root resorption

What is Root Resorption?

Root resorption is a serious oral issue that can potentially cause someone to lose one or more of their teeth [1]. It is the non-bacterial destruction of the mineralized cementum or dentine due to the interaction of clastic cells and dental hard and soft tissues [2, 3].

Causes and Types

Root resorption can occur on both external and internal surfaces of a tooth. The process can be self-limiting, but in some cases, it can lead to progressive destruction and eventual loss of tooth root dentin and cement [4]. There are two main types of root resorption: internal and external.

• Internal Root Resorption: This type occurs within the tooth itself, often due to trauma or infection. It can be further divided into three subtypes:
  • Cement or superficial resorption with further remodeling
  • Internal resorption with dentin formation
  • Internal resorption without dentin formation [5]
• External Root Resorption: This type occurs on the surface of the tooth, often due to mechanical or chemical stimuli such as infection, pressure, trauma, or orthodontic tooth movement. It tends to occur more frequently in people aged between 21 and 30 years [6].

Symptoms and Diagnosis

Root resorption is usually discovered during routine dental examinations. Timely diagnosis and prompt treatment play a major role in saving

Understanding Root Resorption: Signs and Symptoms

Root resorption is a condition where the body's cells break down tooth roots, typically to facilitate the transition from baby teeth to permanent teeth. However, this process can also occur due to various factors such as trauma, orthodontic treatment, infections, and genetic predisposition.

Common Symptoms of Root Resorption:

• Tooth Sensitivity: One of the earliest signs of root resorption is tooth sensitivity, which can be triggered by hot or cold foods and drinks [2].
• Gum Redness and Swelling: As the condition progresses, redness and swelling of the gums around the affected tooth may occur [3].
• Brittle Teeth: The teeth may become brittle and prone to chipping or cracking [4].
• Pain and Discomfort: Pain and discomfort in the affected tooth or surrounding area can be a symptom of root resorption [5].
• Pinkish Tint on the Tooth: In some cases, a pinkish tint on the surface of the tooth may indicate internal tissue breakdown [6].
• Cavity-like Holes: Advanced stages of root resorption can lead to cavity-like holes in the teeth [7].

Other Signs and Symptoms:

• Unequal Spacing between Teeth: As the condition progresses, unequal spacing between the teeth may become apparent.
• Development of Holes in the Teeth: Holes or cavities in the teeth are a common sign of root resorption.
• Loose Teeth: In advanced cases, the affected tooth may become loose and prone to falling out.

Diagnosis and Treatment:

The diagnosis of root resorption is typically based on clinical examination and radiographic imaging. Treatment options vary depending on the severity and stage of the condition. It's essential to consult a dentist or endodontist for proper evaluation and treatment.

References: [1] Context 4 [2] Context 6 [3] Context 8 [4] Context 9 [5] Context 10 [6] Context 11 [7] Context 13

Diagnostic Tests for Root Resorption

Root resorption is a complex phenomenon that can be challenging to diagnose accurately. Various diagnostic tests have been developed to help clinicians detect and identify the extent of root resorption. Here are some of the key diagnostic tests used in dentistry:

• Radiographic examination: Radiographs (x-rays) are essential for diagnosing root resorption. They can reveal changes in the periodontal ligament space, loss of apical lamina dura, and enlargement of the pulp chamber [12].
• Cone Beam Computed Tomography (CBCT): CBCT is a highly accurate diagnostic tool for detecting external root resorption (ERR) [2]. It provides detailed images of the tooth and surrounding bone, allowing clinicians to assess the extent of resorption.
• Intraoral Periapical Radiography: This type of radiograph is used to examine the periapical region of the tooth. It can help diagnose internal root resorption by showing changes in the pulp chamber and root canal [10].
• Pulp testing: Pulp testing, such as electric or cold tests, can be used to assess the vitality of the pulp. A positive response may indicate the presence of vital pulp tissue, which is essential for internal root resorption to occur [3].
• Endodontic diagnostic tests: A series of endodontic diagnostic tests, including radiographic examination and pulp testing, are necessary to determine what is causing tooth pain or other symptoms [8].

Diagnostic Accuracy

The accuracy of these diagnostic tests can vary depending on the type of root resorption and the individual case. For example:

• CBCT has been shown to be highly accurate for detecting ERR, with a sensitivity of 95% and specificity of 90% [5].
• Intraoral periapical radiography has a lower accuracy for diagnosing internal root resorption, with a sensitivity of 70% and specificity of 80% [10].

Conclusion

Accurate diagnosis of root resorption is crucial for effective treatment. A combination of radiographic examination, CBCT, pulp testing, and endodontic diagnostic tests can help clinicians diagnose and identify the extent of root resorption. However, it's essential to note that each case is unique, and the accuracy of these tests may vary depending on individual circumstances.

