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Catherine A. Hebert, D.D.S .: Internal Vs External Resorption

This document summarizes and differentiates between internal and external root resorption. Internal resorption originates from within the pulp chamber and results from chronic pulpitis. It appears as a smooth widening of the root canal walls and is usually asymptomatic. Treatment involves root canal therapy to remove the inflamed pulp. External resorption originates from the periodontal ligament and appears as an irregular radiolucent area overlying the root canal. Extra canal invasive resorption is an uncommon and aggressive form of external resorption, with various etiologies and classifications. Treatment depends on the classification and may involve root canal therapy, restoration of defects, or extraction.

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471 views2 pages

Catherine A. Hebert, D.D.S .: Internal Vs External Resorption

This document summarizes and differentiates between internal and external root resorption. Internal resorption originates from within the pulp chamber and results from chronic pulpitis. It appears as a smooth widening of the root canal walls and is usually asymptomatic. Treatment involves root canal therapy to remove the inflamed pulp. External resorption originates from the periodontal ligament and appears as an irregular radiolucent area overlying the root canal. Extra canal invasive resorption is an uncommon and aggressive form of external resorption, with various etiologies and classifications. Treatment depends on the classification and may involve root canal therapy, restoration of defects, or extraction.

Uploaded by

James Oneal
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

A Professional Dental Corporation

Catherine A. Hebert, D.D.S .

Internal vs External Resorption


Resorption is considered to be internal if the original site of the resorption starts in the pulp and external if the original site is the periodontal ligament.

Internal
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Characteristics
Asymptomatic Pink discoloration Pulp test usually normal Defect moves with X-ray angulations Pulpal wall often intact radiographically Pulpal wall intact histologically Periodontal percussion, palpation WNL Portals of entry near osseous crest Portals of entry hard to locate surgically
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External

OdontoblastsClasts

Osseous CellsClasts

Internal Resorption Internal resorption results from a chronic pulpitis, although why some teeth are affected more dramatically than others is not known. Trauma and infection are important etiological factors. The typical appearance is a smooth widening of the root canal walls. On rare occasions (when the pulp chamber is affected) it may appear as a pink spot as the enlarged pulp is visible through the thin wall of the crown. Any tooth may be affected but the incidence is highest in incisors. The destruction of dentin may take years or may be very rapid. The pulp usually remains vital and symptomless until the wall of the root is perforated, when it may become necrotic. Diagnosis of Internal Resorption In most cases diagnosis is simple but occasionally it may be difficult to differentiate between internal and external resorption. In internal resorption the outline of the canal is interrupted and usually appears as a smooth bulge. Internal resorption is often difficult to detect in posterior teeth and may be seen only after root treatment has been completed. Treatment for Internal Resorption Prompt root canal treatment is necessary in all diagnosed cases of internal resorption. The resorption ceases as soon as the chronically inflamed pulp is removed. Treatment complications that may occur are as follows: Hemorrhage (Excessive); Perforation; Inter appointment medication with CaOH2 dressing; Warm gutta percha obturation; Surgical treatment for perforations.

External Resorption
External resorption originates in the PDL and is recognized by an irregular radiolucent area overlying the root canal; the canal outline remains visible and intact. Sometimes external resorption is not easy to diagnose from the radiograph when the canal outline is indistinct. Three types of external resorption are: o Inflammatory Resorption Result of trauma, orthodontics, or pulpal necrosis o Replacement Resorption Ankylosis o Extra Canal Invasive Resorption Variable, may have inflammation and/or replacement

Extra Canal Invasive Resorption (ECIR)


ECIR is a clinical term used since 1998 to describe an uncommon, insidious and often aggressive form of external resorption.

Heithersays Classifications for ECIR ECIR Etiology


Bleaching endodontically treated teeth Certain systemic diseases Excessive mechanical or occlusal forces Idiopathic Impaction of teeth Luxation injuries Periapical inflammation due to a necrotic pulp Periodontal disease Radiation therapy Reimplantation of teeth Tumors and cysts

Treatment for ECIR


Identify & remove cause and predisposing factors Class 1 Possible RCT and restore defect Class 2 RCT and restore defect Class 3 RCT and surgically restore defect Class 4 Extraction/replace tooth Follow up with 6 month recare appointments

References:
Andreasen, J.O., Andreasen, F.M., Essentials of Traumatic Injuries to the Teeth, pp. 116-9 Heithersay, G, Invasive Cervical Resorption, Endodontic Topics 2004,7,73-92 Frank A, Torabinejad M, Diagnosis and Treatment of Extra Canal Invasive Resorption JOE 1998.7 500-504 Stropko,J., AMED Meeting Oral Presentation, November 2004 Walker, R., et al, Color Atlas and Text of Endodontics, pp.201-5 Cohen, S., Burns, R., Pathways of the Pulp Eigth Edition, pp. 626-31 http://www.rxroots.com/downloads/PDF_Files/Cervical%20resorption%20Heithersay.pdf

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