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An unusual case of idiopathic internal root resorption beginning in an unerupted permanent tooth
0099-2399/86/1207-0309/$02.00/0 JOURNAL OF ENOODONTICS Copyright 9 1986 by The Amercan Assooatlon of EndoOontists
Printed in U.S.A. VoL 12, No. 7, JULY1986
CASE REPORTS An Unusual Case of Idiopathic Internal Root Resorption Beginning in an Unerupted Permanent Tooth John K. Brooks, DDS
Root canal therapy was initiated by way of an occlusal access opening. Following extirpation of hemorrhagic pulpal tissue, cleansing of the single canal consisted of instrumentation with a series of K-type files, #40 through 90, and copious irrigation with 2.5% sodium hypochlorite. The tooth was medicated with formocresol and the canal was sealed with zinc oxideeugenol cement. Two weeks later the patient returned totally asymptomatic and the canal was obturated with gutta-percha and root canal sealer using a lateral condensation technique (Fig. 3). Amalgam was used to restore the occlusal surface. An l 1-month recall revealed no radiographic changes and the tooth has remained symptom free (Fig. 4).
A rare case of idiopathic internal root resorption detected in an unerupted mandibular premolar is described. The resorptive process continued following eruption, and the tooth became symptomatic. Endodontic therapy was then performed. Closer inspection of unerupted teeth for internal resorption is recommended.
Lesions of internal root resorption are uncommon and are generally confined to erupted teeth. The root canal or pulp chamber displays an enlarged area that can vary greatly in proportion. Perforating defects resulting from massive intemal resorption may occur (1,2). Early diagnosis and treatment of this lesion must be undertaken. Rarely, internal resorption may be detected radiographically in an unerupted tooth (3, 4). The following case report describes a patient with idiopathic internal resorption of a mandibular premolar initiated prior to its eruption.
DISCUSSION AND SUMMARY An unusual case of internal resorption occurring in an unerupted tooth is presented. The practitioner is advised to scrutinize more closely the integrity of developing teeth for this lesion. Because of the destructive
CASE REPORT An 11-yr-old male patient presented to the dental office for a routine examination. Review of his medical history was noncontributory. Bite-wing radiographs indicated a late mixed dentition. Close inspection of the unerupted mandibular right second premolar suggested the presence of incipient internal resorption of the coronal aspect of the pulp chamber (Fig. 1). Subsequent to the exfoliation of the primary molar, an otherwise normal-shaped premolar erupted into position. A follow-up periapical radiograph of the premolar revealed further progression of the resorptive process (Fig. 2). In addition, the patient complained of thermal sensitivity and pain upon mastication. The periodontal status was unremarkable and the tooth was caries free. A diagnosis of irreversible pulpitis involving internal resorption was made and endodontic treatment was started.
FIG 1. Bite-wing radiograph demonstrating incipient internal resorption
(arrowheads) in the unerupted mandibular right second premolar. 309
310
Brooks
FIG 2. Periapical view of the erupted tooth showing considerable enlargement of the resorptive lesion.
Journal of Endodontics
FIG 4. Eleven-month fonow-up film showing no apparent change.
pulpotomy (8). These disturbances initiate an inflammatory response in the pulp. With this increase in vascularity, the production of granulation tissue and transformation of macrophages and embryonic connective tissue into giant multinucleated odontoclasts is seen (4). With the formation of these osteoclast-like cells, the resorptive process may begin. In this particular case report, the cause of the internal resorption remains obscure. Dr. Brooks is a clinical instructor of Oral Diagnosis, Baltimore College of Dental Surgery, University of Maryland, Baltimore, MD. He also maintains a private practice in Mount Airy, MD. Address requests for reprints to him.
References FIG 3. Immediate postoperative view of the completed root canal.
potential of internal resorption, prompt endodontic treatment is recommended. Radiographically, it is not possible to determine whether the lesion has perforated the root (5). The exact etiology of internal resorption is not known, although several predisposing factors have been implicated: carious pulpal exposure (6), trauma (7), and
1. Wright PA. Surgical treatment of idiopathic internal resorption with lateral perforation. Br Dent J 1982;152:55-6. 2. Frank AL, Weine FS. Non-surgical therapy for the perforative defect of internal resorption. J Am Dent Assoc 1973;87:863-8. 3. Luten JR, Jr. Internal resorption or caries? J Dent Child 1958;25:156-9. 4. Goaz PW, White SC. Oral radiology: principles and interpretation. St. Louis: CV Mosby. 1982:398-9. 5. Gartner AH, Mack T, Somerlott RG, Walsh LC. Differential diagnosis of internal and external root resorption. J Endodon 1976;2:329-34. 6. Shafer WG, Hine MK, Levy BM. Oral pathology, 4th ed. Philadelphia: WB Saunders. 1983:332. 7. Andreasen JO. Luxation of permanent teeth due to trauma. Scand J Dent Res 1970;78:273-86. 8. Bennett CG, Poleway SA. Internal resorption. Postpulpotomy type. Oral Surg 1964;17:228-34.
