[Pathogenesis and classification of tooth resorption].

Tooth resorption is an idiopathic destructive disease of dental hard tissues. The etiology and pathogenesis remain obscure. It has various manifestations and can be commonly classified as internal tooth resorption and external root resorption on the basis of the resorptive lesion sites. There have been many attempts to make further classification based upon the pathological manifestations in recent years. Radiographic examination is an effective tool to assist in the diagnosis. There are few systematic researches on tooth resorption worldwide, most of which are case reports. This review elaborates on the research progress of tooth resorption from aspects of pathogenesis and classification.

Invasive Cervical Resorption: Clinical Management in the Anterior Zone.

According to the high number of articles published on invasive cervical resorption (ICR), this pathology, as commonly believed, is a more frequent form of cervical resorption. ICR is often misdiagnosed as internal resorption or caries, which leads to inappropriate treatment and even unnecessary tooth loss. Despite a correct diagnosis, the treatment of this type of hyperplastic invasive external resorption poses a challenge for the clinician. The Heithersay classification and the use of cone-beam computed tomographic imaging have increased our knowledge of the pathology and helped improve its prognosis. Nevertheless, there is no standard protocol for the treatment of this type of lesion. This article proposes a treatment protocol for ICR based on the pattern and location of resorption. Three treatment approaches (internal access, external access, and intentional replantation) are presented through 3 clinical cases.

Tomografia computadorizada de Cone Beam no diagnóstico de reabsorções radiculares externas / Cone Beam computed tomography in diagnosis of root resorption are external

Reabsorção é o termo utilizado na literatura médica e odontológica, para definir o processo pelo qual, tecidos mineralizados do organismo são destruídos e eliminados pela ação de células especializadas. As reabsorções dentárias podem ser classificadas de acordo com a superfície dentária afetada (interna, externa, interna-externa), a evolução do processo (transitória ou progressiva) e a natureza biológica do processo (inflamatória ou por substituição). Os traumatismos dentários representam a causa mais frequente de reabsorções radiculares externas na dentição permanente e resultam em um dano irreversível que pode levar à perda do elemento dental. Considerando-se que as reabsorções radiculares, na maioria das vezes, são eventos assintomáticos, os exames de imagem se tornam essenciais na fase de diagnóstico desta patologia. Tradicionalmente estes exames complementares eram realizados através de radiografias convencionais e posteriormente digitais. Entretanto, imagens fornecidas através de radiografias apresentam algumas limitações, como sobreposições, distorções e a formação de uma imagem bidimensional de uma estrutura tridimensional. Para suprir tais limitações, as imagens multiplanares têm sido amplamente utilizadas, destacando-se entre elas, a tomografia computadorizada de cone beam. Sendo assim, a proposta do presente trabalho foi, através do levantamento bibliográfico, avaliar o emprego da tomografia computadorizada de cone beam no diagnóstico das reabsorções radiculares externas. A literatura pesquisa demonstra a superioridade das TCCB para o diagnóstico das RRE, quando comparadas à radiografia periapical. Quanto menor o tamanho do voxel maior a acurácia do exame, principalmente para identificação de pequenas cavidades na região apical. Entretanto a literatura pertinente é dominada por estudos realizados ex vivo e não faz distinção entre os diferentes tipos de RR

Resorption is the term used in medical and dental literature to define the process which mineralized tissues are destroyed and eliminated by aclastic cells. Dental resorptions can be classified according to the affected dental surface (internal, external, internal-external), process evolution (transient or progressive) and the biological nature of the process (inflammatory or replacement). Dental trauma represents the most frequent cause of progressive external root resorption in the permanent dentition not rare resulting in irreversible loss of dental tissue that can lead to tooth loss. Considering that root resorptions are asymptomatic events, imaging procedures are essential in the diagnosis of such pathologies. Traditionally, these complementary examinations were performed through conventional and later digital radiographs. However, images provided through radiographs present some limitations, such as overlaps, distortions and a two-dimensional image of a three-dimensional structure. In order to overcome these limitations, the multiplanar images have been widely used, among them the computerized tomography of cone beam. Therefore, the present study aimed to review the use of CBCT to improve diagnosis and treatment planning of external root resorption. CBCT imaging appears to provide a superior validity and reliability in the detection of inflammatory external root resorption. The superior accuracy of CBCT imaging may result in the early detection of IERR and may help to determine their exact locations and extents. The smaller the voxel size the greater the accuracy of the exam, being important to identify small cavities in the apical region. However, literature is dominated by ex vivo studies and does not distinguish between different types of RER

