Internal Root Resorption Research Articles

Spontaneous remission of internal root resorption during orthodontic treatment: A clinical follow-up report

Internal root resorption (IRR) is a pathologic process that occurs because of external stimuli that affect the pulp and result in the loss of dentinal tissue. The occurrence of IRR is considered relatively rare, and the etiology is not fully understood, although trauma is believed to be the main etiologic agent. The current study presented a case report of spontaneous remission of an IRR lesion diagnosed during orthodontic treatment. The lesion was characterized by a circular and delimited radiolucent image, located in the apical third of the root canal of the maxillary right lateral incisor diagnosed during orthodontic treatment. After the diagnosis, clinical and radiographic follow-up was performed without any intervention. The follow-up radiographic images showed loss of contour definition and reduction in the size of the lesion. At the end of orthodontic treatment, 27months after diagnosis, the space of the lesion had been filled by tissue with similar radiopacity to the adjacent dentin, and the tooth did not change its color and response to mechanical and thermal stimuli. Eight years after the end of the treatment, the maxillary right lateral incisor still presented normal responses to vitality tests and color stability; therefore, it was impossible to notice the root canal space. The reported patient presents a possible behavior of the IRR characterized by spontaneous remission of the lesion. However, nonendodontic treatment after diagnosis should not be the routine therapy adopted for IRR because of the potential risk to the tooth.

BIODENTINE- A REVIEW ON ITS PROPERTIES AND CLINICAL APPLICATIONS

Ever since the introduction of Biodentine it has gained popularity which is because of its superior mechanical and biological characteristics that makes it a versatile material to be use for various clinical applications. The most important properties are its shorter setting time, biocompatibility and lesser possibilities to cause discoloration compared to other calcium silicate based cements because of these characteristics it has been used in various clinical applications such as Pulp capping, Pulpotomy, Apexification, Regenerative procedures, in Internal and External root resorption, for Perforation repair and as Root end filling material. This review article highlights various properties of Biodentine and its clinical applications.

Comparison of Diagnostic Accuracy of Conventional and Photo Stimulable- Phosphor Periapical Radiography in Internal Root Resorption Lesions

Background and Objectives Internal Root Resorption (IRR) occurs in pulpchamber and canals of the tooth and results in desolation of around dentin. Regarding to important role of early diagnosis of IRR in prognose and treatment plan of the teeth and also limitations of intraoral technics in early detecting of these lesions, in this study we evaluated the accuracy of PSP in diagnosis of these lesions. Subjects and Methods We split 70 single root premolar teeth mesiodistalyand made artificial IRR in 35 teeth. The rest of them used as control group PSP and Conventional radiography captured from all teeth. IRR existence or not was considered in PSP and Conventionalradiographies of each tooth. Results PSP has complete agreement in all cases with reality but Conventional radiography in some cases particularly in 1/3 apical lesions of the root has moderate accuracy with reality and its results diden’t have considerable differences with reality. Conclusion Regarding to this study, has higher accuracy for PSP than Conventional radiography in detecting Internal root resorption lesions particularly in apical sites.

Efficacy of Laser-Activated Irrigation and Conventional Techniques in Calcium Hydroxide Removal from Simulated Internal Resorption Cavities: Micro-CT Study.

Objective: This study aimed to evaluate the effectiveness of different irrigant-activation techniques for eliminating calcium hydroxide from an internal root canal resorption cavity by using microcomputed tomography (micro-CT). Background: Several techniques and irrigants are inadequate for the complete removal of calcium hydroxide from an internal root resorption cavity. Recently, a few studies have investigated the effectiveness of various methods, but there has been no micro-CT study that compares the effectiveness of photon-induced photoacoustic streaming (PIPS) and shock wave enhanced emission photoacoustic streaming (SWEEPS) techniques. Methods: Seventy single-canal mandibular premolar teeth were selected and divided into seven groups (n = 10) according to the techniques to be used: syringe irrigation (SI), passive ultrasonic irrigation (PUI), EndoActivator (EA), XP-Endo finisher file (XP), Er,Cr:YSGG laser-activated irrigation, PIPS, and SWEEPS. The root canals were instrumented using a rotary system and divided vertically. Internal resorption cavities were created and standardized through diamond burs. Calcium hydroxide was placed into the root canal space. All specimens were evaluated using micro-CT in two different periods. The initial and residual calcium hydroxide volumes in the simulated cavities were calculated. Data were analyzed using a Kruskal-Wallis H test. Results: SWEEPS and PIPS were significantly more effective than EA, Er,Cr:YSGG, PUI, XP, and SI (p < 0.05). There was no significant difference between the SWEEPS and PIPS groups (p > 0.05). SI and XP showed the least effective activity (p < 0.05). Conclusions: The SWEEPS and PIPS techniques were superior to the EA, Er,Cr:YSGG, PUI, XP, and SI techniques. None of the techniques used entirely removed the calcium hydroxide from the resorption cavities.

