Abstract
Introduction
Internal root resorption is the progressive destruction of intraradicular dentin and
dentinal tubules along the middle and apical thirds of the canal walls as a result
of clastic activities.
Methods
The prevalence, etiology, pathogenesis, histologic manifestations, differential diagnosis
with cone beam computed tomography, and treatment perspectives involved in internal
root resorption are reviewed.
Results
The majority of the documentation that exists in the literature is in the form of
case reports, and there are only a limited number of studies that attempted to examine
the histologic manifestations and biologic aspects of the disease. This might be due,
in part, to the relatively rare occurrence of this type of resorption and the lack
of an in vivo model, apart from the previous attempt on the use of diathermy, to predictably reproduce
the condition for study. From a histologic perspective, internal root resorption is
manifested in one form that is purely destructive, internal (root canal) inflammatory
resorption, and another that is accompanied by repair, internal (root canal) replacement
resorption that is featured by the deposition of metaplastic bone/cementum-like tissues
adjacent to the sites of resorption.
Conclusions
From a differential diagnosis perspective, the advent of cone beam computed tomography
has considerably enhanced the clinician's capability of diagnosing internal root resorption.
Nevertheless, root canal treatment remains the treatment of choice for this pathologic
condition to date.
Key Words
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References
- Is the resorption external or internal?.Dent Update. 2007; 34: 218-229
- Unexpected early apical resorption of primary molars and canines.Eur Arch Paediatr Dent. 2007; 8: 144-149
- A possible association between early apical resorption of primary teeth and ectodermal characteristics of the permanent dentition.Eur J Orthod. 2008; 30: 346-351
- Physiologic root resorption in primary teeth: molecular and histological events.J Oral Sci. 2007; 49: 1-12
- The role of dental pulp cells in resorption of deciduous teeth.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105: 113-120
- Review of root resorption systems and models: biology of root resorption and the homeostatic mechanisms of the periodontal ligament.in: Davidovitch Z. Proceedings of the International Conference on the Biological Mechanisms of Tooth Eruption and Root Resorption. Ebsco Media, Birmingham, UK1988: 9-21
- Root resorption: etiology, terminology and clinical manifestations.Endod Dent Traumatol. 1988; 4: 241-252
- The anatomy, physiology, and disease of the teeth.Carey and Lee Publishing, Philadelphia, PA1830 (171–2)
- Root resorption.in: Hargreaves K.M. Goodis H.E. Seltzer and Bender's dental pulp. Quintessence Publishing Co Inc, Chicago, IL2002: 425-448
- Clinical diagnosis of internal resorption: an exception to the rule.Int Endod J. 1995; 28: 255-260
- Internal inflammatory root resorption: the unknown resorption of the tooth.Endod Topics. 2006; 14: 60-79
- External cervical resorption: a review.J Endod. 2009; 35: 616-625
- External-internal progressive resorption and its nonsurgical correction.J Endod. 1981; 7: 473-476
- Internal root resorption studied by radiography, stereomicroscope, scanning electron microscope and computerized 3D reconstructive method.Dent Traumatol. 2002; 18: 148-152
- Root resorption: review and discussion.Oral Surg Oral Med Oral Pathol. 1982; 54: 586-591
- Prognosis of permanent teeth with internal resorption: a clinical review.Endod Dent Traumatol. 1997; 13: 75-81
- Root resorption following traumatic dental injuries.Proc Finn Dent Soc. 1992; 88: 95-114
- Luxation of permanent teeth due to trauma: a clinical and radiographic follow up study of 189 injured teeth.Scand J Dent Res. 1970; 19: 273-286
- Long term evaluation of autotransplanted maxillary canines with completed root formation.Acta Odontol Scand. 1983; 41: 23-31
- Internal resorption of dentine: histopathologic control of eight cases after pulp amputation and capping with calcium hydroxide.Oral Surg Oral Med Oral Pathol. 1957; 10: 90-96
- Internal apical resorption and its correlation with the type of apical lesion.Int Endod J. 2004; 37: 730-737
- Examination of external apical root resorption with scanning electron microscopy.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 82: 89-93
- Apical inflammatory root resorption: a correlative radiographic and histological assessment.Int Endod J. 2000; 33: 483-493
- Origin of osteoclasts: mature monocytes and macrophages are capable of differentiating into osteoclasts under a suitable microenvironment prepared by bone marrow-derived stromal cells.Proc Natl Acad Sci U S A. 1990; 87: 7260-7264
