Resorption of Teeth

Resorption of a tooth may begin either on the external surface (arising as a result of a tissue reaction in
the periodontal or pericoronal tissue) or inside the tooth (from a pulpal tissue reaction), the general
terms ‘external resorption’ and ‘internal resorption’ are used to distinguish between the two types.
The chief causes or situations in which resorption may occur are as follows:
External resorption
• Periapical inflammation • Reimplantation of teeth • Tumors and cysts
• Excessive mechanical or occlusal forces • Impaction of teeth • Idiopathic
Internal resorption • Idiopathic

External Resorption
Resorption Associated with Periapical Inflammation
Resorption of calcified dental tissues occurs in the same fashion as that of bone, and in most instances,
the presence of osteoclasts is an outstanding feature in areas of active resorption.
A periapical granuloma occasionally causes resorption of the root apex if the inflammatory lesion
persists for a sufficient period of time.
Bone is more readily resorbed than dental tissue because bone is always destroyed when a periapical
granuloma develops, whereas resorption of the tooth root without loss of bone seldom occurs except at
a microscopic level.

Reimplanted Teeth
The reimplantation almost invariably results in severe resorption of the root. The implanted tooth is
comparable to a bone graft which acts only as a temporary scaffold and is ultimately resorbed and
replaced. The tooth root is resorbed and replaced by bone, producing an ankylosis. If the tooth root
does not become completely resorbed, the ensuing ankylosis may result in a functional tooth.

Tumors and Cysts

Resorption by tumors or cysts appears to be essentially a pressure phenomenon.
Benign lesions are more likely to produce displacement than actual destruction of the tooth. In most
cases connective tissue is present between the tumor and the tooth, and it is from this tissue that cells
develop, chiefly osteoclasts, which appear responsible for the root resorption.
Cysts cause root resorption by pressure, although displacement of the tooth is more common than
resorption. An apical periodontal cyst arising as a result of pulp infection may exert such pressure on the
apex of the involved or adjacent tooth that the intervening connective tissue is stimulated, osteoclasts
form, and resorption begins.

Excessive Mechanical or Occlusal Forces

The usual form of excessive mechanical force with which root resorption may be associated is that
applied during orthodontic treatment.

Impacted Teeth
Teeth that are completely impacted or embedded in bone occasionally will undergo resorption of the
crown or of both crown and root.
Internal Resorption: (Chronic perforating hyperplasia of pulp, internal granuloma, odontoclastoma,
pink tooth of Mummery)
Internal resorption is an unusual form of tooth resorption that begins centrally within the tooth,
apparently initiated, in most cases, by a peculiar inflammatory hyperplasia of the pulp.
The cause of the pulpal inflammation and subsequent resorption of tooth substance is unknown,
although an obvious carious exposure and accompanying pulp infection are sometimes present.
It is even possible that true internal resorption does not exist but rather is a result of resorption of the
tooth and invasion of the pulp by granulation tissue arising in the periodontium.

Clinical Features
The first evidence of the lesion may be the appearance of a pink-hued area on the crown of the tooth,
which represents the hyperplastic, vascular pulp tissue filling the resorbed area and showing through
the remaining overlying tooth substance.
In the event that the resorption begins in the root, there are no significant clinical findings.
It is unusual for more than one tooth in any given patient to be affected by internal resorption.
The individual tooth involved may be any tooth.

Radiographic Features
The involved tooth exhibits a round or ovoid radiolucent area in the central portion of the tooth,
associated with the pulp but not with the external surface of the tooth unless the condition is of such
duration that perforation has occurred.
Complete perforation is not an uncommon finding if the tooth is left untreated.

Histologic Features
Microscopic examination of a tooth with internal resorption shows a variable degree of resorption of the
inner or pulpal surface of the dentin and proliferation of the pulp tissue filling the defect.
The resorption is of an irregular lacunar variety showing occasional osteoclasts or ‘odontoclasts’, hence
the term ‘odontoclastoma’.
The pulp tissue usually exhibits a chronic inflammatory reaction.
Sometimes the tooth exhibits alternating periods of resorption and repair, as manifested by irregular
lacuna-like areas in the dentin that are partially or completely filled in with irregular dentin or
osteodentin, which itself is undergoing resorption.
As the resorptive process advances, the dentin may be completely resorbed in a narrow segment.
The enamel is also resorbed if the lesion is situated in the coronal portion of the tooth.
If the lesion is in the root, perforation of the dentin and cementum may occur, which, if left untreated,
may eventually result in complete separation of the apical portion from the remainder of the tooth.
When the root surface is perforated, it is impossible to determine whether the lesion began ‘externally’
or ‘internally’.

Treatment and Prognosis

If the condition is discovered before perforation of the crown or root has occurred, root canal therapy
may be carried out with the expectation of a fairly high degree of success. Once perforation has
occurred, the tooth must usually be extracted.
Hypercementosis: (Cementum Hyperplasia)

Hypercementosis is a non-neoplastic condition in which excessive cementum is deposited in

continuation with the normal radicular cementum.
Hypercementosis may be regarded as a regressive change of teeth characterized by the deposition of
excessive amounts of secondary cementum on root surfaces.

This most commonly involves nearly the entire root area, although in some instances the cementum
formation is focal, usually occurring only at the apex of a tooth.

Etiology

• Accelerated elongation of a tooth

• Inflammation about a tooth
• Tooth repair
• Osteitis deformans, or Paget’s disease of bone.
In addition, hypercementosis of unknown etiology may occur either in a generalized form, involving all
the teeth, or in a localized form, involving one tooth.

Clinical Features
Hypercementosis produces no significant clinical signs or symptoms indicative of its presence.
There is no increase or decrease in tooth sensitivity, no sensitivity to percussion unless periapical
inflammation is present, and no visible changes in gross appearance in situ.
When the tooth with hypercementosis is extracted, the root or roots appear larger in diameter than
normal and present rounded apices.

Radiographic Features
Hypercementosis, of any significant degree, is distinguished by the thickening and apparent blunting of
the roots.
The roots lose their typical ‘sharpened’ or ‘spiked’ appearance and exhibit rounding of the apex.

It is generally impossible to differentiate the root dentin from the primary or secondary cementum
radiographically; therefore the diagnosis of hypercementosis is established by the shape or outline of
the root rather than by any differences in radiodensity of the tooth structure.

Histologic Features
The microscopic appearance of hypercementosis is a characteristic one in which an excessive amount of
secondary or cellular cementum is found deposited directly over the typically thin layer of primary
acellular cementum.
The area involved may be the entire root or only a portion, typically the apical region.

The secondary cementum has been termed ‘osteocementum’ because of its cellular nature and its
resemblance to bone.
This cementum typically is arranged in concentric layers around the root and frequently shows
numerous resting lines, indicated by deeply staining hematoxyphilic lines parallel to the root surface.