Comparison of the accuracy of different electronic apex locators used in working length determination via changing of initial cleaning solutions

Aim: The aim of this study is to compare the accuracy of the Root ZX Mini, Raypex 6, E-Pex Pro, and Propex Pixi electronic apex locators by changing the initial cleaning solutions (NaOCl vs. EDTA).&#x0D; Methodology: Eighty mandibular premolar teeth were used. Radiographs were obtained from the mesio-distal and bucco-lingual angles for all teeth, and teeth with suspected external or internal root resorption and/or calcified canals were not included in the study. The true canal lengths of the teeth were determined with a precision of 0.01 mm with a stereomicroscope at x5 magnification by placing a #20 K-type canal file into the root canal. The samples were then embedded in freshly mixed alginate blocks up to the cemento-enamel junction. The coronal 1/3 was pre-enlarged with a Protaper SX instrument. Electronic apex finders (Root ZX Mini, Raypex 6, E-Pex Pro, Propex Pixi) specified on each tooth were used, and measurements were made by changing the initial solutions (NaOCl vs. EDTA). Distilled water was used between application of 5.25% NaOCl and 17% EDTA to prevent chemical interactions. Three measurements were taken for each tooth, and the average of these 3 measurements was taken as reference. The data obtained in this study were analyzed.&#x0D; Results: There were no statistically significant differences between the solutions in terms of the measurement values and actual length values found by each device (p&gt;0.05). Although there were no statistically significant differences, the deviation from the actual measurement was greater when EDTA solution was used than when NaOCl solution was used. In addition, although the difference was not found to be statistically significant, the deviation from the actual measurement was found to be highest when the Root ZX mini device was used with NaOCl and EDTA solution.&#x0D; Conclusion: The results of this study showed that the difference in the initial washing solutions did not affect the EAL devices in making measurements close to the true length.&#x0D; &#x0D; How to cite this article: Tellioğlu Avcı GR, Kaya S Comparison of the accuracy of different electronic apex locators used in working length determination via changing of initial cleaning solutions. Int Dent Res 2021;11(Suppl.1):56-62. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.9&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.&#x0D;

REPETITIVE REGENERATIVE ENDODONTIC PROTOCOL TREATMENT FOR MATURE TEETH WITH DENS INVAGINATUS AND SEVERE PERFORATED INTERNAL ROOT RESORPTION: A CASE REPORT WITH 24-MONTH FOLLOW-UP

The association of internal root resorption (IRR) with dens invaginatus is an extremely rare finding, and its incidence may be underestimated, adding to the difficulty of endodontic treatment. A 9-year-old boy was admitted with complaints of swelling and pain. Radiological examination revealed closed apex Oehlers type II dens invaginatus and severe IRR, as well as apical third of two lateral root perforation and lesion. Calcium hydroxide applied in the regenerative endodontic protocol (REP) as intracanal medicament. Differently, bleeding was achieved by irritating the lateral perforation area. However, the tooth showed spontaneous pain and sensitivity to percussion after 2 months. The same REP was performed, but a triple antibiotic paste was used as the intracanal medicament. After 2 years, the tooth was asymptomatic, and radiographic examination revealed the decrease was cared on the previous resorption sites, and one of the openings on the lateral root surface had closed.

Efficacy of Passive Ultrasonic Activation in Removing Calcium Hydroxide from Simulated Internal Resorption Cavities at Different Root Regions.

The aim of this study was to evaluate the effect of passive ultrasonic activation on calcium hydroxide removal from simulated internal root resorption (IRR) cavities at different root levels. Sixty mandibular canines were prepared and divided into 3 groups to create IRR cavities at apical, middle, coronal root levels. The cavities filled with calcium hydroxide (CH). Specimens were divided into two subgroups according to the technique used for CH removal: Passive ultrasonic activation (PUA), Classic syringe irrigation (CSI). The cavities were photographed with a stereomicroscope, and percentage of remaining CH was measured using digital image analysis software (Image J). Statistical analysis was performed with two-way ANOVA and post-hoc Duncan tests. PUA removed significantly more CH at apical and middle levels. (p < 0.05) There was no significant difference between PUA and CSI at coronal level. (p > 0.05) In PUA group, the amount of residual CH was the highest at coronal level. (p < 0.05) In CSI group, the amount of residual CH was the highest at apical level. (p < 0.05). None of the tested technique was able to completely remove CH from the simulated IRR cavities. CH was removed better with PUA than CSI at middle and apical root levels. For both techniques, the best results were obtained at middle root level.

