal resorption.

Indirect pulp treatment vs antibiotic sterilization of deep caries in mandibular primary molars

Calcium hydroxide indirect pulp treatment (CH-IPT) and antibiotic sterilization using a mixture of three antibiotics (3Mix-MP) of deep caries are similar non-invasive vital pulp treatments. No studies have compared their clinical and radiographic success rates in primary molars. To compare the clinical and radiographic success rates of CH-IPT and 3Mix-MP in carious lesions approaching the pulp of mandibular primary molars. Eighty-two mandibular primary molars from 50 children, aged 3-8years, with carious lesions approaching the pulp, and meeting the inclusion criteria, were randomly assigned for either treatment. After treatment, blinded clinical/radiographic evaluation was performed at 6-11 and 12-29month recalls. At 6-11months, the overall success rates of CH-IPT and 3Mix-MP were 82% and 81% (P=0.91), respectively. At 12-29months, the success rates were 94% and 78% (P=0.08), respectively. The most frequently observed failure at the 12-29month recall was internal resorption (one CH-IPT tooth and three 3Mix-MP teeth). There was no statistically significant difference in overall success rates between CH-IPT and 3Mix-MP in treating deep caries approaching the pulp in mandibular primary molars at either 6-11month or 12-29month follow-up.

Predictive factors for pulp necrosis in traumatized primary incisors: a longitudinal study

This study aimed to assess factors associated with occurrence of pulp necrosis (PN) in traumatized primary incisors, which may contribute to the prognosis of this outcome. Data were collected by single examiner through the analysis of clinical files of traumatized patients. The occurrence of PN in traumatized teeth was the evaluated outcome. Poisson regression analysis was applied to calculate the relative risk (RR) and the respective 95% confidence interval. Five hundred and twenty-one files were assessed, summing up 727 traumatized primary incisors. The proportion of teeth affected by PN was 23.8%. Multiple regression analysis indicated the following factors as positively associated with PN: trauma with displacement, pulp exposure fracture, self-report of pain, yellow, grey and brown crown discoloration, internal root resorption, and bone loss. Trauma in 4- to 5-year old and more than 5-year-old children, pulp canal obliteration, and external root resorption with bone formation were negatively associated with PN. Teeth that suffered more aggressive injuries, pain, some types of discoloration, and other radiographic findings (for instance, internal root resorption) are positively associated with the occurrence of PN. On the other hand, trauma in older children, canal obliteration, or external resorption show less probability of PN.

Tooth resorption part I - pathogenesis and case series of internal resorption

Resorption is a pathologic process that often eludes the clinician with its varied etiologic factors and diverse clinical presentations. The key cells involved in tooth resorption are odontoclasts which are multinucleated cells that produce resorption lacunae. Resorption can be classified as internal and external resorption. Internal resorption has been described as a rare occurrence as compared to external resorption. This article describes the pathogenesis of tooth resorption and various forms of internal resorption along with some clinical cases. Early diagnosis is the key factor in the successful management of resorptive lesions.

Treatment of Internal Resorption with Mineral Trioxide Aggregates: A Case Report

Tooth resorption is a common sequel which follows injuries or irritation to the periodontal ligament and/or tooth pulp. The course of tooth resorption involves an elaborate interaction among inflammatory cells, resorbing cells, and hard tissue structures. The key cells which are involved in resorption are multi-nucleated giant cells. Internal root resorptions are usually non-symptomatic and they are discovered occasionally through periapical radiographs, which reveal very defined and regular outlines. Many techniques and materials have been used to fill internal resorptive defects. Among them, Mineral Trioxide Aggregates (MTAs) have satisfactory properties, which include: biocompatibility, a favourable sealing ability, mechanical strength and a capacity to promote a periradicular tissue healing. Thus, a Mineral Trioxide Aggregate (MTA) repair of a maxillary left central incisor tooth with an inflammatory resorptive defect, in the middle third of the root canal, has been reported here.