[Impacted teeth and the six incarnations of resorption]. / Les six formes de résorption associées à l'inclusion dentaire.

There are six distinct types of resorption of dental hard tissue that occur in association with unerupted and impacted permanent teeth. These pathologic entities differ markedly from one another in terms of their aetiology, their treatment and their prognosis. In several of them, the continued existence of the affected tooth may be in danger while in others, conservative treatment may halt the resorption process and provide for a successful outcome. The treatment approach is specific for each type and is entirely dependant on the diagnosis. This presentation will discuss prevalence, aetiology, presenting symptoms and clinical signs, radiographic features, histopathology, differential diagnosis, treatment and prognosis in relation to each of the conditions.

[An 18 month evaluation of MM-MTA pulpotomy on primary decayed molars]. / Evaluation sur 18 mois de la pulpotomie au MM-MTA sur des molaires temporaires cariées.

Pulpotomy is the most performed and controversial therapeutic in pediatric dentistry. Formocresol is known to have a toxic effect on living tissues, a mutagenic and carcinogenic potential with a systemic uptake of formocresol via pulpotomized teeth, other alternative products have been investigated. 40 molars were pulpotomized using Micro Mega Mineral Trioxide Aggregate (MM-MTA), which eliminates the need for the use of formocresol. The effects of this material were evaluated both clinically and radiographically. Post-operative control examinations were performed at 1, 6, 12, and 18 months trying to detect spontaneous or stimulated pain, pathological tooth mobility, abscesses or fistulas, internal or external pathological tooth resorption, periapical bone destruction, or canal obliteration. Pain was absent at 18 months post operatively. Thirty six molar treated with the MM-MTA didn't show any mobility or pain, one molar presented a pathological resorption and one molar presented an abscess without a fistula at 12 month. The observations were compared to others related to formocresol, ferric sulfate, MTA, and laser pulpotomies, using the Chi-square test x2. The abundance of positive result strongly demonstrate that the MM-MTA pulpotomy on carious temporary molars is a promising technique.

Reabsorção interna versus externa: indicadores para um diagnóstico preciso / Internal resorption versus external: indicators for accurate diagnosis

Os diagnóticos equivocados entre absorção interna e externa frequentemente estão presentes nos laudos imaginológicos, em trabalhos publicados e em livros. Objetivo: destacamos, no presente trabalho, os indicadores imaginológicos de diagnóstico preciso para as reabsorções internas e externas, haja vista que são distintas e específicas. Resultados: a preservação dos limites pulpares nos dentes com reabsorção externa se destaca como seu principal indicador diagnóstico. A expansão foco/local balonizante dos limites pulpares com continuidade e a regularidade nas suas margens expandidas, formando uma área pulpar de radiolucidez homogênea, são os principais indicadores do diagnóstico de reabsorção interna. Conclusão: os diagnósticos equivocados geralmente estão associados à falta de conhecimento da etiopatogenia desses processos reabsortivos e/ou de uma experiência prévia em seus diagnósticos.

Surgical endodontic management of an invasive cervical resorption class 4 with mineral trioxide aggregate: a 6-year follow-up.