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.

Assessment of Clinical and Radiographic Success Rate of Formocresol-based Pulpotomy versus Collagen-based Pulpotomy: An In Vivo Study

The aim of the study is (a) To use collagen as a pulpotomy material in comparison with the gold standard formocresol-based pulpotomy, (b) to assess the clinical and radiographic success rate of formocresol pulpotomy and collagen-based pulpotomy, and (c) to compare the success rate of formocresol-based pulpotomy and collagen-based pulpotomy over a definitive interval of time. Totally 30 primary first or second molars indicated for pulpotomy after confirming with the operative diagnosis were taken as samples for this study. This split-mouth technique consists of two groups: Group 1-formocresol pulpotomy (n = 15), and group 2-collagen-based pulpotomy (n = 15). Both the procedures were done in the same patient on regular appointments. Pre- and postoperative radiographs were taken. The children were recalled for clinical and radiographic follow-up at 2, 4, and 6 months. The success of the procedure was assessed based on clinical signs (pain, tenderness to percussion, abscess, swelling, fistula, and pathologic mobility) and radiographic findings (radicular radiolucency, internal and external root resorption, periodontal ligament (PDL) space widening, and furcation radiolucency). The Chi-square test was used to compare the differences between the groups. The overall success rate for formocresol pulpotomy (n = 15) was 14, 13, and 10 for the second-, fourth-, and sixth-month review period, respectively. For collagen pulpotomy group (n = 15), the overall success rate was 14, 14, and 14 for the second-, fourth-, and sixth-month review period, respectively. The obtained data from the overall success rate were subjected to statistical analysis, and chi-square test was used. The p-value less than 0.1 was considered a statistically significant result. The chi-square value for the fourth- and sixth-month review was 0.37 and 3.33, respectively. Statistically significant value was obtained from the sixth-month review period (p <0.1), which describes that the overall success rate was better for the collagen pulpotomy group when compared with the formocresol pulpotomy group. Collagen had proven to be a very good alternative for formocresol, its biocompatibility, and regenerative efficiency and is a benchmark for a better clinical success rate in dentistry. However, its implication in pulpotomy should be subjected to further comparative research study on mineral trioxide aggregate (MTA), Biodentine, etc. Keywords: Collagen-based pulpotomy, Formocresol-based pulpotomy.

Assessment of Fracture Resistance in Teeth with Simulated Perforating Internal Root Resorption Cavities Repaired with Biodentine, Retro MTA and Portland Cement (A Comparative In Vitro Study)

Assessment of Fracture Resistance in Teeth with Simulated Perforating Internal Root Resorption Cavities Repaired with Biodentine, Retro MTA and Portland Cement (A Comparative In Vitro Study)

A Clinical and Radiographic Assessment of Sodium Hypochlorite Versus Formocresol Pulpotomy in Primary Molar Teeth: 12-month Follow-up.

Objective: The aim of this study was to compare the clinical and radiographic success rates of pulpotomy in primary molars using formocresol versus sodium hypochlorite.Methods: Twenty-three children aged 4-9 years with at least two primary molars requiring pulpotomy were randomly allocated into two groups. All teeth received stainless steel crown after conventional pulpotomy procedure with either NaOCl or formocresol. Clinical and radiographic signs/symptoms were recorded at six and 12 months. Outcomes were statistically analyzed using Fisher’s exact test and Chi-squaretest.Results: Clinical success rates at 6 and 12-month follow-up in both groups was 100%. At 6-month follow-up, radiographic success rate for NaOCl and formocresol groups was 100%. At 12-month recalls, in NaOCl group, 20 teeth (87%) and in formocresol group, 21 teeth (91.3%) had radiographic success. No significant difference was found in the radiographic success rates at 12 months (P=1.00). Internal root resorption was the most common radiographic pathologic finding in both groups.Conclusion:Clinical and radiographic success rates in NaOCl group was comparable with formocresol group, so NaOCL can be suggested as an alternative for primary teeth pulpotomies. However further clinical studies with long-term follow-ups are needed.

