Internal Resorption Research Articles

Mechanical force regulates root resorption in rats through RANKL and OPG

BackgroundExternal root resorption is one of common complications of orthodontic treatment, while internal root resorption is rarely observed, and the difference between pulp and periodontal tissues during orthodontic treatment is still unknown. The purpose of this study was to evaluate the effects of orthodontic forces on histological and cellular changes of the dental pulp and periodontal tissues.MethodsOrthodontic tooth movement model was established in Forty-eight adult male Wistar rats. The distance of orthodontic tooth movement was quantitatively analyzed. The histological changes of pulp and periodontal tissues were performed by hematoxylin–eosin staining, tartrate-resistant acid phosphate staining was used to analyze the changes of osteoclast number, immunohistochemistry analysis and reverse transcription polymerase chain reaction were used to examine the receptor of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) expression. The width of tertiary dentine was quantitatively analyzed. Tartrate-resistant acid phosphate staining and the erosion area of osteo assay surface plate was used to evaluate osteoclast activity.ResultsThe orthodontic tooth movement distance increased in a force dependent manner, and reached the peak value when orthodontic force is 60 g. Heavy orthodontic force increased the RANKL expression of periodontal ligament srem cells (PDLSCs) which further activated osteoclasts and resulted in external root resorption, while the RANKL expression of dental pulp stem cells (DPSCs) was relatively low to activate osteoclasts and result in internal root resorption, and the dental pulp tend to form tertiary dentine under orthodontic force stimulation.ConclusionsHeavy orthodontic forces activated osteoclasts and triggered external root resorption by upregulating RANKL expression in rat periodontal tissues, while there was no significant change of RANKL expression in dental pulp tissue under heavy orthodontic forces, which prevented osteoclast activation and internal root resorption.

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.

Ferric sulfate pulpotomy in primary teeth with different base materials: a 2-year randomized controlled trial.

To evaluate the effects of zinc oxide-eugenol, calcium hydroxide, and mineral trioxide aggregate as base materials on the clinical and radiographic success of ferric sulfate pulpotomies in primary molars. Following hemostasis with 15.5% ferric sulfate, 105 teeth were randomly allocated to three groups: Group 1, zinc oxide-eugenol; Group 2, calcium hydroxide; and Group 3, mineral trioxide aggregate. All teeth were restored with stainless-steel crowns. Clinical and radiographic examinations were conducted at 6, 12, 18, and 24 months. After 24 months, clinical success rates for Groups 1 to 3 were 97.1% (34/35 teeth), 94.2% (33/35 teeth), and 97.1% (34/35 teeth), respectively (P > .05). Radiographic success rates were 65.7% (23/35 teeth), 65.7% (23/35 teeth), and 77.1% (27/35 teeth), respectively (P > .05). Internal resorption was the most observed radiographic finding (15/105 teeth). The choice of zinc oxide-eugenol, calcium hydroxide, and mineral trioxide aggregate, as base materials, did not affect the clinical and radiographic success of ferric sulfate pulpotomies in primary teeth.

Tooth resorption-Part 2: A clinical classification.

Tooth resorption is either a physiological or a pathological process resulting in loss of dentin and/or cementum. It may also be associated with bone loss. Currently there is no universal classification for the different types of tooth resorption. This lack of a universal classification leads to both confusion amongst practitioners and poor understanding of the resorptive processes occurring in teeth which can result in incorrect/inappropriate diagnoses and mis‐management. When developing a classification of diseases and/or conditions that occur within the body, several criteria should be followed to ensure a useful classification. The classification should not only include pathological conditions but also physiological conditions. Since tooth resorption can be either pathological or physiological, a classification of tooth resorption should include both of these categories. Any classification of diseases should be possible to use clinically, meaningful, useful, clear and universal. It should enable easy storage, retrieval and analysis of health information for evidenced‐based decision‐making. It should also be possible to share and compare data and information between different institutions, settings and countries. A classification of tooth resorption should be developed by combining anatomical, physiological and pathological approaches. For some types of resorption, the aetiological approach should also be incorporated. A classification of tooth resorption that uses simple, relevant and appropriate terminology based on the nature and location of the resorptive process occurring in teeth is proposed. There are two broad categories of internal and external tooth resorption which are sub‐divided into three types of internal tooth resorption (surface, inflammatory, replacement) and eight types of external tooth resorption (surface, inflammatory, replacement, invasive, pressure, orthodontic, physiological, idiopathic). The clinician's understanding, diagnosis and management of tooth resorption can be facilitated by using this simple classification which should ideally be used universally by the entire dental profession to ensure clarity and to avoid confusion.

