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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 84-86

Endodontic management of internal inflammatory resorption


1 Lecturer, Department of Conservative Dentistry and Endodontics, Dr. G D Pol Foundation's Y M T Dental College and Hospital, Navi Mumbai, Maharashtra, India
2 Head of Department, Department of Conservative Dentistry and Endodontics, Dr. G D Pol Foundation's Y M T Dental College and Hospital, Navi Mumbai, Maharashtra, India

Date of Submission28-Jun-2020
Date of Acceptance24-Jul-2020
Date of Web Publication29-Sep-2020

Correspondence Address:
Dr. Rahul Paresh Ved
305 Mansarovar, MG Road, Vohra Colony, Kandivali West, Mumbai - 400 067, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_27_20

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  Abstract 


Management of internal resorptive defects are always a challenge for an endodontist. Internal resorption occurs mostly commonly due to trauma or a long stand chronic pulpal irritation following caries or trauma and is most commonly seen in the anterior teeth and sometimes in the posterior teeth as well. Early diagnosis and removal of underlying pathology are important for long-term success. The case paper reports nonsurgical management of a case of internal inflammatory resorption treated by root canal therapy followed by obturation with thermoplasticized gutta-percha.

Keywords: Internal resorption, thermoplasticized gutta percha, trauma


How to cite this article:
Ved RP, Hegde V. Endodontic management of internal inflammatory resorption. Int J Prev Clin Dent Res 2020;7:84-6

How to cite this URL:
Ved RP, Hegde V. Endodontic management of internal inflammatory resorption. Int J Prev Clin Dent Res [serial online] 2020 [cited 2020 Oct 24];7:84-6. Available from: https://www.ijpcdr.org/text.asp?2020/7/3/84/296538




  Introduction Top


Resorption is defined as a condition associated with either a physiologic or a pathologic process resulting in the loss of dentin, cementum, or bone.[1] Andreasen has classified tooth resorption as internal (inflammatory and replacement) and external (surface, inflammatory, and replacement).[2] The progressive destruction of intraradicular dentin and dentinal tubules along the middle and apical thirds of the canal walls due to the presence of osteoclastic activity is known as internal root resorption.[3] Traumatic injuries, bacterial infection, and orthodontic forces are some of the most common causes of internal root resorption. Internal resorption could be inflammatory in nature which is characterized by progressive loss of dentin which may communicate with the external surface if not contained or it could be replacement type which is characterized by deposition of hard tissue in the resorptive defect that is similar to bone or cementum but not dentin.[4],[5]

Internal resorptive defects are generally asymptomatic unless seen along the cervical line of the clinical crown which appears as a pink spot. Radiographic interpretation plays an important role in diagnosis. Treatment options include both surgical and nonsurgical approach based on the type of lesion and use of advanced technique of obturation using mineral trioxide aggregate or thermoplasticized gutta-percha depending on the clinical situation. The case presented in this article is of internal inflammatory resorption treated by nonsurgical modality by help of root canal therapy and thermoplasticized gutta-percha.


  Case Report Top


A young 15-year-old female patient was referred by a private practitioner to our operatory with a complaint of mild pain in the region of upper anterior. On detailed history, it was revealed that there was an episode of trauma 8–10 months back. On conducting visual examination, no evident discoloration or draining sinus or any other sign of any bacterial infection was noticed except in the upper right central incisor had a small GV Black's Class III carious lesion and the lateral incisor had similar carious lesion but seemed to be more extensive on visual examination. On conducting cold test with Endo-Ice, all teeth responded normally except for the lateral incisor which gave a delayed response. On shooting digital radiographs with the RVG device, a radiolucent balloon-shaped defect was observed confined to the dentinal wall at the junction of middle and apical one-third as seen in [Figure 1]. A diagnosis of internal inflammatory resorption was made. A decision to perform root canal therapy was taken. After administering sufficient local anesthesia, the tooth was isolated under a rubber dam. Access cavity preparation was performed under Carl Zeiss dental operating microscope. Working length determination using Root ZX Mini Apex Locator and confirming with radiograph was done. We were able to achieve patency as seen in [Figure 1]. After completing the shaping procedure, thorough disinfection with the help of 3% sodium hypochlorite with sonic activation was performed. Intracanal medicament in the form of calcium hydroxide was placed for 7 days. On recall, the patient was asymptomatic. Intracanal medicament was removed with the help of a master apical file and copious irrigation with sodium hypochlorite and ethylenediaminetetraacetic acid (EDTA) chelating liquid. Obturation was performed by selecting appropriate master cone and performing sectional obturation below the resorptive defect and the remaining canal was including the resorptive as seen in [Figure 1] defect was obturated with the help of an injectable warm gutta-percha device EQ-V in this case. After the procedure was completed, the cavity was temporized and the patient was referred back for coronal rehabilitation.
Figure 1: (a) Preoperative radiograph showing balloon-shaped radiolucency. (b) Working length determination. (c) Obturation completed

