internal pathological resorption

Internal Pathological Resorption (IPR)

Internal pathological resorption, also known as internal root resorption or internal tooth resorption, is a rare and insidious pathological process that affects the dentin within the pulp chamber or root canal. This condition involves the progressive loss of dentin and sometimes enamel due to the activation of odontoclastic cells within the pulp space.

Characteristics

• Location: IPR occurs within the middle and apical thirds of the canal walls.
• Cause: The exact cause of IPR is not fully understood, but it is believed to be related to inflammation within the pulp space.
• Progression: IPR can progress significantly before detection, making its diagnosis and management a challenge.

Types

Internal pathological resorption can be classified into two types:

• Apical internal resorption: associated with periapical pathology and relatively common.
• Intra-radicular internal resorption: less common and often related to trauma or orthodontic tooth movement.

Key Points

• IPR is a rare condition, but its diagnosis and management are crucial to prevent further damage to the tooth.
• The condition can be caused by various factors, including inflammation within the pulp space.
• Early detection and treatment are essential to prevent progression of the condition.

References:

[3] Internal resorption is an inflammation process initiated within the pulp space with loss of dentin and possible invasion of cementum. (1) ... [6] In summary, internal resorption is the loss of dentin in the canal space, and is caused by multi-nucleated giant cells called dentinoclasts. [10] Internal resorption (IR) is a rare, insidious, resorptive pathological process, beginning in the pulpal space and extending into the surrounding dentin.

Early Signs and Symptoms of Internal Pathological Resorption

Internal pathological resorption, also known as internal root resorption, can be a challenging condition to diagnose in its early stages. However, there are some common signs and symptoms that may indicate the presence of this condition.

• Dark or pinkish discoloration: One of the earliest signs of internal pathological resorption is a dark or pinkish discoloration of the tooth, which can be visible on the surface of the tooth or in X-rays (see [3], [11]). This discoloration occurs due to the decomposition of the tooth structure from the inside outwards.
• Holes in the teeth: As internal pathological resorption progresses, small holes may appear on the surface of the tooth, which can be visible to the naked eye or detected through X-rays (see [10], [11]).
• Loose teeth: In advanced cases of internal pathological resorption, the affected tooth may become loose due to the weakening of its structure (see [11]).
• Tooth sensitivity: Some patients may experience tooth sensitivity or pain in the affected tooth, although this is not always a reliable indicator of internal pathological resorption.
• Redness and swelling of the gum: In some cases, internal pathological resorption can cause redness and swelling of the surrounding gum tissue (see [4], [8]).

Radiographic Signs

Internal pathological resorption can also be detected through radiographic examination. Some common radiographic signs include:

• A uniform, semicircular radiolucent area contiguous with the pulp (see [6])
• Radiolucency or darkening of the affected tooth on X-rays

It's essential to note that internal pathological resorption is often asymptomatic in its early stages and may go unnoticed for many years. Regular dental check-ups and X-rays can help detect this condition before it progresses to more severe stages.

References:

[3] May 29, 2019 — With internal resorption, a dentist or dental hygienist may notice dark spots inside your teeth that are visible in X-rays of your mouth. [4] Feb 16, 2023 — Symptoms of Dental Resorption · Redness and swelling of the gum [6] Jun 13, 2016 — Radiographically, a uniform, semicircular radiolucent area contiguous with the pulp is a sign of internal resorption (Figure 1). [8] May 28, 2024 — What are the Signs & Symptoms of Tooth Resorption? · Pain and swelling around the affected tooth [10] Dec 04, 2024 — Internal pathological resorption can cause small holes to appear on the surface of the tooth. [11] Nov 15, 2023 — Some warning signs include: Holes in the teeth. Dark or pinkish discoloration of the teeth. Loose teeth. Teeth that easily break or crack.

Diagnostic Tests for Internal Pathological Resorption

Internal pathological resorption is a challenging condition to diagnose, and various diagnostic tests are employed to confirm its presence. The following diagnostic tests are commonly used:

• Cone-Beam Computed Tomography (CBCT): CBCT scans provide a precise three-dimensional image of the tooth and surrounding bone, allowing for accurate diagnosis of internal pathological resorption [2].
• Dental Computer Tomography: This imaging technique is also widely used to diagnose internal pathological resorption, as it provides detailed images of the tooth and surrounding structures [4][5].
• Radiological Criteria: A change in the radiographic appearance of the tooth, such as a loss of lamina dura or a change in the periodontal ligament space, can indicate internal pathological resorption [4][5].

Other Diagnostic Tests

In addition to imaging tests, other diagnostic tests may be employed to confirm the presence of internal pathological resorption. These include:

• Clinical Examination: A thorough clinical examination is essential to rule out other conditions that may mimic internal pathological resorption.
• Pulpal Testing: Pulpal testing can help determine the vitality of the pulp and whether it is affected by the resorptive process.