- Role of cell-matrix interactions in osteoclast differentiation.Adv Exp Med Biol. 2007; 602: 107-111
- Signaling networks that control the lineage commitment and differentiation of bone cells.Crit Rev Eukaryot Gene Expr. 2009; 19: 1-46
- Regulation of osteoclast polarization.Odontology. 2007; 95: 1-9
- Actin cytoskeletal organisation in osteoclasts: a model to decipher transmigration and matrix degradation.Eur J Cell Biol. 2008; 87: 459-468
- Experimental basis for the management of dental resorption.Endod Dent Traumatol. 1989; 5: 255-265
- Microelectrode studies on the acid microenvironment beneath adherent macrophages and osteoclasts.Exp Cell Res. 1988; 175: 66-76
- The resorption process of human teeth studied by light microscopy, microradiography and electron microscopy.Arch Oral Biol. 1968; 12: 417-431
- Repair of periodontal tissues in vivo and vitro.J Clin Periodontol. 1983; 10: 188-205
- Enzyme histochemistry of induced heterotopic bone formation in guinea pigs.Arch Oral Biol. 1979; 24: 833-841
- Murine dendritic cell transdifferentiation into osteoclasts is differentially regulated by innate and adaptive cytokines.Eur J Immunol. 2007; 37: 747-757
- Genome-wide expression analyses establish dendritic cells as a new osteoclast precursor able to generate bone-resorbing cells more efficiently than monocytes.J Bone Miner Res. 2009; ([Epub ahead of print] doi: 10.1359/jbmr.090829)
- Functions of RANKL/RANK/OPG in bone modeling and remodeling.Arch Biochem Biophys. 2008; 473: 139-146
- Root resorption and the OPG/RANKL/RANK system: a mini review.J Oral Sci. 2008; 50: 367-376
- Periodontal ligament cells secrete the factor that inhibits osteoclastic differentiation and function: the factor is osteoprotegerin/osteoclastogenesis inhibitory factor.J Periodontal Res. 2001; 36: 56-63
- Dental pulp and periodontal ligament cells support osteoclastic differentiation.J Dent Res. 2009; 88: 609-614
- Root resorption of dental and traumatic origin: classification based on etiology.Pract Periodontics Aesthet Dent. 1998; 10: 515-522
- Evidence for a dentin-derived inhibitor of macrophage spreading.Scand J Dent Res. 1987; 95: 381-388
- Evidence for a resorption inhibitor in dentine.Eur J Oral Sci. 1987; 95: 205-211
- Structure and function of RGD peptides involved in bone biology.Cell Mol Life Sci. 2003; 60: 119-132
- Involvement of alpha(v)beta3 integrins in osteoclast function.J Bone Miner Metab. 2007; 25: 337-344
- Enhancement of osteoclastic bone resorption and suppression of osteoblastic bone formation in response to reduced mechanical stress do not occur in the absence of osteopontin.J Exp Med. 2001; 193: 399-404
- OPN deficiency suppresses appearance of odontoclastic cells and resorption of the tooth root induced by experimental force application.J Cell Physiol. 2008; 214: 614-620
- Experimental internal resorption in monkey teeth.Endod Dent Traumatol. 1985; 1: 221-227
- Internal resorption.Oral Surg Oral Med Oral Pathol. 1972; 33: 2643-2682
- The anachoretic effect in root resorption: report of case.ASDC J Dent Child. 1980; 47: 53-55
- Idiopathic multiple internal resorption: report of case.ASDC J Dent Child. 1980; 47: 196-199
- A tooth with internal resorption treated with a hydrophylic plastic material: a case report.J Endod. 1981; 7: 430-432
- Internal resorption complicating orthodontic tooth movement.Br J Orthod. 1983; 11: 155-157
- Cracked tooth: an etiology for ‘idiopathic’ internal resorption?.J Endod. 1986; 12: 167-169
- An unusual case of idiopathic internal root resorption beginning in an unerupted permanent tooth.J Endod. 1986; 12: 309-310
- Double ‘pink tooth’ associated with extensive internal root resorption after orthodontic treatment: a case report.Dent Traumatol. 2009; 25: e43-e47
- Internal resorption in human teeth: a histological, scanning electron microscopic and enzyme histochemical study.J Endod. 1987; 6: 255-259
- Apical limit of root canal instrumentation and obturation: part I—literature review.Int Endod J. 1998; 31: 384-393
- Endodontic treatment of traumatized teeth.in: Andreasen J.O. Traumatic injuries of the teeth. Munskaard Publishers, Copenhagen1981: 321-383
- Effect of topical application of doxycycline on pulp revascularization and periodontal healing in reimplanted monkey incisors.Endod Dent Traumatol. 1990; 6: 170-176
- Tooth resorption.Quintessence Int. 1999; 30: 9-25
- Management of tooth resorption.Aust Dent J. 2007; 52: S105-S121
- Nonsurgical therapy for the perforative defect of internal resorption.J Am Dent Assoc. 1973; 87: 863-868
