Internal Resorption Research Articles

Effectiveness of the self-adjusting file versus ProTaper systems to remove the smear layer in artificially induced internal root resorption cavities

Aim: Smear layer removal from artificially prepared internal root resorption (IRR) cavities using the self-adjusting file (SAF) system with activated continuous irrigation or the ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) with conventional syringe/needle irrigation was compared. Materials and methods: Twenty-eight maxillary central incisors were selected, decoronated and 20 of them were randomizedly splited along the coronal plane into labial and lingual sections, and artificial IRR cavities were prepared in both walls. Tooth segments were rejoined and teeth were divided into two groups. Each group (n = 10) was prepared using the SAF or ProTaper system with 12-mL 5.25% NaOCl and 12-mL 17% EDTA. Root canals were prepared in six intact positive control teeth using the SAF or ProTaper system with 5.25% NaOCl and 17% EDTA. As negative controls, two intact teeth were prepared using NaOCl only. Roots were than split longitudinally from the rejoined segments and samples were evaluated under scanning electron microscopy using a five-point scoring system. Results: Most SAF (87%) and ProTaper (83%) samples (P > 0.05), had scores of 1 and 2 indicating clean canal walls for the IRR cavities. Conclusions: SAF with activated continuous irrigation and ProTaper with conventional syringe/needle irrigation both successfully removed the smear layer from artificially prepared IRR cavities

Frequency and Distribution of Dental Anomalies in Iran: A Radiographic Survey

ABSTRACT Aim Many epidemiological studies have been performed around the world in order to determine the frequency of different types of dental anomalies. There are regional and ethnic variations in the prevalence of dental anomalies. To determine the prevalence of developmental and acquired dental anomalies in Iran, study was done from 2011 to 2012. Materials and methods A total of 1,000 digital panoramic radiographs of patient were evaluated which consisted of 424 (42/4%) male and 576 (57/6%) female. Data were analyzed by Chi-square and Fisher exact tests. Results Wisdom tooth impaction was the most prevalent anomaly (41.4% in females and 36% in males) followed by missing (8.7% male, 7/3% female), microdontia (3.2%), dilacerations (2.2%), macrodontia (1%), supernumerary teeth (0.8%), fusion and taurodontism (0.2%). A case of bilateral second mandibular molar impaction was observed. Germination, transposition and concrescence were not observed. Among the acquired anomalies, hypercementosis (0.6%) and internal resorption (0.4%) were the most prevalent respectively. External resorption was not observed. Conclusion Comparison of these results with those of other studies, showed that the frequency of these disorders were different in countries and communities around the world. Knowledge about these anomalies may facilitate the endodontic, prosthodontics, periodontics and surgical management of such teeth. How to cite this article Tofangchiha M, Azimi S, Neirizi M. Frequency and Distribution of Dental Anomalies in Iran: A Radiographic Survey. Int J Experiment Dent Sci 2013;2(1): 14-17.

MTA as Apical Filling Material In Internal Resorption

Root resorption is a dental complication caused by dental trauma, surgical procedures, excessive pressure or irritation from bleaching agents that can lead to loss of tooth. This paper presents a case of internal resorption in maxillary central incisor and demonstrates the use of MTA as filling material

Tooth resorption part II - external resorption: Case series

External tooth resorption usually follows trauma to the periodontal ligament. It can be classified into five categories based on its clinical and histological manifestations. Calcium hydroxide has long been used as an intracanal medicament to slow down the resorption process due to its alkaline pH. A combination of both external and internal resorptions can also occur on the same tooth, making the management more complex. Five case reports of external resorption have been presented in this article along with pertinent review of literature. Successful management was possible in two cases, while extractions had to be advised in 3 cases due to advanced nature of the lesions.