Intentional Replantation of a Second Premolar with Internal Resorption and Root Fracture: A Case Report

This case aims to detail intentional replantation as a last resort to save an otherwise hopeless premolar with perforated internal resorption and root fracture. Internal root resorption, progressive destruction of intraradicular dentin, is a condition that sometimes renders a tooth non-restorable. In the rare cases reported where severe internal resorption leads to root fracture, extraction of the tooth seemed to be a common treatment of choice, and a few literatures had reported endodontic surgery as an alternative treatment option. To date, there had been no report of treating internal root resorption using intentional replantation. A 20-year-old male presented swelling at the buccal region of his left maxillary second premolar (#13). Clinical examination revealed a sinus tract and fractured dens evaginatus at the occlusal surface of the tooth. Radiographically, a large area of radiolucency was detected within the middle third of the root, where root fracture was present, leaving a triangular-shaped mature root apex. The condition was diagnosed as internal root resorption and root fracture. Endodontic surgery was excluded from treatment choices due to potential damage of periodontal bone. Instead, intentional replantation was performed, with the application of biomaterials including mineral trioxide aggregate (MTA) and platelet-rich fibrin (L-PRF). The tooth achieved satisfactory healing and remained asymptomatic after 2 years of follow-up. The successful outcome of the case suggests that intentional replantation could preserve a fractured tooth caused by internal root resorption. Incorporated application of biomaterials, such as MTA and L-PRF, might as well improve the chances of saving this otherwise hopeless tooth. Through careful planning and execution, intentional replantation is a viable alternative treatment option to preserve a fractured tooth caused by internal root resorption, while leaving periodontal bone architecture almost intact. How to cite this article: Yang Y, Zhang B, Huang C, et al. Intentional Replantation of a Second Premolar with Internal Resorption and Root Fracture: A Case Report. J Contemp Dent Pract 2021;22(5):562-567.

Knowledge and treatment plan of root resorption

Root resorption is very rare disease in the dental field. However, when dentist faced root resorption in the clinic without knowledge, it is very difficult situation to solve. Root resorption can be classified into external root resorption and internal root resorption according to developing place of resorption. Also, root resorption is classified into surface resorption, inflammatory resorption, replacement resorption according to developing reason of resorption. In this article, we can understand the cause and reason of root resorption development and can know how to prevent and treat the root resorption

Assessment Of Internal Root Resorption Cases Reported To Private Dental Hospital - A Retrospective Study

Assessment Of Internal Root Resorption Cases Reported To Private Dental Hospital - A Retrospective Study

Three-Dimensional Volumetric/ Linear Analysis and Axial Classification of Root Resorptions Using Cone Beam Computed Tomography: A Retrospective Study

Objectives: The purpose of this study was to investigate the volumetric-linear analysis and to present a new axial classification of root resorptions using cone-beam computed tomography (CBCT). &#x0D; Materials and Methods: A total of 43 teeth with root resorption (external cervical resorption (ECR) (n=27), external replacement resorption (ERR) (n=4) and internal root resorption (IRR) (n=12)) from 34 patients were included in this study. On CBCT images of teeth, the volume of total tooth and resorption for the volumetric analysis, the widest lengths of resorptions and the amount of thinnest dentin thickness around them for the linear analysis were measured, and volumetric/linear measurements were compared according to age and gender. In addition, the eight regional axial classification was performed, and these regions were compared. Data were evaluated using Shapiro-Wilk, Pearson’s r., Kruskal-Wallis and Dwass-Steel-Critchlow-Fligner post-hoc tests. Significance was set at p=0.05 for statistical analysis.&#x0D; Results: No significant difference was found between the volumetric and linear measurements of ECRs, ERRs, and IRRs. No difference between genders in volumetric and linear measurements of ECRs and IRRs, except total tooth volume, was higher in males than in females in ECRs (p

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.

Evaluation of Different Root Canal Obturation Techniques in Internal Root Resorption of Three-Dimensional Printed Teeth Manufactured Using Computer Software.