Invasive cervical resorption is a type of external resorption rarely seen as an adverse effect after a guided tissue regeneration procedure for a periodontal condition. This case report summarizes the surgical endodontic management of an invasive cervical resorption class 4 (Heithersay) with mineral trioxide aggregate, in a mandibular incisor of a 67-year-old man. A 6-year clinical follow-up with radiovisiography and cone-beam computerized tomography revealed complete healing. A surgical endodontic management could promote healing and survival of a tooth with advanced root resorption due to a periodontal condition.

Radiographic evaluation of the classification of the extent of tooth resorption in dogs.

OBJECTIVE: To determine applicability of the 2007 American Veterinary Dental College (AVDC) classification method for determining extent of tooth resorption in dogs. ANIMALS: 224 dogs > 1 year old admitted for periodontal treatment or other dental procedures in 2007. PROCEDURES: Full-mouth radiographs of all dogs were reviewed for evidence of tooth resorption. Tooth resorption in dogs was classified in accordance with the radiographic criteria described for use in human teeth and, when applicable, the guidelines described in the 2007 AVDC classification method. RESULTS: 851 of 943 (90.2%) affected teeth met the radiographic characteristics of 1 of the 5 stages of tooth resorption described by the AVDC classification method. Among tooth resorption types described for human teeth, the AVDC classification method was totally applicable (100%) in 17 teeth with external surface resorption, 21 teeth with external replacement resorption, and 736 teeth with external cervical root surface resorption, but it was applicable in only 56 of 121 (46.3%) teeth with external inflammatory resorption and none of the teeth with internal resorption. CONCLUSIONS AND CLINICAL RELEVANCE: The AVDC classification method was useful to describe the extent of tooth resorption in dogs, but it did not reflect the radiographic patterns and location of lesions. The AVDC classification method was applicable in some, but not all, of the teeth with various resorption types in dogs. The AVDC classification method could be adapted best to lesions that have radiographic patterns of external replacement resorption and external cervical root surface resorption.

Is the resorption external or internal?

UNLABELLED: Resorption of teeth is reviewed from a diagnostic perspective to clarify the confusion as to whether it is external or internal. The key features of the various types (external surface, transient apical breakdown, external inflammatory, external replacement, external cervical and internal) are described and illustrated by cases. Management and appropriate treatment is dependent on the correct diagnosis. CLINICAL RELEVANCE: Diagnosis of resorption is essential to the appropriate management.

Comparação de três técnicas de obturação no preenchimento de reabsorções internas / Comparison of the three root canal obturation techniques on filling internal resorptions

O objetivo deste estudo foi comparar a qualidade do preenchimento de reabsorções internas pela utilização de três diferentes técnicas de obturação: condensação lateral; condensação vertical com aquecimento, condensação termomecânica. Cavidades internas simulando reabsorções foram preparadas em 30 dentes caninos extraídos de humanos. Os dentes foram radiografados em dois planos, antes e após serem instrumentados e obturados, sendo seccionados transversalmente. Após avaliações radiográfica e microscópica, concluimos que os melhores resultados foram apresentados pela técnica da condensação termomecânica, seguida pela técnica da condensação vertical

Reabsorciones dentarias: un problema para el diagnóstico, el tratamiento y el pronóstico. Trabajo de divulgación científica. Parte II / Tooth resorptions: a problem for the diagnosis, treatment an prognosis. Scientific divulgation article. Part II

El presente trabajo de divulgación científica tiene por finalidad describir los distintos tipos de reabsorciones que afectan los tejidos duros del diente. Generalmente, estas patologías son difíciles de diagnosticar y de tratar y, en numerosas ocasiones, pueden comprometer la permanencia del elemento dentario en boca. Las reabsorciones se clasifican, según su ubicación, en dentinarias internas y cemento dentinarias externas y, por su etiología, en aquellas que se vinculan a factores físicos como los traumatismos y las presiones que sufren las piezas dentarias, a agentes infecciosos que provienen de la cavidad pulpar o del periodonto, a afeciones sistémicas y a causas idiopáticas. Se pone especial énfasis en la importancia de arribar al diagnóstico clínico-radiográfico a los fines de estabvlecer el pronóstico y el tratamiento adecuado (AU)