- The pathology of pink spots on teeth.Br Dent J. 1920; 41: 301-311
- Internal resorption of the dentine: a complication arising from unhealed pulp wounds.Br Dent J. 1965; 118: 241-249
- Osteocytes inhibit osteoclastic bone resorption through transforming growth factor-beta: enhancement by estrogen.J Cell Biochem. 2002; 85: 185-197
- Death of osteocytes turns off the inhibition of osteoclasts and triggers local bone resorption.Biochem Biophys Res Commun. 2005; 335: 1095-1101
- Osteocyte apoptosis controls activation of intracortical resorption in response to bone fatigue.J Bone Miner Res. 2009; 24: 597-605
- Immunocytochemical detection of apoptosis in human odontoblasts.Eur J Oral Sci. 1998; 106: 384-387
- In situ detection of apoptosis in dental and periodontal tissues of the adult mouse using annexin-V-biotin.Histochem Cell Biol. 2000; 113: 293-301
- Differential induction of apoptosis by capping agents during pulp wound healing.J Endod. 2003; 29: 41-43
- Apoptosis in developmental and repair-related human tooth remodeling: a view from the inside.Exp Cell Res. 2008; 314: 869-877
- A case of internal resorption following injury.Br Dent J. 1951; 90: 13-16
- Robbins: pathologic basis of disease.6th ed. WB Saunders, Philadelphia, PA1999 (36–7)
- Resorption and mineralization processes following root fracture of permanent incisors.Endod Dent Traumatol. 1988; 4: 202-214
- Stem cell properties of human dental pulp stem cells.J Dent Res. 2002; 81: 531-535
- Mesenchymal stem cells derived from dental tissues vs. those from other sources: their biology and role in regenerative medicine.J Dent Res. 2009; 88: 792-806
- Dentine regeneration: key roles for stem cells and molecular signalling.Oral Biosci Med. 2005; 2: 127-132
- Application of bioactive molecules in pulp-capping situations.Adv Dent Res. 2001; 15: 91-95
- Ultrastructural and immunocytochemical analyses of osteopontin in reactionary and reparative dentine formed after extrusion of upper rat incisors.J Anat. 2007; 210: 418-427
- Influence of TGF-beta1 on the expression of BSP, DSP, TGF-beta1 receptor I and Smad proteins during reparative dentinogenesis.J Mol Histol. 2008; 39: 153-160
- Genes affecting tooth morphogenesis.Orthod Craniofac Res. 2007; 10: 237-244
- Cell fate determination during tooth development and regeneration.Birth Defects Res C Embryo Today. 2009; 87: 199-211
- Different roles of Runx2 during early neural crest-derived bone and tooth development.J Bone Miner Res. 2006; 21: 1034-1044
- Runx2, osx, and dspp in tooth development.J Dent Res. 2009; 88: 904-909
- Mineralized tissue formation by BMP2-transfected pulp stem cells.J Dent Res. 2009; 88: 1020-1025
- Diseases of the dental pulp.in: Tieck R.W. Oral pathology. McGraw Hill, New York1965
- The role of the blood clot in endodontic therapy: an experimental histologic study.Acta Odont Scand. 1961; 19: 323-353
- Tissue formation in the root canal following pulp removal.Scand J Dent Res. 1971; 79: 333-349
- Tissue formation in the root canal after total pulpectomy and partial root filling.Oral Surg Oral Med Oral Pathol. 1978; 46: 275-282
- Pulp revascularization in reimplanted immature monkey incisors - predictability and the effect of antibiotic systemic prophylaxis.Endod Dent Traumatol. 1990; 6: 157-169
- Pulp revascularization of immature dog teeth with apical periodontitis.J Endod. 2007; 33: 680-689
- Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis.J Endod. 2010; 36: 56-63
- Fracture of tooth by internal resorption: case report.Endod Dent Traumatol. 1993; 9: 79-80
- The potential applications of cone beam computed tomography in the management of endodontic problems.Int Endod J. 2007; 40: 818-830
- Differential diagnosis of internal and external cervical resorption.J Endod. 1976; 2: 329-334
- Clinical, radiographic, and histopathologic features of invasive cervical resorption.Quintessence Int. 1999; 30: 27-37
- Invasive cervical resorption.Endod Topics. 2004; 7: 73-92
- The detection and management of root resorption lesions using intraoral radiography and cone beam computed tomography: an in vivo investigation.Int Endod J. 2009; 42: 831-838
- Accuracy of cone beam computed tomography and panoramic radiography for the detection of apical periodontitis.J Endod. 2008; 34: 273-279
- New dimensions in endodontic imaging: part 1—conventional and alternative radiographic systems.Int Endod J. 2009; 42: 447-462
- Radiographic manifestations of periapical inflammatory lesions.Endod Topics. 2004; 8: 55-67
- Cone-beam CT diagnostic applications: caries, periodontal bone assessment, and endodontic applications.Dent Clin North Am. 2008; 52: 825-841