Management of Internal Root Resorption on Permanent Teeth

Internal root resorption (IRR) is a particular category of pulp disease characterized by the loss of dentine as a result of the action of clastic cells stimulated by pulpal inflammation. This review article explains the etiology, the prevalence of IRR, and, in addition to the clinical data, the contribution of the three-dimensional imaging (CBCT) to the diagnosis, the clinical decision, and the therapeutic management of IRR. The authors discussed the various therapeutic options including the orthograde or retrograde fillings of the root canal resorption area. Root canal treatment remains the treatment of choice of internal root resorption as it removes the granulation tissue and blood supply of the clastic cells. The authors describe with different clinical cases the modern endodontic techniques including optical aids, ultrasonic improvement of chemical debridement, and the use of alternative materials such as calcium silicate combined with thermoplastic filling (warm gutta-percha). In these conditions, the prognosis of the conservative treatment of internal resorptions, even if root walls are perforated, is good.

Multiple internal resorption in permanent teeth associated with hyperparathyroidism

Internal resorption has been described as a resorptive defect of internal aspect of tooth. It is caused by transformation of normal pulp tissue into granulomatous tissue with giant cells which resorb dentin. Though mostly idiopathic in origin, trauma, caries and restorative procedures have also been suggested to be contributing factors of internal resorption of pulp. Most of the internal resorption cases were found on isolated individual tooth. There are few case reports on multiple root resorptions. External root resorption have been frequently associated with systemic disorders like renal diseases hyperparathyroidism, rickets etc. A rare association of multiple internal resorption of permanent teeth (including lateral incisors, canines, premolars, sparing 2 nd and 3 rd. Permanent molars and missing 35,36, 42) with elevated levels of PTH and uric acid was evident in a 28 year old female patient who presented with fracture of crowns of permanent teeth. Though many cases related to dental manifestations of chronic renal disease and internal resorption of permanent teeth have been documented in literature, there is no evidence on association of hyperparathyroidism with multiple internal resorptions of teeth.

Resorptions revisited - internal resorption : Two case reports

An endodontist has to encounter a multitude of pulpo-pathologic conditions. One such challenging condition is resorption. Internal as well as external resorption signifies a very complex pathological interaction of the cells of pulp, periradicular and periodontal tissues. These conditions demand a comprehensive understanding of the pathologic process, so as to identify the cause and arrest the resorptive phenomena. This paper describes two case reports of internal resorption that were managed successfully. It also carries out an elaborate evidence based review on the relevant literature which must be taken into account while treating any case of resorption.

Endodontically related lesions on panoramic radiographs in a Turkish subpopulation

Objective: The purpose of this study was to evaluate the prevalence of detectable endodontically related lesions as determined from the reports of panoramic radiographs in a Turkish subpopulation. Materials and Methods: There were 19,625 reports of panoramic radiographs that were evaluated. Four investigators assessed the radiographs and reports that had been written. For each tooth of the subjects, the following items were surveyed: presence of periapical lesion, inadequate root canal treatment, external and internal root resorption. Results: The patients who had panoramic radiography reports were between the ages of 3 and 91 years (mean age 29,43 ± 18,83 years). 10,941 (56%) were female and 8684 (44%) were male patients. Inadequate root canal treatment was recorded in 588 (3%) radiography reports and it was more frequent in mandibular molar teeth. 2287 (11.7%) of the patients had periapical lesions and it was more frequent in maxillary incisor teeth and mandibular molar teeth. External resorption was observed in 61 (0.3%) patient records, while internal root resorption was reported in 14 (0.1%) reports. 81 inadequate root-filled teeth presented a periapical lesion. A positive strong linear correlation was found between the presence of inadequate root canal treatment and a periapical lesion among the patients (r = 0.098, P = 0.000). Conclusions: The results of this study suggest that external and internal root resorption were not frequent clinical conditions. The high frequency of periapical lesions and inadequate canal treatment in molar teeth indicate the need to improve the technical quality of root fillings, especially in molar teeth.