Tooth Resorption - Part 1: The evolvement, rationales and controversies of tooth resorption.

In 1966, Andreasen and Hjørting‐Hansen were the first to describe a relationship between tooth resorption and dental trauma. However, Andreasen's original classification did not include other resorptive processes which have since been identified. Numerous articles have been published suggesting new terminology and definitions for tooth resorption. A uniform language with universally accepted terminology is crucial to eliminate the multiplicity of terms and definitions which only cause confusion within the profession. An electronic literature search was carried out in the PubMed database using the following keywords for articles published in English: “root resorption,” “inflammatory root resorption,” “replacement resorption,” “cervical resorption,” “trauma,” “ankylosis,” “surface resorption,” and “internal resorption.” The search also included textbooks and glossaries that may not have surfaced in the online search. This was done to identify articles related to tooth resorption and its etiology in dentistry. The aim of this review was to present the history that has led to the variety of terms and definitions for resorption. This review emphasizes the need for a clearer, simpler, and more comprehensive nomenclature for the various types of tooth resorption which are presented in Part 2 of this series.

Long-term Complications of Previously Successful Regenerative Endodontic Procedures after Orthodontic Movement: A Report of 3 Different Complications after 4, 8, and 11 Years

There is a paucity of literature on late complications of regenerative endodontic procedures. The aim of this article was to report 3 cases of previously successful regenerative endodontic procedures with long-term follow-up that developed different complications after the application of orthodontic forces. In the first case, an 8-year-old female patient received a regenerative endodontic procedure in her previously intruded tooth (tooth no. 21) that had been rendered necrotic after a successful spontaneous repositioning procedure. The 5-year follow-up revealed uneventful healing, continuous root development, dentinal wall thickening, and regaining of pulp vitality for tooth no. 21. Four years later, the patient received orthodontic treatment with mild forces that lasted 2 years. The 11-year follow-up revealed severe external invasive cervical resorption, and the tooth had to be extracted. In the second case, a 6-year-old female patient suffered a lateral luxation injury in tooth no. 11. Six months after the injury, the tooth developed symptoms and discoloration and tested negative in pulp vitality testing. Single-step regenerative endodontic procedures were applied, and successful continuous root development, dentinal wall thickening, and apical closure were achieved at the 3-year follow-up. Two months after the initiation of orthodontic treatment, the tooth developed symptomatic apical periodontitis. Root canal treatment was performed to treat the disease, and the orthodontic treatment was continued. In the third case, a previously published successful regenerative endodontic procedure developed a perforating internal resorption 6 months after the application of orthodontic forces. The internal resorption was arrested with root canal treatment, the resorptive defect was repaired with bioceramic obturation, and the orthodontic treatment plan was modified. Previously successful regenerative cases might develop external invasive cervical resorption, regenerative tissue necrosis, or internal resorption after the application of orthodontic forces. Best practice/evidence-based guidelines on the appropriate orthodontic management of successful regenerative endodontic therapy teeth are lacking. Whenever possible, careful monitoring and partial or complete exclusion off orthodontic treatment might be necessary. In some cases, preventive root canal treatment before the initiation of orthodontic movement might be considered.

Present status and future directions: Root resorption.

Root resorption is the loss of dental hard tissue because of odontoclastic action. In permanent teeth, it is undesirable and pathological in nature. Root resorption may occur on the inner aspect of the root canal (internal root resorption) or on the outer aspect of the root (external root resorption). Regardless of its location, root resorption is irreversible, and may result in discomfort for the patient, requires management and/or, in some cases, results in the premature loss of the affected tooth. Root resorption is often challenging to accurately diagnose and manage. The aim of this narrative review is to present the relevant literature on the aetiology, pathogenesis, diagnosis and management, as well as discuss the future directions of diagnosis and management of root resorption.