- Cone beam CT in dental practice.Br Dent J. 2009; 207: 23-28
- Geometric accuracy of the NewTom 9000 Cone Beam CT.Dentomaxillofac Radiol. 2005; 34: 28-31
- Clinical indications for digital imaging in dento-alveolar trauma: part 2—root resorption.Dent Traumatol. 2007; 23: 105-113
- Endodontic applications of CBVT.J Endod. 2007; 9: 1121-1132
- Receiver operating characteristic analysis for the evaluation of diagnosis and prediction.Radiology. 2009; 253: 593-596
- Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology.Int Endod J. 2006; 39: 921-930
- Clinical radiographic, and histologic study of endodontic treatment failures.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1991; 71: 603-611
- Aetiology of root canal treatment failure: why well treated teeth can fail.Int Endod J. 2001; 39: 249-281
- Influence of residual bacteria on periapical tissue healing after chemomechanical treatment and root filling of experimentally infected monkey teeth.Eur J Oral Sci. 2006; 114: 278-285
- Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after ‘one-visit’ endodontic treatment.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 99: 231-252
- Apical limit of root canal instrumentation and obturation: part 2—a histological study.Int Endod J. 1998; 31: 394-409
- Efficacy of instrumentation techniques and irrigation regimens in reducing the bacterial population within root canals.J Endod. 2002; 3: 181-184
- On the causes of persistent apical periodontitis: a review.Int Endod J. 2006; 39: 249-281
- Histologic investigation of root canal-treated teeth with apical periodontitis: a retrospective study from 24 patients.J Endod. 2009; 35: 493-502
- The in vivo evaluation of hand/rotary/ultrasound instrumentation in necrotic, human mandibular molars.J Endod. 2007; 33: 782-787
- Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy.Scand J Dent Res. 1981; 89: 321-328
- Bacteriologic evaluation of the effect of 0.5 per cent sodium hypochlorite.Oral Surg Oral Med Oral Pathol. 1983; 55: 307-312
- Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis.Int Endod J. 1997; 30: 297-306
- Reduction of intracanal bacteria using GT rotary instrumentation, 5.25% NaOCl, EDTA and Ca(OH)2.J Endod. 2005; 31: 359-363
- Effects of chemomechanical preparation with 2.5% sodium hypochlorite and intracanal medication with calcium hydroxide on cultivable bacteria in infected root canals.J Endod. 2007; 33: 800-805
- The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals.Endod Dent Traumatol. 1985; 1: 170-175
- The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing.Int Endod J. 1991; 24: 119-125
- In vitro solubility of human pulp tissue in calcium hydroxide and sodium hypochlorite.Endod Dent Traumatol. 1992; 1: 170-175
- The effects of sodium hypochlorite and calcium hydroxide on tissue dissolution and root canal cleanliness.Int Endod J. 1997; 30: 335-342
- Apical actinomycosis as a continuum of intraradicular and extraradicular infection: case report and critical review on its involvement with treatment failure.J Endod. 2008; 34: 1124-1129
- Anatomical and microbiological challenges to achieving success with endodontic treatment: a case report.J Endod. 2008; 34: 1249-1254
- Effectiveness of different gutta-percha techniques when filling experimental internal resorptive cavities.Int Endod J. 2008; 41: 836-842
- Comparison of different techniques for obturating experimental internal resorptive cavities.Endod Dent Traumatol. 2000; 16: 116-121
- A new treatment modality for internal resorption.J Endod. 1986; 12: 315-319
- Treatment of internal root resorption with thermoplasticized gutta-percha: a case report.Int Endod J. 1987; 20: 94-97
- Tissue reaction to implanted Super EBA and Mineral Trioxide Aggregate in the mandible of guinea pigs: a preliminary.J Endod. 1995; 21: 569-571
- Comparison of Diaket and MTA when used as root-end filling materials to support regeneration of the periradicular tissues.Int Endod J. 2002; 35: 840-847
- Repair of root perforations using mineral trioxide aggregate: a long term study.J Endod. 2004; 30: 80-83
- Root canal filling with cements based on mineral aggregates: an in vitro analysis of bacterial microleakage.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 140-144
- Repair of perforating internal resorption with mineral trioxide aggregate: a case report.J Endod. 2003; 29: 538-539
- Treatment of inflammatory internal root resorption with mineral trioxide aggregate: a case report.Int Endod J. 2008; 41: 905-912
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Published online: May 20, 2010
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© 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
