Reabsorción dentinaria interna coronaria: informe de un caso clínico / Coronary internal dentine resorption: report of a clinical case

Objetivo: La reabsorción dentinaria interna es un pro- ceso causado por la actividad odontoclástica asociada princi- palmente a la inflamación pulpar crónica y/o traumatismos, y se caracteriza por la pérdida progresiva de tejido dentinario y la posible invasión al cemento. El presente informe describe el diagnóstico y tratamiento de un molar inferior que presentó un cuadro sintomático de reabsorción dentinaria interna. Caso clínico: Un paciente de 38 años fue derivado a la consulta por presentar una zona de reabsorción interna en un segundo molar inferior. Durante el examen clínico y ra- diográfico se tomó una radiografía preoperatoria periapical con radiovisiógrafo en la que se observó la presencia de un área compatible con el diagnóstico de reabsorción dentinaria interna, el que fue posteriormente confirmado por medio de una tomografía computada de haz cónico. La imagen de la lesión se presentó como una zona radiolúcida deformante de bordes nítidos, localizada a nivel de la cámara pulpar. El tra- tamiento consistió en la extirpación de la pulpa coronaria y de la instrumentación, desinfección y obturación de los conduc- tos radiculares y la cavidad de acceso. En el control clínico y radiográfico realizado luego de 3 años se observó que el paciente estaba asintomático y las estructuras perirradiculares se encontraban dentro de los límites normales. La observación histológica del material removido de la cámara pulpar reveló la presencia de un tejido granulomatoso con numerosos vasos sanguíneos y escasos focos micro hemorrágicos. Hasta el momento, el tratamiento endodóntico es el pro- cedimiento indicado para el tratamiento de la reabsorción dentinaria interna. Se destaca la importancia de la tomografía computada de haz cónico para el diagnóstico y tratamiento temprano de las reabsorciones dentinarias internas a efectos de contar con un pronóstico favorable (AU)

Aim: Internal dentine resorption is aprocess caused by odontoclastic activity, mainly associated with chronic pulpal inflammation and/or trauma, and it'scharacterized by a pro- gressive loss of dentine tissue and the possible invasion of the cementum. This report describes the diagnosis and treatment of a lower molar that presented a symptomatic case of inter- nal dentine resorption. Clinical case: A 38-years old patient was referred to the office because of presenting an area of internal resorption in a lower second molar. During clinical and radiographic exam- ination, a periapical preoperative radiograph with radiovisio- graph was taken, in which the presence of an area compatible with the diagnosis of internal dentine resorption was observed, which was later confirmed by a cone-beam computed tomog- raphy.The image of the lesion was presented as a deforming radiolucent area with sharp edges, located at pulp chamber level. Treatment consisted of the removal of the coronary pulp and the instrumentation, disinfection and filling of the root ca- nals and the access cavity. In the clinical and radiographic control carried out 3 years after procedure, it was observed that the patient was asymptomatic and the periradicular struc- tures were within normal limits. The histological observation of the removed material from the pulp chamber revealed the presence of a granulomatous tissue with numerous blood ves- sels and scarce micro hemorrhagic focus. Until now, the endodontic treatment is the indicated pro- cedure to treat internal dentine resorption. It is necessary to highlight the importance of the cone-beam computerized to- mography for the early diagnosis and treatment of internal dentine resorptions in order to have a favorable outlook (AU)

Case report of an internal granuloma investigated by light and scanning electron microscopy.

There is no doubt that the main reason for an internal grauloma is a traumatic event. The trauma may be physical or chemical as in the case of caries or coronal pulpectomy. In most of the cases it is diagnosed by hazard or, when in case of fracture or mobility, extraction is the only therapy to be performed. If diagnosed in time root canal treatment may be adequate.In the presented case no single specific event could be determined being the cause of this large internal granuloma extending from the coronal third of the root canal to the whole crown just leaving an eggshell of enamel that fractured and mimicked mobility of the whole tooth to the patient finally causing him to attend the clinic. As the patient presented severe aggressive periodontitis and mobility of all teeth it first was assumed that periodontitis was the ethiological reason in this case. Due to secondary trauma the front teeth were labially positioned thus probably being exposed to traumatic insults more frequently. Clinically the upper right medial incisor appeared discoloured darkly not showing the typical pink spot. Without any force the coronal part of the right medial incisor could be removed manually and the root was extracted using a periostal extractor. As it was not suitable to leave the patient with a missing tooth in the front the wound was sutured and as a temporary solution the tooth was reconstructed with composite intraorally and fixed to the neighbour teeth adhesively. The histopathology of the internal granuloma and the crown was investigated.

The fate of developing teeth in mandibular lengthening by distraction: an experimental study.

PURPOSE: The purpose of this study was to observe developing teeth in a lengthened mandible after distraction. MATERIAL: Ten mongrel dogs with deciduous dentitions were used. METHODS: A corticotomy was carefully made around a tooth bud and the external distractor (Orthofix M-100) was connected. After a 5-day latent period, distraction was started at a rate of 0.75 mm per day for 10 consecutive days. Then, the lower jaw was stabilized by an external fixation to allow ossification. While the operation was performed on the left side (Distraction group), the contralateral side was studied for comparison (Control). In addition, a corticotomy, artificial fracture and external fixation were carried out to confirm the influence of the operation (Fracture group). Then macroscopic, radiographic and histological evaluations were carried out. RESULTS: In the Distraction group, the space between the wall of the dental follicle and the crown expanded as distraction began. The end of the calcified root became wider and irregular during the distraction period, and finally, the apex closed. In the Fracture group, the teeth erupted although slight alterations of the root shape were observed in association with the operation period. CONCLUSION: The root became irregular, but the teeth erupted within the distraction area.