Reabsorciones dentarias: un problema para el diagnóstico, el tratamiento y el pronóstico. Trabajo de divulgación científica. Parte II / Tooth resorptions: a problem for the diagnosis, treatment an prognosis. Scientific divulgation article. Part II

El presente trabajo de divulgación científica tiene por finalidad describir los distintos tipos de reabsorciones que afectan los tejidos duros del diente. Generalmente, estas patologías son difíciles de diagnosticar y de tratar y, en numerosas ocasiones, pueden comprometer la permanencia del elemento dentario en boca. Las reabsorciones se clasifican, según su ubicación, en dentinarias internas y cemento dentinarias externas y, por su etiología, en aquellas que se vinculan a factores físicos como los traumatismos y las presiones que sufren las piezas dentarias, a agentes infecciosos que provienen de la cavidad pulpar o del periodonto, a afeciones sistémicas y a causas idiopáticas. Se pone especial énfasis en la importancia de arribar al diagnóstico clínico-radiográfico a los fines de estabvlecer el pronóstico y el tratamiento adecuado

Feline odontoclastic resorptive lesions an unsolved enigma in veterinary dentistry.

This article presents a comprehensive review of the literature on feline odontoclastic resorptive lesions (FORLs), including etiopathogenesis, prevalence and predisposition, classification, histopathologic appearance, diagnosis, and treatment. Approximately one-third of all domestic cats may develop FORLs during their life span, and the risk of developing FORLs increases with age. Sophisticated dental treatments promise neither cure nor permanent improvement of affected teeth. Extraction is the current treatment of choice. Research on the etiology of FORLs has not been rewarding in recent years, and the causative factors contributing to the development of FORLs are still unknown.

Reabsorciones dentarias: un problema para el diagnóstico, el tratamiento y el pronóstico. Trabajo de divulgación científica / Tooth resorptions: a problem for the diagnosis, treatment and prognosis. Scientific divulgation article

El presente trabajo de divulgación científica tiene por finalidad describir los distintos tipos de reabsorciones que afectan los tejidos duros del diente. Generalmente, estas patologías son difíciles de diagnosticar y de tratar y, en numerosas ocasiones, pueden comprometer la permanencia del elemento dentario en boca. Las reabsorciones se clasifican, según su ubicación, en dentinarias internas y cemento dentinarias externas y, por su etiología, en aquellas que se vinculan a factores físicos como traumatismos y las presiones que sufren las piezas dentarias, a agentes infecciosos que provienen de la cavidad pulpar o del periodonto, a afecciones sistémicas y a causas idiopáticas. Se pone especial énfasis en la importancia de arribar al diagnóstico clínico-radiográfico correcto a los fines de establecer el pronóstico y el tratamiento adecuado (AU)

Reabsorciones dentarias: un problema para el diagnóstico, el tratamiento y el pronóstico. Trabajo de divulgación científica / Tooth resorptions: a problem for the diagnosis, treatment and prognosis. Scientific divulgation article

El presente trabajo de divulgación científica tiene por finalidad describir los distintos tipos de reabsorciones que afectan los tejidos duros del diente. Generalmente, estas patologías son difíciles de diagnosticar y de tratar y, en numerosas ocasiones, pueden comprometer la permanencia del elemento dentario en boca. Las reabsorciones se clasifican, según su ubicación, en dentinarias internas y cemento dentinarias externas y, por su etiología, en aquellas que se vinculan a factores físicos como traumatismos y las presiones que sufren las piezas dentarias, a agentes infecciosos que provienen de la cavidad pulpar o del periodonto, a afecciones sistémicas y a causas idiopáticas. Se pone especial énfasis en la importancia de arribar al diagnóstico clínico-radiográfico correcto a los fines de establecer el pronóstico y el tratamiento adecuado

