Resorption is considered to such a condition which is associated with physiologic and pathologic process which results in the loss of dentin, bone and cementum. Its etiology initiates from various injuries to the tooth which may include thermal, mechanical and chemical injuries.
Different Types of Root Resorption
Presently there exist two different types of root resorption which include the following:
- External resorption – In case of external root resorption, the same gets initiated in the periodontium and initially affects the external surfaces of tooth. It can be further classified as surface, inflammatory, replacement or by cervical, lateral and apical location.
- Internal resorption – In case of internal root resorption, the inflammatory process is initiated within the pulp space with loss of dentin along with possible invasion of cementum.
The pathology associated with internal resorption is caused due to transformation of normal pulp tissue into granulomatous tissues along with giant cells, known for resorbing dentin. The main classifications associated with the same can be specified as under:
- Inflammatory resorption – In an inflammatory resorption, the resorptive process in case of intra-radicular dentin progresses without adjunctive deposition of hard tissues adjacent to resorptive sites. The phenomenon is associated with presence of granulation tissues and easily identifiable with routine radiographs.
- Replacement resorption - In case of replacement resorption, the resorptive activity leads to the building of several defects in the dentin which is adjacent to the root canal along with concomitant deposition of bone like tissue. This results in an irregular enlargement of pulp space with partial or full obliterated area of the pulp chamber.
Recent studies have revealed the fact that trauma and pulpal infection are the two major contributory factors in the initiation of internal root resorption. It is typically detected clinically via routine radiographs. This is mainly observe in all areas of the root canal but is most commonly discovered in the cervical region of tooth. In a recent study conducted regarding the diagnosis of IRR, 43% of the patients hold trauma as common etiological factor following carious lesions at 25%.
Proper observation of defined outline of the pulp chamber is one of the key ways to diagnose internal resorption. The presence of pulp chamber outline is within the lesion, it refers to internal resorption. If the same is recognizable within radiolucent halo then it refers to external root resorption.
CBCT – Permits Accurate and Complete Diagnosis
As the usage of CBCT allows highly accurate and complete diagnosis of IRR, it is highly recommended in early presentations of potential resorption. As per Wimpole street dentist, though IRR is usually asymptotic, pain and discomfort can be considered to be the chief complaint in case of exposure of granulation tissue to oral fluids.
The pink shade is highly related to the vascular connective tissue which is adjacent to the resorbing cells. When the pulp becomes necrotic, it turns out to be grey. Teeth with IRR typically respond normally to the pulpal as well as periapical tests until significant growth of the size of lesion. It finally turns into perforation!
Rendering of Treatment and Prognosis
After necrosis of the pulpal tissue, the typical symptoms of an abscessing tooth get reflected. As vital pulp tissue is required for IRR, in case of complete pulpal necrosis, the growth of resorption ceases as resorbing cells are cut off from nutriments and blood supply. After getting diagnosed by dentist in W1, treatment considerations and prognosis get rendered.
Initiation of root canal therapy is highly recommended in case removal of vital tissue ceases progression of lesion. Still, the prognosis of long term form and function of the tooth is dependent on the size of the lesion. Dentists are still on their own way to opt for further research studies regarding the same!
Reflection by Radiographs
Radiograph reveals significant bone loss around tooth in addition to the focalized loss of internal tooth structure in the apical one-third of the root in case of a loose front tooth. Sometimes perforation is also observed. Clinical exam revealed lack of recession probing depths of 8+ mm with class III mobility. Frequent dental visits after placing of crowns in the anterior area also results into such complicated issues!
Different forms of diagnosis of both internal and external resorption exist. Though earlier radiographs may aid differently in a more accurate and definitive diagnosis, internal resorption was due to the focal point of radio-lucency within the pulp chamber area. Due to extent of the associated defect and advanced bone loss along with periodontal disease, removal of tooth is recommended.
Assessing of Restoration Options – Also Recommended
Also assessing of other restoration options is also sometimes recommended. Upon removal of tooth, little root structure remains as it comes out in multitude of pieces. Internal root resorption is observed by Wimpole street dentist on a daily basis which is rare than external resorption. Root problems are generally neglected, but needs due extra attention.
The rendered treatment becomes highly favorable with early detection especially by the use of technology and CBCT scans, proper diagnosis and management. A wide number of resources are available which have been known to offer significant aid in the diagnosis and proper treatment of such lesions. This will enable proper maintenance of oral health hence preventing further spread of infections.