Immediate Placement Implant in Fresh Extraction Socket: A Clinical Study of Seven Cases

Aims and objectives: To reduce the prolonged waiting period post tooth extraction for rehabilitation with implants. This study was carried out to determine the outcome of implants placed into fresh extraction sockets with the simultaneous use of particulate bone graft. Patient response to rehabilitation with immediate placement single tooth implants was monitored clinically and radiographically. Materials and methods: Among seven patients, with the average age of 28 years were treated for single tooth replacement in fresh extraction sockets in the esthetic zone by means of 2 stage immediate placement of implant. Bioactive glass particulate bone graft was used as bone graft material. Reason for teeth loss was caries, trauma and internal resorption. All patients were followed clinically and radiographically for 1 year after loading of implant. Results: Follow-up was done after stage I surgery (placement of implant) for pain, soft tissue dehiscence, inflammation, altered sensation at site of implant placement monthly for 4 to 6 months. After giving final prosthesis, patients were evaluated for bleeding index (Muhlemann and Son), plaque index (TureskyGilmoreGlickman) gingival index (Loe and Silness), marginal bone loss (parallel cone technique using IOPA) with follow-up at 6th and 12th months. All the implants were osseointegrated at the time of abutment placement. Radiographic examination showed only slight marginal bone around the implants. Conclusion: Hence, implants can be placed successfully in fresh extraction socket using bioactive glass (perioglass) particulate bone graft material to fill gap between implant and bone through a submerged (2 stage) surgical technique.

Regenerative periapical surgery: A case report

Introduction: Periapical surgery is an important treatment alternative in the presence of a large periapical cyst. To achieve optimal healing and regeneration of the bone different bone substitutes can be used. Case Report: A 35 year old male patient reported with the soft diffuse swelling in anterior palatal region and drainings in us with 21 labially. He had a history of trauma 5 years back. The clinical and radiographic diagnosis of infected periapical cyst with 11,21; invasive cervical root resorption with 21 and internal root resorption with 11 was made. Endodontic treatment was performed with11,2 followed by periapical curettage. A picectomy and retrograde filling with white mineral trioxide aggregate (MTA) was carried out with 11,21. The cervical resorption defect with 21 was restored with white MTA. Platelet rich fibrin (PRF) was mixed with demineralised bone matrix (Osseograft) and used as a regenerative biomaterial in the periapiacl defect. 14 months follow up shows satisfactory healing and regeneration of periapical region. Discussion: There is considerable clinical interest in using PRF alone or in combination with graft materials as it is a reservoir of many growth factors and have potential for accelerated soft-and hard tissue healing. PRF is a new generation of platelet concentrate, derived from patients own blood.

Bone-Forming Capabilities of a Newly Developed NanoHA Composite Alloplast Infused with Collagen: A Pilot Study in the Sheep Mandible

Lateral or vertical bone augmentation has always been a challenge, since the site is exposed to constant pressure from the soft tissue, and blood supply only exists from the donor site. Although, for such clinical cases, onlay grafting with autogenous bone is commonly selected, the invasiveness of the secondary surgical site and the relatively fast resorption rate have been reported as a drawback, which motivated the investigation of alternative approaches. This study evaluated the bone-forming capability of a novel nanoHA alloplast infused with collagen graft material made from biodegradable polylactic acid/polyglycolic acid versus a control graft material with the same synthesized alloplast without the nanoHA component and collagen infiltration. The status of newly formed bone and the resorption of the graft material were evaluated at 6 weeks in vivo histologically and three dimensionally by means of 3D microcomputed tomography. The histologic observation showed that newly formed bone ingrowth and internal resorption of the block were observed for the experimental blocks, whereas for the control blocks less bone ingrowth occurred along with lower resorption rate of the block material. The three-dimensional observation indicated that the experimental block maintained the external geometry, but at the same time successfully altered the graft material into bone. It is suggested that the combination of numerous factors contributed to the bone ingrowth and the novel development could be an alternative bone grafting choice.

