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MAR JOVANI
1. External root resorption caused by an injury restricted to the external root surface
An injury causes loss of the protective layer and serves as an inflammatory stimulus.
Types
Localized injury: Healing with cementum. Diffuse injury: Healing by osseous replacement.
Treatment
Localized area of root resorption The initial damage was caused by a mild localized luxation injury. It has healed with new cementum and periodontal ligament (PDL).
Treatment
Osseous replacement
2. External root resorption caused by an injury to the external root surface with an inflammatory component
Pressure
Causes Excessive forces of orthodontic tooth movement. Impacted teeth and tumors. Pressure both damages the cementum and provides a continuous stimulus for the resorbing cells.
Treatment
A "pink spot" of external inflammatory resorption. The granulomatous tissue has spread coronally and undermined the enamel, causing the pink color in the crown.
Careful removal of the granulomatous tissue shows the canal to be almost entirely encircled but not penetrated by the resorptive defect.
The resorptive defect on the mesial side of the molar shows a small opening into the root.
The apical and coronal expansion reaches but usually does not penetrate the pulp canal.
Because the pulp is not involved, its outline can usually be distinguished through the resorptive defect
ETIOLOGY
Infected coronal pulp tissue Traumatic episodes Extreme heat produced by cutting on dentin without an adequate water spray
CLINICAL MANIFESTATIONS
Usually asymptomatic It is first recognized clinically through routine radiographs. Pain may be a presenting symptom if perforation of the crown occurs and the granulation tissue is exposed to oral fluids. A positive response to pulp sensitivity testing is possible. Pink tooth, due to the granulation tissue in the coronal dentin undermining the crown enamel.
Pink spot on a mandibular central incisor indicating internal root resorption. Because the pink spot is so far from the periodontal attachment level, this example is unlikely to be external in nature.
RADIOGRAPHIC APPEARANCE
A fairly uniform radiolucent enlargement of the pulp canal. The original outline of the root canal is distorted. Unlike external root resorption, the adjacent bone is not affected by internal root resorption.
TREATMENT
Because the resorptive defect is the result of the inflamed pulp, endodontic treatment is the treatment approach
undermining enamel is a possible sign of both subepithelial external and internal root resorption
When the defect is external, the root canal outline appears normal and can usually be seen "running through" the radiolucent defect. External inflammatory root resorption is always accompanied by resorption of the bone in addition to the root.
A defect on the external aspect of the root moves away from the canal as the angle changes
In internal resorption, the outline of the root canal is usually distorted and the root canal and the radiolucent resorptive defect appear contiguous Internal root resorption does not involve the bone; as a rule, the radiolucency is confined to the root. On rare occasions, if the internal defect perforates the root, the adjacent bone is resorbed and appears radiolucent on the radiograph.
A lesion of internal origin appears close to the canal whatever the angle of the X ray
Internal resorption. Radiographs from two different horizontal projections depict the lesion within the confines of the root canal in both views
External resorption. Radiographs from two different horizontal projections depict movement of the lesion to outside the confines of the root canal.
Vitality testing:
External inflammatory resorption on the apical and lateral region
Internal root resorption Usually occurs in teeth with vital pulps and elicits a positive response to sensitivity testing.
Common misdiagnoses:
Apparent internal root resorption
Bleeding within the canal should cease quickly after pulp extirpation
If bleeding continues during treatment, particularly if it is still present at the second visit
Internal resorption
External resorption
CLINICAL CASE 1
Woman, 60 years old She came to an annual check-up visit
pulp capping with calcium hydroxide, glass ionomer and composite, two years ago. Soft tissue: Percusion and palpation:Periodontal examination: Positive pulp sensitivity test
Radiographic examination
1 YEAR LATER
CLINICAL CASE 2
1 week ago
Soft tissue: Percusion and palpation: Periodontal examination: 5mm mesial Positive pulp sensitivity test
Root canal outline is undistorsed and can be visualized radiographically Crestal bony defect associated with the lesion.
Pink spot possible
CLINICAL CASE 3
Chief complaint: I have a toothache in 2.1
test Rx
CLINICAL CASE 4
CLINICAL CASE 5
Common misdiagnoses:
Apparent internal root resorption
Bleeding within the canal should cease quickly after pulp extirpation
If bleeding continues during treatment, particularly if it is still present at the second visit
Internal resorption
External resorption