The impact of digital filters on the diagnosis of simulated root resorptions in digital radiographic systems.

To evaluate the influence of digital filters of intraoral radiographic systems on the diagnosis of simulated internal and external root resorptions and image quality. Internal root resorption (IRR) and external root resorption (ERR) were simulated in 34 teeth. For image acquisition, two radiographic systems were used: Digora Toto and VistaScan. All filters available in these systems were applied. Three observers scored the detection of root resorptions in a 5-point scale. The noise and the contrast-to-noise ratio (CNR) were calculated. The area under ROC curve, sensitivity, specificity, and accuracy were obtained. One-way ANOVA with Tukey's post hoc tests compared the diagnostic values, noise, and CNR between the filters (α = 0.05). For ERR, there were no significant differences in diagnostic values between the filters tested for both systems. For IRR, Original and Noise Reduction filters presented higher sensitivity than the Sharpen2 filter for images from Digora Toto, with no differences between the other groups. For VistaScan, there were no significant differences of diagnostic values between the groups studied. Noise values differed among the filters of both systems. The CNR of the filters differed only for the bone region for Digora Toto, while for VistaScan, both tooth and bone regions differed. Despite promoting changes in pixel intensities and affecting the noise level of the radiographic images, the digital filters of Digora Toto and VistaScan systems do not affect the diagnosis of internal or external root resorptions. Digital filters are common tools in digital radiographic systems and may be used by the professional without impairment in root resorptions diagnosis.

Pattern of Root Resorption in Luxation Injuries in Permanent Incisors Presented to Restorative Unit , Institute of Oral Health, Maharagama – Sri Lanka

The aim of this descriptive study was to evaluate the association between root resorption and each type of luxation injury, the effect of timely treatment, age of the patient at presentation and maturity of maxillary anterior teeth presented with luxation injuries. A cross sectional descriptive study was carried out on 132 patients aged 6 to 50 years old with luxation injuries occurred to 213 teeth and were followed up for 24 months. Data were collected on the age, sex, the tooth/teeth involved, type of trauma, date of occurrence of trauma and date of presentation for treatment. Radiographically teeth were assessed for the presence/absence of resorption and type of resorption (External inflammatory, external replacement and Internal inflammatory) at review appointments. Data analysis was done using the SPSS version- 24 and non- parametric tests were used assess associations. Amongst all types of luxation injuries, most frequently presented type was subluxation (40.8%) injuries followed by concussion (25.4%), Intrusive and palatal luxation (15.5% each) and extrusive luxation (2.8%) respectively. Further, 51 of 213 teeth (23.9%) showed root resorption after luxation injury. The most frequently observed resorption was external inflammatory resorption in 44 teeth (20.7%) followed by external replacement resorption in 6 teeth (2.8%) and internal inflammatory resorption in 1 tooth (0.5%). Out of 43 late presenters 77% (34) showed root resorption, while only 10% (17) of immediate presenters showed resorption of root. The results indicated that there is a statistically significant difference in occurrence of root resorption and the late presentation for treatment (X2=91.63, df=3, p=0.000), as well as with the type of injury (X2=35.9, df=12, p=0.000). Furthermore, there was a statistically significant difference between the age of the patient and the type of luxation injury (X2 =54.29, df-12, P=0.000).

Irrigant flow characteristics in the root canal with internal root resorption: a computational fluid dynamics evaluation.

Irrigation dynamics of syringe irrigation with different needle designs (side-vented, double side-vented, notched) and ultrasonic irrigation in the root canal with internal root resorption were evaluated using a computational fluid dynamics model. A micro-CT scanned mandibular premolar was used for modeling internal root resorption. The needles and the ultrasonic tip were positioned at 2, 4, and 5mm from the working length. The insertion depth and the irrigation model were found influential on the shear stress and the irrigant extension. The extension of the irrigant increased toward 2-5mm from the working length. Ultrasonic irrigation revealed the highest shear stress values regardless of the insertion depth. The shear stress distribution on the resorption cavity walls gradually increased when the needles were positioned coronally. The residence time of the irrigant in the canal was affected by the needle position relative to the internal root resorption cavity and the needle type.