Endodontic management of a mandibular second premolar with perforating internal resorption by using MTA and cone beam computed tomography as a diagnostic aid

This case report demonstrates the benefits of utilizing Cone Beam Computed tomography (CBCT) in the assessment and mineral trioxide aggregate (MTA) in the management of perforating internal resorption in a 54-year-old woman. The advent of CBCT has enhanced the clinician's ability to make a confirmatory diagnosis and determining the treatment plan before undertaking the actual treatment. Thorough cleaning and shaping of the root canal space and the resorptive defect was achieved by mechanical instrumentation, irrigation, and interim calcium hydroxide dressing. Following this obturation of the canal below, the resorptive defect was done with gutta percha using lateral and warm vertical condensation. The resorptive defect was filled with mineral trioxide aggregate. Follow-up intraoral periapical radiographs and CBCT scans at 6 months showed adequate repair of the resorption and periapical rarefaction and the tooth remained asymptomatic.

Using MTA in the treatment of internal and external root resorption of permanent teeth – report on own observation

Using MTA in the treatment of internal and external root resorption of permanent teeth – report on own observation

Comparative Evaluation of Formocresol and Mineral Trioxide Aggregate in Pulpotomized Primary Molars - 2 Year Follow Up

The aim of the present study was to clinically and radiographically evaluate Mineral Trioxide Aggregate (MTA) as an agent for pulpotomy in primary teeth and to compare it with that of Formocresol (FC) pulpotomy. Seventy first and second primary mandibular molars of children were chosen on patients who required minimum two pulpotomies in either arch or same arch. After the standardized technique of Pulpotomy with MTA and Formocresol, all molars were treated with a thick mix of Zinc oxide Eugenol cement into the coronal pulp chamber followed by preformed stainless steel crown. The children were followed up for clinical and radio graphical examination after 6, 12 and 24 month for Pain, Swelling, Sinus/fistula, Periapical changes, Furcation radiolucency and internal resorption. MTA represents 97% clinical success rate in comparison to Formocresol with 85% success. Radiographically also MTA showed more promising results with 88.6% success in comparison to Formocresol with 54.3%. Thus, MTA pulpotomy has emerged as an easier line of treatment to save the premature loss of primary teeth due to caries or trauma.

Diagnosis of invasive cervical resorption by using cone beam computed tomography: report of two cases

A radiographic interpretation is essential to the diagnosis of invasive cervical resorption (ICR) and the difficulty in distinguishing this lesion from internal root resorption has been highlighted in the literature. This paper reports the use of cone beam computed tomography (CBCT) in the diagnosis of ICR. The cases reports describe how CBCT can be used to make a differential diagnosis and also show that the use of this technology can provide relevant information on the location and nature of root resorption, which conventional radiographs cannot. As a result, the root canal treatment was not initially considered. The patients will be monitored and will undergo a scan after a short period of time to detect any small changes. It was observed that both cases benefited from CBCT in the diagnosis of ICR, because this imaging modality determined the real extent of resorption and possible points of communication with the periodontal space.

The receptor activator of NF‐κB ligand‐osteoprotegerin system in pulpal and periapical disease

To summarize the collective in vitro, in vivo and clinical evidence of the involvement of the receptor activator of NF-κB ligand (RANKL)-osteoprotegerin (OPG) system, a system of two molecules controlling osteoclast differentiation and hard-tissue resorption, in pulpal and periapical pathophysiology. A systematic search related to RANKL and/or OPG and pulp or periapical disease was conducted on Medline, Biosis, Cochrane, Embase and Web of Science databases using keywords and controlled vocabulary. No language restriction was applied. Two independent reviewers first screened titles and abstracts and then the full texts that were initially included. The reference lists of the identified publications were examined for additional titles. A total of 33 papers were identified. In vitro studies (N = 11) revealed that pulpal cells can be stimulated by various inflammatory agents to produce RANKL, whilst many studies did not consider the RANKL/OPG ratio. Animal studies (N = 9) mostly focused on the time course and development of periapical lesions in relation to the RANKL-OPG system. Levels of RANKL and OPG in the necrotizing pulp were not investigated. Human studies (N = 13) showed a steady-state expression of OPG in the odontoblast layer. Conflicting results have been reported regarding the role of RANKL in active apical periodontitis, again because the correlation of this molecule with its inhibitor (OPG) was often disregarded. There is relatively little information currently available that would highlight the specific role of RANKL and OPG in pulpal and periapical disease. OPG may play a protective role against internal resorption, whilst an increased periapical RANKL/OPG ratio might indicate bone resorption.