References

[1] Jun 13, 2016 — Tooth resorption is defined as a physiologic or pathologic process that results in the loss of dental tissue, such as dentin and cementum. [2] The diagnosis of internal root resorption presents a significant challenge in clinical practice due to the absence of unified criteria and the diverse clinical presentations of the pathology. Accurate diagnosis often requires the use of advanced imaging techniques such as cone-beam computed tomography (CBCT), which provides a more precise three-dimensional image of the tooth and surrounding bone. [4] The leading role belongs to dental computer tomography. One of the radiological criteria of pathological tooth resorption is a change in the ... [5] by N Gadzhula · 2024 — The leading role belongs to dental computer tomography. One of the radiological criteria of pathological tooth resorption is a change in the ...

Internal pathological root resorption, also known as internal inflammatory root resorption, is a condition where the dentin and pulp tissue within the tooth are affected by inflammation and subsequent destruction of the dental hard tissues.

Treatment Options

The primary treatment for internal pathological root resorption involves addressing the underlying cause of the condition. This may include:

• Root Canal Therapy: The removal of infected or damaged pulp tissue from the tooth, followed by the cleaning and disinfection of the root canal system.
• Calcium Hydroxide Use: Calcium hydroxide has been shown to be effective in treating internal inflammatory resorption (IIR) as it has several modes of action, including the induction of a chemical barrier against bacterial invasion [8].
• Bioactive Materials: The use of bioactive materials such as calcium hydroxide or other medicaments may be applied within the root canal system to promote healing and prevent further destruction.

Other Considerations

In some cases, treatment for internal pathological root resorption may also involve:

• Removal of an adjacent impacted tooth: If the resorption is caused by an adjacent impacted tooth, removal of this tooth may be necessary.
• Eradication of a cyst or tumor: In rare cases, the resorption may be caused by a cyst or tumor. Eradication of this lesion may be required.

Treatment Outcomes

The success of treatment for internal pathological root resorption depends on various factors, including:

• Degree of perforation: The extent to which the tooth structure has been compromised.
• Amount of remaining tooth structure: The amount of healthy tooth structure remaining.
• Experience of the clinician: The skill and experience of the dentist or endodontist performing the treatment.

It is essential to note that internal pathological root resorption can be a challenging condition to treat, and success rates may vary depending on individual cases [15].

References:

[8] PV Abbott (2022) - Calcium hydroxide in the treatment of internal inflammatory resorption. [15] Internal tooth resorption: A review of the literature.

Understanding Internal Pathological Resorption

Internal pathological resorption (IPR) is a complex dental condition that requires accurate diagnosis to ensure proper treatment. The differential diagnosis of IPR involves identifying the underlying causes and distinguishing it from other similar conditions.

Key Factors in Differential Diagnosis

• Radiographic findings: A thorough examination of radiographs is crucial in diagnosing IPR. Look for signs such as a well-defined radiolucent area within the root canal, often accompanied by a thin layer of dentin surrounding the resorbed area [2].
• Clinical symptoms: Patients with IPR may exhibit symptoms like pain, swelling, or sensitivity to temperature changes. However, these symptoms can also be present in other conditions, making it essential to consider them in conjunction with radiographic findings.
• Dentin wall thickness: The thickness of the dentin wall surrounding the resorbed area is a critical factor in differentiating IPR from other conditions. A considerable amount of pulpal dentin wall must be resorbed to be reliably detected on radiographs [2].
• Cone beam computed tomography (CBCT): CBCT has enhanced the clinician's capability of diagnosing IPR by providing detailed images of the affected area [4].

Distinguishing IPR from Other Conditions

• Internal resorption: IPR can be distinguished from internal resorption, which is a more common condition characterized by the resorption of dentin within the root canal. Internal resorption typically presents with a larger radiolucent area and less distinct dentin walls [2].
• External root resorption: IPR can also be differentiated from external root resorption, which involves the loss of tooth structure due to external factors like trauma or orthodontic treatment. External root resorption often presents with a more pronounced cervical resorption sign [6].

Conclusion

The differential diagnosis of internal pathological resorption requires a comprehensive evaluation of radiographic findings, clinical symptoms, dentin wall thickness, and CBCT images. By considering these factors, clinicians can accurately diagnose IPR and provide appropriate treatment to prevent further complications.

References:

[1] B Blicher — Resorption occurs when developmental precementum or predentin are lost or damaged and inflammation of the adjacent soft tissues allows for clastic cell activity. [2] P Thomas · 2014 · Cited by 71 — The diagnosis of internal resorption is mainly based on radiographs. A considerable amount of pulpal dentin wall must be resorbed to be reliably detected in the literature. [3] May 17, 2023 — Both resorptive dental diseases and physiologic resorption associated with the exfoliation of primary teeth share a common pathogenesis. [4] by S Patel · 2010 · Cited by 507 — From a differential diagnosis perspective, the advent of cone beam computed tomography has considerably enhanced the