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  Discussion Top


Clinical occurrence of internal resorption is rare. In some studies, the occurrence of internal resorption has been estimated to be between 0.01% and 1%.[6] A study conducted by Gabor et al. reported an incidence of 50% occurrence of resorptive defects in teeth with pulpal inflammation, but they also reported that these defects were detected in anin vitro setup with size as small as 100 micrometer in depth and 200 Um in length, but in a clinical scenario, such small defects cannot be detected.[7]

The treatment of such cases although appears simple, but in reality, it is multifactorial. The first step involves arriving at an accurate diagnosis. In the above case, a past history of trauma has possibly led to necrosis of the pulp above the defect which could have caused constant chronic irritation to the pulp. Such a constant irritation can stimulate osteolytic activity that can lead to resorption; however, the delayed response of the tooth to cold test is suggestive of presence of some form of vitality of the pulp apical to the resorptive process. Furthermore, a typical ovoid or fusiform radiographic appearance and the absence of any external signs of communication lead to the diagnosis of internal inflammatory resorption.[8]

The effective treatment of internal root resorption is directed toward eliminating the inflamed pulp.

This is achieved by a combination of thorough shaping of the canal, disinfection with sodium hypochlorite, and management of the microflora with the help of calcium hydroxide intracanal medicament.[9] A two-visit approach was decided for the same reason. In the first visit, the shaping of the canal was done using NiTi Rotary files with tip size 35 and taper 4%. Irrigation with 3% sodium hypochlorite about 15 ml with sonic activation was done and intracanal medicament in the form of calcium hydroxide was placed. In the second visit, the use of liquid EDTA was incorporated as it is an effective chelating agent, especially when used in combination with sodium hypochlorite.[10]

Use of advanced aids of magnification like a dental operating microscope allows us to prepare conservative access cavities, and modern techniques of obturation such as thermoplasticized gutta are important for long-term success in such cases, especially when we are dealing with irregular areas such as a resorptive defect to achieve three-dimensional hermetic seal.[11]


  Conclusion Top


A detailed history and radiographic examination is imperative in cases like internal resorption, also cone-beam computed tomography can be incorporated in more complicated cases. The introduction of advanced mechanisms like dental operating microscope and thermoplasticized gutta-percha in endodontics is a boon and should gradually be the norm in clinical practice.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ne RF, Witherspoon DE, Gutmann JL. Tooth resorption. Quintessence Int 1999;30:9-25.  Back to cited text no. 1
    
2.
Tronstad L. Root resorption-etiology, terminology and clinical manifestations. Endod Dent Traumatol 1988;4:241-52.  Back to cited text no. 2
    
3.
Patel S, Ricucci D, Durak C, Tay F. Internal root resorption: A review. J Endod 2010;36:1107-21.  Back to cited text no. 3
    
4.
Mittal S, Kumar T, Mittal S, Sharma J. “Internal root resorption: An endodontic challenge”: A case series. J Conserv Dent 2014;17:590-3.  Back to cited text no. 4
  [Full text]  
5.
Fernandes M, de Ataide I, Wagle R. Tooth resorption part I-Pathogenesis and case series of internal resorption. J Conserv Dent 2013;16:4-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Haapasalo M, Endal U. Internal inflammatory root resorption: The unknown resorption of the tooth. Endod Topics 2006;14:60-79.  Back to cited text no. 6
    
7.
Gabor C, Tam E, Shen Y, Haapasalo M. Prevalence of internal inflammatory root resorption. J Endod 2012;38:24-7.  Back to cited text no. 7
    
8.
Darcey J, Qualtrough A. Resorption: part 1. Pathology, classification and aetiology. BR Dent J 2013;214:439-51.  Back to cited text no. 8
    
9.
Lima TF, Neto JV, de Jesus Soares A. Diagnosis and management of root resorption in traumatized teeth: Report of two cases. Eur J Gen Dent 2017;6:127-30.  Back to cited text no. 9
  [Full text]  
10.
Uzunoglu E, Turker SA, Ozcelik B. The effectiveness of various chelates used alone or in combination with sodium hypochlorite in the removal of calcium hydroxide from root canals. Saudi Endod J 2015;5:161-5.  Back to cited text no. 10
  [Full text]  
11.
Collins J, Walker MP, Kulild J, Lee C. A comparison of three gutta-percha obturation techniques to replicate canal irregularities. J Endod 2006;32:762-5.  Back to cited text no. 11
    


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