Effects of folk medicinal plant extract Ankaferd Blood stopper® in vital primary molar pulpotomy

To compare the clinical and radiographic success rates of two vital pulpotomy agents: formocresol (FC) and Ankaferd Blood Stopper(®) (ABS), in primary molars during a 12-month follow-up period. A randomised, single-blind study design was used in a sample of 30 healthy 6-9 year old children with 60 carious primary molars without clinical or radiographic evidence of pulp degeneration. The pulpotomy agents were assigned as follows: Group 1 was 1:5 diluted Buckley's formocresol (FC) and Group 2 was ABS. Clinical and radiographic follow-up at 3, 6, and 12 months used the following criteria: pain, swelling, sinus tract, mobility, internal root resorption, and furcation and/or periapical bone destruction. The data were analysed using Chi-square tests. The clinical and radiographic evaluation at 3 months revealed total success rates of 100% in the FC and ABS groups. Success rates in FC and ABS groups at 6 months were 96.7% and 93.3% respectively. At the 12-month follow-ups, the total success rates in the FC, and ABS groups were 89.3% and 85.7%, respectively. When the groups were compared according to the time intervals, no significant differences were observed between the 3, 6, and 12 month values. The success rates of the materials decreased over time. FC and ABS were found successful as pulp dressings in primary molars. ABS appears to be an alternative pulpotomy agent but periodical follow-ups must be considered to evaluate long term success rates.

Management of Tooth Resorption by Using Calcium Hydroxide: A Case Report

In this case report, the treatment of internal root resorption in a 24 years-old male was done by using nonsurgical root canal therapy and the clinical outcome was evaluated. Both the maxillary central incisors were examined clinico-radiographically. On clinical examination, the maxillary incisors were found discolored. Radiographic examination revealed a punched-out radiolucent lesion on the cervical area of pulpal canal of both of the teeth and periradicular radiolucency was also evident. Conservative non-surgical root canal treatment was performed with long term calcium-hydroxide therapy. Following eight months of the treatment, the resorption process was stopped and a calcific bridge was formed at the apex of the roots indicated the evidence of recalcification. Conventional root canal obturation method was implied followed by clinical and radiological evaluation for next two years.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11029 BSMMU J 2012; 5(1):72-75

Application of cone beam volumetric tomography in endodontics

In a 2008 article on cone beam volumetric tomography (CBVT) and dentoalveolar applications, Tyndall and Rathore wrote: 'It is in the area of endodontic applications that the literature has proved most fruitful to date.' This statement is even truer today than in 2008. A review of the literature has demonstrated that, in many cases, CBVT is more efficacious than traditional forms of 2-D imaging. Endodontic applications of CBVT include the diagnosis of periapical lesions due to pulpal inflammation, identification and localization of internal and external resorption, the detection of vertical root fractures, the visualization of accessory canals, and elucidation of the causes of non-healing endodontically treated teeth. Prior to 2008, most published articles on CBVT applications in endodontics were either case reports or in vitro studies. Since that time more well designed clinically related scholarly activity has been published. This article attempts to survey the field of CBVT applications in endodontics and provide the readers with an overview of what has been found. The authors hope that this knowledge will form a foundation for appropriate clinical decision making with specific reference to selection criteria for the endodontic applications of CBVT.

