Pathological resorptions of the dental hard tissues

Mateusz Radwański, DMD, PhD

Department of Endodontics
 RESORPTIONS
INTERNAL RESORPTION EXTERNAL RESORPTION
1. Inflammatory, due to extent and localization includes:
According to the main etiological factor and
• chamber (coronal resorption - type A)
pathogenesis:
• tooth canal (canal resorption - type B)
• through the destruction of tissues, it breaks into the 1. Apical root inflammatory resorption caused by
periodontal (internal C-type resorption) chronic inflammation of the periapical tissues
2. Cervical resorption.
3. Ankylosis and replacement resorption.
4. Resorption caused by the chronic mechanical
injuries.
5. Resorption in systemic diseases.

Katarzyna Fabjańska, DMD, PhD

2. Replacement
INTERNAL RESORPTION
 • chronic inflammation of the pulp, necrosis
• pulpotomy, direct capping (with CH-calcium hydroxide*)
• traumatic factors: restorations, excessive heat generated
during preparation
• materials: silver nitrate, silicon fillings

Etiology of internal resorption • genetic factors

• pregnancy, shingles
• general diseases: hyperparathyroidism, liver disorders,
hypertension, atherosclerosis, lack of vit. A
• factor that is difficult to determine: idiopathic resorption

*1. The irritating effect of CH on monocytes, which transform into osteoclasts,

2. Pre-existing (before pulpotomy), more advanced pulp inflammation than indicated by clinical symptoms
 THE X-RAY IMAGES

oval / spherical shape with regular and clearly demarcated walls

constant saturation of the resorptive cavity

symmetrical arrangement relative to canal

fixed position of resorption regardless of the angle at which the X-ray

picture is taken

smooth passage of the resorption cavity into adjacent tissues

 CBCT

A B C

Internal resorption of 21 (type B).

A- axial, B- horizontal, C- sagittal
Case report #1
45-year-old patient was referred to the dental office
for endodontic treatment of 22.
Medical History: Irrelevant.
Subjective symptoms: No symptoms.
Objective symptoms: No response in thermal (cold,
hot) and electrical test, no reaction on palpation
and percussion.
RVG: oval, symmetrical radiolucency associated
with the root canal.
Diagnosis: internal resorption type B.
Case report #1- treatment
Ist appointment:
✓ Infiltration anesthesia with Septanest
200 (articaine), rubber dam isolation.
✓ Chemo-mechanical shaping with
ultrasonic irrigation (5,25% NaOCl).
✓ Intracanal dressing- Biopulp (calcium
hydroxide).
IInd appointment:
✓ Rubber dam. Removal of calcium
hydroxide, final rinsing.
✓ Obturation with lateral compaction
technique (GP+ Ah plus) to the level of
the resorptive cavity, resorptive cavity
and coronal part of canal were filled
with thermal injection technique
(BeeFill 2in1).
Case report #2
28- year-old patient reported to the dental office due to
pain of tooth 12.
Medical History: Irrelevant.
Subjective symptoms: Spontaneous pain, lasted 5 days,
at night, pulsating.
Objective symptoms: Excessive restoration in tooth 12,
prolonged reaction to cold, negative palpation and
percussion tests.
RVG: oval radiolucency associated with root canal and
radiolucency located on the lateral wall of root (red
arrow).
Diagnosis: internal resorption type C (with perforation).
 Case report #2- treatment
Ist appointment:
✓ Infiltration anesthesia with Septanest 200 (articaine), rubber dam isolation.
✓ Chemo-mechanical shaping with ultrasonic irrigation (5,25% NaOCl), persistent bleeding despite
preparation (indicating the presence of perforation).
✓ Intracanal dressing- Biopulp (calcium hydroxide).
IInd appointment:
✓ Rubber dam. Removal of calcium hydroxide, final rinsing.
✓ Obturation with lateral compaction technique (GP+ Ah plus) to the level of the resorptive cavity,
✓ Resorptive cavity was filled with ProRoot MTA, then the moist cotton pellet and temporary filling
were placed.
IIIrd appointment:
✓ Rubber dam. Coronal part of canal were filled with thermal injection technique + Ah plus (BeeFill
2in1).
EXTERNAL RESORPTION
 • chronic inflammation of the periapical tissues (granulomas and
cysts)
• orthodontic treatment
• tooth injuries (e.g. avulsion, subluxation)
• replantation
• non-vital teeth whitening (perhydrol, sodium perborate)
Etiology of • pressure from adjacent teeth, tumors and cysts
external • teeth retained in the alveolar process
• periodontal disease
resorption • systemic diseases (Paget's disease, Turner, Kabuki syndrome -
resorption of lower roots of central incisors and molars)
• radiotherapy
• spontaneous (idiopathic)
 THE X-RAY IMAGES

