Internal inflammatory resorptions may be
classified according to location as: (1) apical and (2)
intraradicular.
(1) Apical
A recent study has shown that apical internal
inflammatory resorption is far more common in teeth
with various inflammatory periapical pathoses than
previously thought.
The study showed that 74.7 per
cent of teeth with periapical lesions had varying degrees
of apical internal resorption, ranging from slight
(grade 1) to severe (grade 4). Radiographically, apical
internal resorption may be difficult to diagnose when
the resorptions are of the lower grades as described by
Vier and Figueiredo, but should be discernable in
grades 3 and 4 lesions. This study has important
clinical implications in root canal preparation.
There are
two approaches to the endodontic management of apical
internal resorption. The first is to extend instrumentation
only to the position of the resorption with the
expectation that with the removal of micro-organisms
followed by root canal filling, hard tissue repair will
occur in the resorbed apical region of the tooth. The
second approach is to enlarge and prepare the apical
region, either with hand or rotary filing techniques, to
include the resorbed region and then root fill to the root
canal “terminus”.
At this stage an evidenced based,
randomized prospective study to compare the long-term
results of the two approaches has not been carried
out. Until such evidence becomes available, treatment
to the position of the resorption is recommended as a
clinical means of achieving biological repair of the
resorbed apex.
In some instances, gross resorption can result from
endodontic pathosis as shown in Fig 12a and treatment
can provide considerable clinical challenges which must
be carefully evaluated by a practitioner who may
consider referral to an endodontist. Treatment involves
root canal preparation to the position of the resorption
followed by long-term calcium hydroxide intra-canal
medication, and a sound overlying and double coronal
seal of Cavit and GIC. Cuspal protection during long-term
medication is also very important. Once periapical
and resorption repair has occurred, the canals can be
filled with gutta-percha and a sealer. An example of the
healing of an extreme example of apical internal
resorption is shown in Fig 12b. ProRoot MTA could
also be used as there is increasing evidence for its
efficacy when used in similar resorptions.
(2) Intraradicular
Internal resorption fully contained within an other-wise
intact root will be referred to as intraradicular
internal inflammatory resorption. Infection induced
internal resorption can be recognized as round or oval-shaped
radiolucencies contained within the tooth root
and examples are shown in Figs 13a, 13b and 14a.
A common finding is a large accessory canal
communicating from the periodontal ligament to the
resorbed area; this may have allowed the passage of a
collateral blood supply which probably played an
important role in the development and maintainance of
the internal resorptive process. Treatment generally
consists of the preparation of the canal to the apical
foramen with particular emphasis on irrigation and
ultrasonication so that the resorbed area is cleansed as
thoroughly as feasible. The obturation of the canal can
be achieved by a variety of techniques including hot
vertically condensed gutta-percha, Obtura-delivered
hot gutta-percha
and more recent innovations such as
the Microseal technique.
An example of a hot vertically condensed root filling
of an intraradicular internal resorption is shown in
Fig 14b.
classified according to location as: (1) apical and (2)
intraradicular.
(1) Apical
A recent study has shown that apical internal
inflammatory resorption is far more common in teeth
with various inflammatory periapical pathoses than
previously thought.
The study showed that 74.7 per
cent of teeth with periapical lesions had varying degrees
of apical internal resorption, ranging from slight
(grade 1) to severe (grade 4). Radiographically, apical
internal resorption may be difficult to diagnose when
the resorptions are of the lower grades as described by
Vier and Figueiredo, but should be discernable in
grades 3 and 4 lesions. This study has important
clinical implications in root canal preparation.
There are
two approaches to the endodontic management of apical
internal resorption. The first is to extend instrumentation
only to the position of the resorption with the
expectation that with the removal of micro-organisms
followed by root canal filling, hard tissue repair will
occur in the resorbed apical region of the tooth. The
second approach is to enlarge and prepare the apical
region, either with hand or rotary filing techniques, to
include the resorbed region and then root fill to the root
canal “terminus”.
At this stage an evidenced based,
randomized prospective study to compare the long-term
results of the two approaches has not been carried
out. Until such evidence becomes available, treatment
to the position of the resorption is recommended as a
clinical means of achieving biological repair of the
resorbed apex.
In some instances, gross resorption can result from
endodontic pathosis as shown in Fig 12a and treatment
can provide considerable clinical challenges which must
be carefully evaluated by a practitioner who may
consider referral to an endodontist. Treatment involves
root canal preparation to the position of the resorption
followed by long-term calcium hydroxide intra-canal
medication, and a sound overlying and double coronal
seal of Cavit and GIC. Cuspal protection during long-term
medication is also very important. Once periapical
and resorption repair has occurred, the canals can be
filled with gutta-percha and a sealer. An example of the
healing of an extreme example of apical internal
resorption is shown in Fig 12b. ProRoot MTA could
also be used as there is increasing evidence for its
efficacy when used in similar resorptions.
(2) Intraradicular
Internal resorption fully contained within an other-wise
intact root will be referred to as intraradicular
internal inflammatory resorption. Infection inducedinternal resorption can be recognized as round or oval-shaped
radiolucencies contained within the tooth root
and examples are shown in Figs 13a, 13b and 14a.
A common finding is a large accessory canal
communicating from the periodontal ligament to the
resorbed area; this may have allowed the passage of a
collateral blood supply which probably played an
important role in the development and maintainance of
the internal resorptive process. Treatment generally
consists of the preparation of the canal to the apical
foramen with particular emphasis on irrigation and
ultrasonication so that the resorbed area is cleansed as
thoroughly as feasible. The obturation of the canal can
be achieved by a variety of techniques including hot
vertically condensed gutta-percha, Obtura-delivered
hot gutta-percha
and more recent innovations such as
An example of a hot vertically condensed root filling
of an intraradicular internal resorption is shown in
Fig 14b.