Management of an Anterior Tooth with External and Internal Resorption

ABSTRACT Tooth resorption is a condition associated with either a physiologic or a pathologic process resulting in a loss of dentin, cementum, and/or bone. Inflammatory process is initiated when the predentin or precemental layer of the tooth is damaged. Resorption can either be external or internal in form. In order to control the tooth resorption, it is necessary to treat the root canal by removing all the pulp tissue. Due to varied root canal morphology, root canal treatment poses a challenge for the clinician. In such cases a combination of conventional lateral compaction and thermoplasticized gutta percha can enable the three-dimensional obturation of the canal space. This case report describes a nonsurgical mode of management of a tooth having internal and external (surface) resorption. How to cite this article Anilkumar A, Nair KR, Nazar F, Rajendran R. Management of an Anterior Tooth with External and Internal Resorption. Cons Dent Endod J 2017;2(1):32-35.

Surgical intervention for treating an extensive internal resorption with unfavorable crown-to-root ratio

Internal resorption is a rare lesion in permanent teeth. Managing perforating internal resorption is a great challenge for dentists. This report presents a successful surgical treatment of a maxillary central incisor that had extensive root perforation due to internal resorption. After unsuccessful nonsurgical approach, during surgical intervention apical part of the resorption defect was removed and the coronal part was filled with mineral trioxide aggregate. Three years later the tooth was symptom free with normal mobility and pocket depth despite unfavorable crown-to-root ratio. This case report have shown that surgical intervention and using mineral trioxide aggregate as root canal filling material in a tooth with extensive internal resorption and unfavorable crown-to-root ratio can be considered as a treatment option.

Calcium hydroxide-induced resorption of deciduous teeth: A possible explanation

Introduction: Calcium hydroxide (CaH) is customarily used for permanent teeth but not for deciduous dentition because it is known to cause internal resorption in the latter. Though this has been attributed to chronic inflammation and odontoclasts, the exact mechanism has not been elucidated. The Hypothesis: The authors propose an explanation that CaH-induced odontoclastogenesis could be multifactorial. Odontoclasts may result from fusion of cells of monocyte/macrophage series either due to inflammatory mediators or through stimulation by stromal odontoblasts /fibroblasts. Pre-existing progenitor cells of primary tooth pulp because of their inherent propensity may transform into odontoclasts. Evaluation of the Hypothesis: The hypothesis discusses the role of various inflammatory cytokines that may be responsible for CaH-induced transformation of pre-odontoclasts to odontoclasts. Alternatively, pre-existing progenitor cells with proclivity to change into odontoclasts may cause internal resorption. The loss of protective layer of predentin over mineralized dentin may also make the primary tooth more susceptible to resorption.

Treatment of perforating internal root resorption with MTA: a case report

Endodontic treatment of teeth with perforating internal root resorption represents a clinical challenge. In most cases, extraction of the tooth and subsequent replacement with an osseointegrated implant is indicated. Presented herein is a case report of a maxillary lateral incisor with advanced perforating internal root resorption in the middle third of the root and the presence of a sinus tract. Mineral Trioxide Aggregate (MTA) was used with the aid of a surgical microscope in order to fill the resorption area after conventional root canal therapy of the apical segment. At the follow-up after 11 years and 8 months, the patient was clinically asymptomatic and the sinus tract had disappeared. The radiographic examination and computerized tomography indicated periodontal bone repair.

Idiopathic internal resorption: Report of a case with unusual features

Tooth resorption can occur from the internal surface of a tooth or from the external surface of a tooth. Internal resorption is commonly termed to be idiopathic because of unknown cause. The aim is to report a case of idiopathic internal resorption showing unusual features. A 25-year-old female patient complains of mobility of tooth in right lower back tooth region since 2 months. Clinically, there was slight mobility in 48. Radiographically a resorptive area was seen in crown region of 48. The crown part was removed with gentle pressure using probe. A hollow crown with resorbed dentin and intact thin enamel was seen in gross specimen. A final diagnosis of idiopathic internal resorption was given. Early detection is essential for successful management of idiopathic internal resorption. This prevents further weakening of remaining tooth structure leading to crown or root perforations.