PREVALENCE OF INTERNAL AND EXTERNAL ROOT RESORPTION IN PERMANENT ANTERIOR TEETH USING DIGITAL AND DIGITALIZED PERIAPICAL RADIOGRAPHS

Objetive: This study aimed to evaluate the prevalence of internal and external resorption in periapical digital radiographs in permanent anterior teeth of patients attended in a private clinic of radiology in the city of Recife, Pernambuco, Brazil, in a period of three years. Study Design: A retrospective and observation study design was realized with the aim of observing an presence of events. A total of 4630 radiographs were analyzed from the archives of the clinic. Thus, it was observed the presence of internal and external root resorption and their location in in digital and digitalized periapical radiographs.Results: It was observed more external than internal resorption (99,65%) and the teeth most affected by dental resorptions were the upper incisors (11,8%). The apical and cervical thirds were also involved with the same frequency in internal resorption while the apical third was the most involved in external resorption. Conclusion: Digital radiograph has a important and essential paper in correct diagnosis of root resorption and to conduct a correct endodontic treatment.

Aberrant NF-\u03baB activation in odontoblasts orchestrates inflammatory matrix degradation and mineral resorption

Inflammation-associated proteinase functions are key determinants of inflammatory stromal tissues deconstruction. As a specialized inflammatory pathological process, dental internal resorption (IR) includes both soft and hard tissues deconstruction within the dentin-pulp complex, which has been one of the main reasons for inflammatory tooth loss. Mechanisms of inflammatory matrix degradation and tissue resorption in IR are largely unclear. In this study, we used a combination of Cre-loxP reporter, flow cytometry, cell transplantation, and enzyme activities assay to mechanistically investigate the role of regenerative cells, odontoblasts (ODs), in inflammatory mineral resorption and matrices degradation. We report that inflamed ODs have strong capabilities of matrix degradation and tissue resorption. Traditionally, ODs are regarded as hard-tissue regenerative cells; however, our data unexpectedly present ODs as a crucial population that participates in IR-associated tissue deconstruction. Specifically, we uncovered that nuclear factor-kappa b (NF-κB) signaling orchestrated Tumor necrosis factor α (TNF-α)-induced matrix metalloproteinases (Mmps) and Cathepsin K (Ctsk) functions in ODs to enhance matrix degradation and tissue resorption. Furthermore, TNF-α increases Rankl/Opg ratio in ODs via NF-κB signaling by impairing Opg expression but increasing Rankl level, which utterly makes ODs cell line 17IIA11 (A11) become Trap+ and Ctsk+ multinucleated cells to perform resorptive actions. Blocking of NF-κB signaling significantly rescues matrix degradation and resorptive functions of inflamed ODs via repressing vital inflammatory proteinases Mmps and Ctsk. Utterly, via utilizing NF-κB specific small molecule inhibitors we satisfactorily attenuated inflammatory ODs-associated human dental IR in vivo. Our data reveal the underlying mechanisms of inflammatory matrix degradation and resorption via proteinase activities in IR-related pathological conditions.

Clinical and radiographic effectiveness of mineral trioxide aggregate (MTA) partial pulpotomy with low power or high power diode laser irradiation in deciduous molars: a randomized clinical trial.

This study investigated the clinical and radiographic effectiveness of MTA partial pulpotomy with low power or high power diode laser irradiation in primary molars. In this randomized single-blind clinical trial, 63 mandibular second molars were assigned into three groups (n = 21). After pulp amputation and achieving hemostasis, MTA was placed over pulp stumps in group 1 (MTA). The patients in groups 2 (LLLT-MTA) and 3 (DL-MTA) underwent low level (660nm, 200 mW) and high power (810nm, 1W) diode laser radiation prior to MTA placement, respectively. The occurrence of clinical failure (spontaneous pain, tenderness upon percussion, swelling, fistula, mobility) and radiographic failure (periodontal ligament widening, external or internal root resorption, periapical or furcal radiolucency) was recorded up to 18months after therapy.MTA and LLLT-MTA groups showed clinical success rate of 100% throughout the experiment. The clinical success rate of DL-MTA group was 95.2%, 95.2%, and 87.5% after 6, 9, and 18months. The radiographic success rates were 90.5%, 90.5%, and 87.5% in the MTA group; 100%, 95.2%, and 88.2% in the LLLT-MTA group, and 85.7%, 76.2%, and 68.7% in the DL-MTA group, at 6-, 9-, and 18-month follow-ups, respectively. No significant differences were found in the frequency of clinical or radiographic failure among the groups at any interval (p > 0.05). MTA partial pulpotomy was a suitable technique for vital pulp therapy in deciduous teeth. The addition of low power or high power diode laser radiation to the procedure did not cause a significant difference in success rate values.