no clear separation of the resorption loss

unbalanced position relative to the center of the canal

different saturation, irregular shape

differences in saturation of the natural tooth cavity and

resorption cavity

occurrence on all root surfaces

 CBCT
A B C

External resorption of 11.

A- axial, B- horizonal, C- sagittal
 External resorption
According to the main etiological factor and pathogenesis:

1. Apical root inflammatory resorption caused by chronic inflammation

of the periapical tissues
2. Cervical resorption.
3. Ankylosis and replacement resorption.
4. Resorption caused by the chronic mechanical injuries.
5. Resorption in systemic diseases.
Apical root inflammatory resorption caused by
chronic inflammation of the periapical tissues
Case report #3
56- year- old patient reported to the dental
office for molar treatment. During clinical
examination, the discoloration of 21 was
noticed.
Medical History: Irrelevant.
Dental History: Teeth trauma in childhood
(11,21).
Subjective Symptoms: Tooth discoloration
(dark brown, bluish), no cavities or fillings in
the crown, no pain.
Objective Symptoms: No reaction in thermal,
electrical and percussion tests, no mobility.
RVG: radiolucency in the apical region of 21 Anna Dejak- Kępka, DMD
and open apex.
Case report #3- treatment
Ist appointment:
• Rubber dam. Trepanation. The X-ray with the file
for working length determination. The patient
was referred for CBCT due to different dentin
saturation at the apex.
• Rinsing with 5,25% NaOCl and saline.
• Chemo-mechanical shaping with step-back
technique (MAF=70).
• Intracanal dressing- calcium hydroxide
(Calcipast) and temporary filling.

Anna Dejak- Kępka, DMD

Case report #3- treatment
• CBCT: irregular defects of root
apex dentine and bone loss.
• Diagnosis: external apical root
resorption.

Anna Dejak- Kępka, DMD

Case report #3- treatment
IInd appointment:
• Rubber dam. Ultrasonic irrigation.
MTA plug.
• Cotton pellet and temporary
filling.
IIIrd appointment:
• Rubber dam. Back-fill with
injection technique of warm
gutta-percha. Flow Color.
• RVG.
• Final restoration with composite.
• After the healing of periapical
tissues, the prosthetic restoration
with fiber post was planned.

Anna Dejak- Kępka, DMD

 Case report #4
The patient reported to the dental office due to
cavity and tooth discoloration.
Medical and Dental History: 6 year after trauma
of maxillary teeth. MH: Irrelevant.
Subjective Symptoms: cavity located on the
palatal surface, tooth discoloration.
Objective Symptoms: no mobility, positive
reaction in thermal tests, no reaction to
percussion.
Buccal side: pink tooth.
Palatal side: a visible defect in hard tissues
revealing the exposed pulp, slightly painful on
probing.
Katarzyna Fabjańska, DMD, PhD
 Case report #4

RVG: oblique fracture line in one thirds of

coronal part, extensive loss of hard tissue
in the crown, ,,cup-shaped" defects on the
outer surfaces of the apical fragment.
Diagnosis: internal resorption type A and
external replacement resorption as a late
post-traumatic complications.