The objective of this study was to evaluate and compare the filling ability of various root canal obturation techniques on the internal root resorption (IRR) cavities of replicated tooth samples manufactured using computer software and a three-dimensional (3D) printer. Orthographic images and root structures of a healthy upper maxilla central incisor in determined volumes and sizes were drawn as a prototype with the aid of computer software. Using the same software, an IRR defect was also modeled. These two images were then transferred to the AutoDesk Fusion 360 3D modeling program (AutoDesk, San Rafael, CA) for meshing. Afterward, the tooth model was transferred to a 3D modeling and prototyping program (RhinoCeros 3D; Robert McNells & Assoc., New York) and printed on a 3D printer. Eighty replicas with IRR were manufactured and divided into four groups (n = 20 per group) according to the obturating techniques as follows: Group 1: Cold lateral compaction (CLC), Group 2: Core Carrier System (GuttaCore), Group 3: Injectable Cold Filling (GuttaFlow® BioSeal), and Group 4: Continuous Wave Obturation System (Elements Free). After root canal filling, replicas were scanned with a high-resolution micro-computed tomography system (SkyScan 1172; Bruker-microCT, Kontich, Belgium), data regarding voids (unobturated areas) inside the IRR defects were statistically analyzed using nonparametric Kruskal-Wallis tests. A pairwise comparison between the tested groups showed that Groups 3 and 4 had significantly fewer voids compared with Groups 1 and 2 in IRR defects (p < 0.05). Group 1/Group 2 and Group 3/Group 4 had similar results in terms of voids and there were no statistically significant differences (p > 0.05). The injectable cold filling system (GuttaFlow BioSeal) and the injectable continuous wave obturation system (Elements Free) successfully obturated the pathological IRR irregularities when compared with CLC and core carrier (GuttaCore) systems.

A Unique Syndrome of Gemination and External/ Internal Root Resorptions in One Dental Arch: A Case Report

A Unique Syndrome of Gemination and External/ Internal Root Resorptions in One Dental Arch: A Case Report

Comparison of digital image displays performance in the detection of artificial internal root resorptions lesions.

To compare the diagnostic efficacy of different devices for visualizing digital images in detecting simulated internal root resorption (IRR). 26 uniradicular human teeth were sectioned along its long axis and randomly divided into two groups. Then, they were submerged in hydrochloric acid (HCl) P.A 37% at different times to make two types of defects: Type 1 (2 hours), and type 2 (3 hours). Digital periapical radiographs were acquired in three moments: before section, after section and after immersion in acid. The images were evaluated on three different devices: 27-inch iMac Desktop, 8-inch Android Tablet, and 5.5-inch iPhone 8 Plus using a 5-point scale. The sensitivity and accuracy values were higher with the use of the Android Tablet, for both types of defects. For the values of the area under ROC curve, higher results were observed with the Android Tablet and lower results with the iMac, showing a significant difference (p < 0.05) when comparing the use of the iMac with the Android Tablet and iPhone 8, for type 1 defects. When comparing the different devices, in the evaluation of images of type 2 defects, the values showed no statistical difference, regardless of the device evaluated (p > 0.05). The size of the lesion interferes with the detection capacity in the image. However, the use of portable devices does not impair the diagnosis of IRR, regardless of size and the dental practioners may use different devices/display, under optimal viewing conditions, to detect IRR lesions, without jeopardizing the diagnostic ability.

Evaluation of the efficacy of XP-endo Finisher, Easy Clean, Passive ultrasonic irrigation, and conventional irrigation in the removal of calcium hydroxide in simulated internal root resorption cavities

This study aimed to evaluate the efficacy of 5 irrigation protocols in removing calcium hydroxide in simulated internal root resorption cavities. Eighteen extracted human teeth, upper anterior and uniradicular, were prepared up to size 50. The teeth were divided longitudinally, and internal root resorption cavities were made by acid demineralization using nitric acid. The same sample was submitted to the five irrigation protocols. The cavities and root canals were filled with Ultracal XS (Ultradent, South Jordan, UT, USA) and stored in an incubator at 37ºC for one week. Afterward, the irrigation protocols were carried out: XP-endo Finisher (XPF; FKG, La Chaux-de-Fonds, Switzerland), passive ultrasonic irrigation (PUI), Easy Clean (Bassi/Easy Equipamentos Odontológicos, Belo Horizonte, Brazil) with reciprocating movement (ECR), Easy Clean with continuous rotation (ECC) and conventional irrigation with a syringe (CI). The solutions used, 2.5% NaOCl, and 17% EDTA, were warmed. The total volume of irrigant used for each sample was 20 mL (10 mL of 2.5% NaOCl, 5 mL of 17% EDTA and 5 mL of distilled water). The amount of calcium hydroxide remaining in the internal resorption after irrigation was assessed using scores. The data were analyzed using the Pearson and Kruskal-Wallis (Dunn) tests. Significantly more calcium hydroxide was removed in the XPF group than all other sample groups (P &lt; 0.0001). XPF was superior to the other methods tested to remove calcium hydroxide in teeth with simulated internal resorptions.