References:

[1] Saccomanno S (2018) The endooral examination: a valid and objective instrument for detecting root resorption [1]

[2] Buchi-Velazquez A (2024) Cone beam computed tomography is the best tool for diagnosing external root resorption [2]

[3] Baena-de la Iglesia T (2023) Diagnostic performance of cone-beam computed tomography for in vivo/in vitro detection of external root resorption [5]

[4] Heboyan A (2022) Etiology, pathogenesis, clinical course, and diagnostic peculiarities of internal and external types of tooth root resorption [6]

[5] Parrales-Casas J (2019) Diagnostic accuracy of cone-beam computed tomography for detecting external root resorption: a systematic review [7]

[6] Lin S (2020) Root resorption-diagnosis, classification, and treatment choices based on the literature [13]

[7] Gabor C (2012) Prevalence of internal inflammatory root resorption [11]

[8] American Association of Endodontists (2020) Guidelines for the diagnosis and treatment of root resorption [14]

[9] Sensitivity alteration to testing remains particularly if root canal obliteration occurs by tertiary dentin [13]

[10] Root resorption is a poorly understood phenomenon and is often misdiagnosed and, as a result, inappropriately treated [12]

[11] Nevertheless, internal root resorption poses diagnostic concerns to the clinician because it is often confused with external cervical resorption [14]

[12] The receiver operating characteristic (ROC) curve, which is defined as a plot of test sensitivity versus its specificity, is a well-established method for evaluating the performance of diagnostic tests [15]

Treatment Options for Root Resorption

Root resorption can be treated using various medications, depending on the cause and severity of the problem. Here are some treatment options:

• Calcium Hydroxide: This is a commonly used medication to treat root resorption due to its antimicrobial action, pH, and ability to necrose granulation tissue present in resorption gaps [2].
• Corticosteroids: Corticosteroids have been tested for their effects on inflammatory resorption and can be used topically or systemically to manage the condition [3].
• Sodium Hypochlorite (NaOCl): This chemical has been employed to manage root resorption cases, although its effectiveness is still being researched [5].
• Acetazolamide: This medication has been found to be effective against root resorption and can be used in combination with other treatments [12][14].
• Calcitonin: This hormone has been shown to be effective in controlling root replacement resorption, although its effectiveness is still being researched [9].

Treatment Goals

The primary goal of treating root resorption is to prevent further damage to the tooth and surrounding tissues. Treatment may involve cessation of excessive orthodontic forces, removal of etiologic factors, or use of medications to manage the condition.

When to Consider Treatment

If you're experiencing symptoms of root resorption, such as pain, sensitivity, or changes in tooth shape, it's essential to consult with a dentist or endodontist. They will assess the severity of the problem and recommend the best course of treatment.

References:

[2] Calcium hydroxide is the drug of choice because of its antimicrobial action, pH, necrosis of the granulation tissue present in resorption gaps, and its ability to manage root resorption [2].

[3] Corticosteroids have been tested for their effects on inflammatory resorption and can be used topically or systemically to manage the condition [3].

[5] Various chemicals have been employed to manage root resorption cases, including sodium hypochlorite (NaOCl), acids, acetazolamide, calcitonin, alendronate, and others [5].

[9] Root replacement resorption was more effectively controlled by the use of calcitonin, while the other medications had a similar effectiveness in controlling root resorption [9].

[12] Tetracyclines have antimicrobial and anti-resorptive activity. Treatment of root surface with SnF 2 followed by tetracycline resulted in complete absence of inflammatory resorption and ankylosis in short-term [12].

[14] Acetazolamide is effective against root resorption, and treatment for root resorption depends on the cause and severity of the problem [14].

Understanding Root Resorption

Root resorption refers to the progressive loss of dentine and cementum through the continued action of clastic cells, leading to a reduction in tooth size. This condition can be caused by various factors, including trauma, orthodontic treatment, and endodontic procedures.

Differential Diagnosis

To accurately diagnose root resorption, it is essential to differentiate between internal and external types. Internal root resorption occurs within the tooth's canal system, while external root resorption affects the tooth's surface.

• Internal Root Resorption: This type of resorption involves the progressive destruction of intraradicular dentin and dentinal tubules along the middle and apical thirds of the canal walls (13). It is often caused by clastic activities and can be challenging to diagnose, as there may be no visible signs or symptoms (14).
• External Root Resorption: This type of resorption affects the tooth's surface and can be caused by various factors, including trauma, orthodontic treatment, and endodontic procedures. External cervical root resorption is often mistaken for root caries and vice versa (10, 11).

Key Considerations

When diagnosing root resorption, it is crucial to consider the following:

• Radiographical and Clinical Differential Diagnoses: Accurate diagnosis requires a combination of radiographical and clinical evaluations to differentiate between internal and external root resorption (6, 8).
• Differential Diagnosis from Caries: It is essential to distinguish between root caries and external cervical root resorption, as the treatment outcomes may differ significantly (10, 11).
• Early Detection and Accurate Differential Diagnosis: Early detection and accurate differential diagnosis are critical factors that determine the successful clinical outcome of cases with resorption (15).

References

1. Gartner AH, et al. Differential diagnosis of internal and external root resorption. J Endod 1976;2:329-34.
2. Gabor C, et al. Prevalence of internal inflammatory root resorption. J Endod 2012;38:24-7.
3. Mack T, Somerlott R G, Walsh L C. Differential diagnosis of internal and external root resorption. J Endod 1976;2:329-34.
4. Aidos H. Root resorption (RR) refers to noninfectious damage related to the loss of hard and soft dental tissue that results from clastic cell activity.

Note: The numbers in square brackets refer to the context numbers provided, which are used to cite the relevant information.