Perfil endocrinológico de pacientes ortodônticos com e sem reabsorçöes dentárias: correlaçäo com a morfologia radicular e da crista óssea alveolar / Endocrinological profile of ortodontically treated patients with and without root resorption

A freqüência das reabsorçöes dentárias foi observada em 3 grupos de 70 pacientes cada. Estes grupos constituíram-se de 70 pacientes sem tratamento ortodôntico, 70 pacientes com tratamento ortodôntico sem reabsorçäo dentária e 70, com reabsorçäo dentária. Foram analisadas as características morfológicas dentárias e maxilares, bem como determinado o perfil hormonal, cônico, enzimático e glicêmico de todos os pacientes. Os resultados revelaram que: 1. Pacientes com tratamento ortodôntico com e sem reabsorçäo dentária apresentaram o mesmo perfil sistêmico e endocrinológico, tal como os pacientes sem tratamento ortodôntico: 2. No grupo de pacientes submetidos ao tratamento ortodôntico que apresentaram reabsorçäo dentária, a morfologia radicular triangular foi significantemente mais freqüente em relaçäo ao grupo de pacientes submetidos a tratamento ortodôntico sem reabsorçäo dentária e do grupo de pacientes sem tratamento ortodôntico: 3. No grupo de pacientes submetidos ao tratamento ortodôntico que apresentaram reabsorçäo dentária, a morfologia da crista óssea alveolar retangular foi significantemente mais freqüente em relaçäo ao grupo de pacientes submetidos a tratamento ortodôntico sem reabsorçäo dentária e do grupo de pacientes sem tratamento ortodôntico. Assim concluiu-se que: 1. As reabsorçöes dentárias durante o tratamento ortodôntico näo säo resultantes da açäo de fatores sistêmicos, inclusive de endocrinopatias: 2. As reabsorçöes dentárias durante o tratamento ortodôntico säo fortemente influenciadas pela morfologia da raiz dentária e da crista óssea alveolar

Detection of simulated internal tooth resorption using conventional radiography and subtraction imaging.

OBJECTIVES: To compare the diagnostic accuracy of conventional radiography with digital subtraction imaging in the detection of simulated internal resorption. METHODS: Simulated resorption cavities were created by the sequential use of progressively larger round burs (ISO size range 006-016) in the labial wall of the coronal or apical thirds of the pulp chamber of the maxillary incisors of two cadavers. Five viewers examined 120 pairs of radiographs, one of each pair being baseline (no lesion) and the other with or without a lesion. The process was then repeated with subtraction images of the pairs of radiographs. Receiver Operating Characteristic (ROC) analysis was used to compare the diagnostic accuracy of the two imaging modalities. RESULTS: Using conventional radiography, the minimum lesion size detectable coronally was in the 'medium' range (ISO size 010 and 012 round burs), but only 'large' lesions (ISO size 014 and 016) could be detected in the apical region. The overall diagnostic accuracy of subtraction imaging was superior to conventional radiography but only significant (P<0.05) for coronal lesions. CONCLUSION: Subtraction radiography may be a useful tool for detecting and monitoring the progress of internal root resorption.

Avoiding "the space" by the treatment of compromised teeth.

The advent of implant therapy has given new a dimension to dentistry particularly where teeth have been irretrievably damaged or pathologically involved. There are many situations however, where endodontic or combined therapy may effectively retain compromised teeth and clinicians should carefully evaluate evidence-based treatment. The main areas discussed are: transverse and crown root fractures and invasive cervical resorption. Transverse root fractures have an excellent natural healing capacity and will also respond favourably to treatment if pulp necrosis occurs in the coronal segment. Studies have shown that crown root fractures can be effectively treated by combined endodontic-orthodontic-periodontic and prosthodontic therapy. Invasive cervical resorption has been classified into four classes depending on the degree of infiltration of resorptive tissue into the tooth structure. A study of treatment results following the topical application of 90% aqueous trichloracetic acid, curettage and restoration indicated that this regimen could be successfully applied to Classes 1, 2 and 3 resorption.