Pulp Dressing Agents Used in Primary Teeth: A Review of the Literature

Background: Pulpotomy is a technique of vital pulp therapy which can be performed in a primary tooth with pulp exposure due to caries or trauma when there is no clinical or radiographic sign of irreversible pulpitis or necrosis. Since today many different medicaments and techniques have been researched as pulpotomy agents and studies have shown the effectiveness but also the limitations of them. 
 Aim: The aim of this literature review is to overview the medicaments which were used in the past for pulpotomy in primary teeth, but also to evaluate the techniques and medicaments from the present and the future. 
 Results: Formocresol was the first-choice material for many decades, but its use has been limited due to potential mutogenetic and carcinogenetic effects in humans. In addition, glutaraldehyde is no longer used as a material for pulpotomy due to its toxicity. Mineral trioxide aggregate (MTA) seems to have better or comparable success rates as the old gold standard – formocresol, while other materials have high effectiveness. Calcium hydroxide was related to lower success rate and due to adverse effects as the internal root resorption is no longer recommended. Electrosurgery and laser are alternative techniques, while collagen and enamel matrix derivative (EMD) have been researched the last years and also studies about the bone morphogenetic proteins (BMPs) presented promising results. Also, other medicaments, which have been evaluated as pulp dressing materials, are included in this review and they seem to lead to acceptable results.
 Conclusions: MTA seems to be the new gold-standard for pulpotomy, while also other medicaments as ferric sulfate, sodium hypochloride, Portland cement, Biodentine can lead to comparable results. Electrosurgery and laser pulpotomy are alternative and non-pharmacological techniques with good success rates, while also other alternative materials seem to have promising results, but further research is needed.

Etiology and pathogenesis of internal root resorption

Internal root resorption is a pathologic phenomenon with a characterization of the intraradicular dentin destruction due to the abnormal activities of odontoclasts. With its insidious pathology, internal root resorption can progress to a great extent before its clinical detection. The etiology and natural history of internal root resorption are uncertain and the associated key molecular pathogenesis have not been understood completely. The resorption is usually initiated by a stimulus with the loss of the protective predentin and progressed by the continuous stimuli of pulp infection. Various factors including trauma, chronic inflammation of the pulp, pulpotomy and tooth transplantation have been proposed for the occurrence of internal root resorption. The present paper reviews the etiology and pathogenesis of internal root resorption and provides guidance for the early intervention in the clinical practice.

Supernumerary teeth in premolar and molar area on CBCT: a pictorial review.

Objective: to build a descriptive classification of premolar and molar supernumerary teeth (ST) when preparing the cone beam computed tomography (CBCT) report. The aim is also to share wide range of CBCT images in the open access publishing model. Material and methods: For our review we systematically searched for articles from PubMed with 1) free full texts on ST in molar and premolar area and using CBCT, and 2) articles providing with information on complications related with the presence of ST in molar and premolar area. We also added to our review studies providing with classic ST classifications in premolar and molar area. Results: We found 29 cases of ST, and we freely illustrated them with 84 figures. We separated our pictorial review in: 1) unilateral ST in the mandible, 2) unilateral ST in the maxilla, 3) unilateral undersized ST, 4) bilateral ST, 5) ST with additional features, and 6) cases with major hyperdontia. Conclusions: we build up the classification matrix for premolar and molar ST with 11 descriptors and 50 boxes. The descriptors were: 1) location if the ST crown in axial view, 2) vertical location of the cusp tip in relation with closest erupted tooth in coronal view, 3) shape, 4) distribution, 5) Position (in relation to normal tooth eruption) in sagittal view, 6) State of eruption of the ST in the sagittal view, 7) Follicle size measurement in sagittal view, 8) External root resorption of adjacent teeth by ST and its location in relation to the long axis of the involved tooth, 9) Internal resorption of ST, 10) Adjacent tooth complication, and 11) Damage to surrounding structures if ST removal. The open access figures from the literature illustrated 11 boxes. With our pictorial review we were able to illustrate 45 out of 50 boxes, and freely provide the readership with the most complete description of ST in premolar and molar area on CBCT than in previously published studies.