Katarzyna Fabjańska, DMD, PhD

 Case report #4- treatment
Ist appointment:
✓Infiltration anesthesia with Ubistesin 200
(articaine) 1amp, rubber dam.
✓Cleaning of resorptive cavity with diamond and
rose bur, restoration of crown with composite.
✓WL (working length) measurement to the fracture
line, confirmed with RVG.
✓Shaping of coronal part, ultrasonic irrigation with
5,25% NaOCl (sodium hypochlorite).
✓Intracanal dressing- calcium hydroxide and
temporary filling.

Katarzyna Fabjańska, DMD, PhD

 Case report #4- treatment
IInd appointment:
✓Infiltration anesthesia with Ubistesin 200
(articaine) 1amp, rubber dam.
✓Removal of temporary filling, 5,25%
NaOCl + ultrasounds, obturation with
Biodentine, after 15 minutes orifice
covered with flow, final composite
restoration.
✓RVG.

Katarzyna Fabjańska, DMD, PhD

 Case report #5
55-year-old patient reported to the dental office due to
discoloration of 11.
Medical History: hypertension, no allergies.
Subjective Symptoms: No reported.
Objective Symptoms: Pink discoloration located in the cervical
region, pathological sulcus (depth 5 mm) from buccal side,
inflammatory granulation tissue during probing, no reaction in
thermal and palpation tests.
Zdjęcie RVG:, radiolucency in the cervical region, asymmetrical
to the root canal.
Rozpoznanie: cervical, inflammatory resorption.
Case report #5- treatment

Michał Łęski, DMD, PhD

 Case report #5- treatment

Resorption cavity was filled with composite material Michał Łęski, DMD, PhD
 Case report #5- treatment

Before treatment After 5 weeks

Michał Łęski, DMD, PhD
 Ankylosis and replacement resorption

If the trauma causes damage

Mostly appeared after tooth
replantation (avulsion)
more than 20% of the root
It is an irreversible form of
cementum surface, healing
resorption (fails to stop
occurs in an atypical form
after root canal treatment).
(root fusion with the
alveolus- ankylosis).

The features of ankylosis:

✓ fusion of the tooth with the alveolus,
✓ no mobility,
✓ METALLIC sound during percussion,
✓ X-ray: no periodontal space.
 Orthodontically Induced Inflammatory Root Resorption – OIIRR

• More often in maxillary than mandibular teeth (McFadden i wsp., 1989).

• In most cases upper maxillary incisors are affected (Beck i Harris, 1994; Goldson i Henrikson, 1975).
• The location and extent of resorption depend on direction, duration of action and the amount of
force applied in the orthodontic appliance.
• More extensive resorption after treatment with fixed braces (higher pressure); for prophylactic
purposes, breaks in orthodontic treatment are recommended.
• Heavy root apex resorption concerns 1-10% of patients, mild - about 48-66% (Pogorzelska i wsp.
2019).

Treatment:
✓Vital teeth- no treatment needed, control and RVG;
✓Depending on the progress of the resorption process: the treatment stop, or forces reduction should
be considered;
✓In non-vital teeth- endodontic therapy.
 Individual and orthodontic factors influencing
the formation of resorption
Features Predisposing factors
Age Over 11 years old
Teeth group (in order of the most susceptible to OIIRR) Maxilla: lateral and central incisors, canines
Mandible: canines, central and lateral incisors
Shape of the roor Bottle or pointed roots

The duration of the treatment More than 2-3 years

Type of malocclusion Open bite
Forces The use of high alternating forces, large tooth shifts,
elastic lifts
Mechanics of treatment Intrusion mechanics combined with anterior retraction

Type of the orthodontic appliance Fixed

Anna Pogorzelska, Anna Stróżyńska-Sitkiewicz, Kazimierz Szopiński Resorpcja korzeni indukowana leczeniem ortodontycznym – przegląd piśmiennictwa.
Nowa Stomatol 2019; 24(2):48-55 DOI: https://doi.org/10.25121/NS.2019.24.2.48)
Resorption after orthodontic treatment
Thank you for your attention