Accuracy of Four Apex Locators in Premolars with Root Resorption: An In vitro Study.

The aim of the present in vitro study was to compare the accuracy of the working length measurements of four foramen locators: Root ZX mini, Raypex 6, Woodpex III and Propex Pixi in uniradicular premolars with simulated root resorption. For this study, 30 single-rooted permanent premolars were selected. The samples were divided into two groups: 15 teeth with simulated external root resorption and 15 teeth with internal resorption. Each sample was immersed in containers with alginate covering only the root part. Measurements were acquired from the four foramen locators and compared with the working length measurements that have been previously obtained with the direct visual technique and the use of a Digital USB Microscope under 5×. Next, the Shapiro-Wilk normality test was applied. The ANOVA test and t-test for related samples were performed, in order to analyze the measurements obtained. In the teeth with external resorption, no statistically significant differences in the measurements were obtained with Raypex 6 and Propex Pixi foramen locators, but there were statistically significant differences with Root ZX mini and Woodpex III Root Zx mini [Root Zx mini (P=0.040) and Woodpex III (P=0.000)]. On the other hand, in the samples with internal root resorption, there were no statistically significant differences in measurements with the Root ZX mini, Propex Pixi and Raypex 6 foramen locators. However, there were significant differences with Woodpex III. Based on this in vitro study, Raypex 6 had the highest accuracy in premolars with simulated external resorption and Root ZX mini was the most accurate in teeth with simulated internal resorption. Furthermore, external root resorption affects the accuracy of foramen locators more than internal resorption.

Management of internal root resorption with mineral trioxide aggregate: A case report

The most significant cause of Internal root resorption is trauma which eventually can lead to destruction of crown or root portion of the tooth. Internal resorption is most commonly seen in the anterior teeth and initiates mainly from the root canal. It may also occur in posterior teeth due to caries involving the pulp cavity. Management of internal resorption requires diagnosis at an early stage using radiographic examination and diagnostic aids like cone beam computed tomography following which successful management of resorbed tooth can be accomplished. This case report demonstrates management of internal resorption in maxillary anterior tooth using calcium hydroxide as intracanal medication and favourable sealing of root canal with Mineral Trioxide Aggregate (MTA) promoting periradicular healing.

Recursos imaginológicos utilizados no diagnóstico de reabsorções radiculares: estudo comparativo

ABSTRACT Objective: Compare the accuracy of early diagnosis of simulated internal root resorptions and external root resorption, using digital periapical radiography and cone beam computed tomography. Methods: Root resorption were simulated in extracted human teeth by demineralization with 5% nitric acid solution and 8% Sodium Hypochlorite in different periods (1 and 5 days). For the group external root resorption (n=12) composite resin cylinders were positioned on middle third of buccal surface of roots, to delimit application of demineralization substances. In group internal root resorptions (n=12) the teeth were sectioned longitudinally, and the composite resin cylinders were positioned in the middle third of root canals. The teeth were mounted in a dry mandible and evaluated by digital radiography and tomography. The images were evaluated by two examiners. Results: Analyzing the tomographic images in period of 1 day, the examiner 2 identified internal root resorptions that were not identified in radiographic images (p<0.05). No examiner was capable of diagnosing external root resorption irrespective of exam, in the group of 1 day (p>0.05). In 5 day period of induction, both exams identified internal root resorptions (p>0.05), however, the tomographic images were more effective in identifying external root resorption (p <0.05) for both examiners. Conclusion: Cone beam computed tomography was shown to be more effective than digital periapical radiography for detecting internal root resorptions with 1 day of induction. The imaginological resources used in this study were not able to early detect external root resorption.

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.