Printed in U.S.A. VoL 12, No. 7, JULY1986
CASE REPORTS An Unusual Case of Idiopathic Internal Root Resorption Beginning in an Unerupted Permanent Tooth John K. Brooks, DDS
Root canal therapy was initiated by way of an occlusal access opening. Following extirpation of hemorrhagic pulpal tissue, cleansing of the single canal consisted of instrumentation with a series of K-type files, #40 through 90, and copious irrigation with 2.5% sodium hypochlorite. The tooth was medicated with formocresol and the canal was sealed with zinc oxideeugenol cement. Two weeks later the patient returned totally asymptomatic and the canal was obturated with gutta-percha and root canal sealer using a lateral condensation technique (Fig. 3). Amalgam was used to restore the occlusal surface. An l 1-month recall revealed no radiographic changes and the tooth has remained symptom free (Fig. 4).
A rare case of idiopathic internal root resorption detected in an unerupted mandibular premolar is described. The resorptive process continued following eruption, and the tooth became symptomatic. Endodontic therapy was then performed. Closer inspection of unerupted teeth for internal resorption is recommended.
Lesions of internal root resorption are uncommon and are generally confined to erupted teeth. The root canal or pulp chamber displays an enlarged area that can vary greatly in proportion. Perforating defects resulting from massive intemal resorption may occur (1,2). Early diagnosis and treatment of this lesion must be undertaken. Rarely, internal resorption may be detected radiographically in an unerupted tooth (3, 4). The following case report describes a patient with idiopathic internal resorption of a mandibular premolar initiated prior to its eruption.
DISCUSSION AND SUMMARY An unusual case of internal resorption occurring in an unerupted tooth is presented. The practitioner is advised to scrutinize more closely the integrity of developing teeth for this lesion. Because of the destructive
CASE REPORT An 11-yr-old male patient presented to the dental office for a routine examination. Review of his medical history was noncontributory. Bite-wing radiographs indicated a late mixed dentition. Close inspection of the unerupted mandibular right second premolar suggested the presence of incipient internal resorption of the coronal aspect of the pulp chamber (Fig. 1). Subsequent to the exfoliation of the primary molar, an otherwise normal-shaped premolar erupted into position. A follow-up periapical radiograph of the premolar revealed further progression of the resorptive process (Fig. 2). In addition, the patient complained of thermal sensitivity and pain upon mastication. The periodontal status was unremarkable and the tooth was caries free. A diagnosis of irreversible pulpitis involving internal resorption was made and endodontic treatment was started.
FIG 1. Bite-wing radiograph demonstrating incipient internal resorption
(arrowheads) in the unerupted mandibular right second premolar. 309
310
Brooks
FIG 2. Periapical view of the erupted tooth showing considerable enlargement of the resorptive lesion.
Journal of Endodontics
FIG 4. Eleven-month fonow-up film showing no apparent change.
pulpotomy (8). These disturbances initiate an inflammatory response in the pulp. With this increase in vascularity, the production of granulation tissue and transformation of macrophages and embryonic connective tissue into giant multinucleated odontoclasts is seen (4). With the formation of these osteoclast-like cells, the resorptive process may begin. In this particular case report, the cause of the internal resorption remains obscure. Dr. Brooks is a clinical instructor of Oral Diagnosis, Baltimore College of Dental Surgery, University of Maryland, Baltimore, MD. He also maintains a private practice in Mount Airy, MD. Address requests for reprints to him.
References FIG 3. Immediate postoperative view of the completed root canal.
potential of internal resorption, prompt endodontic treatment is recommended. Radiographically, it is not possible to determine whether the lesion has perforated the root (5). The exact etiology of internal resorption is not known, although several predisposing factors have been implicated: carious pulpal exposure (6), trauma (7), and
1. Wright PA. Surgical treatment of idiopathic internal resorption with lateral perforation. Br Dent J 1982;152:55-6. 2. Frank AL, Weine FS. Non-surgical therapy for the perforative defect of internal resorption. J Am Dent Assoc 1973;87:863-8. 3. Luten JR, Jr. Internal resorption or caries? J Dent Child 1958;25:156-9. 4. Goaz PW, White SC. Oral radiology: principles and interpretation. St. Louis: CV Mosby. 1982:398-9. 5. Gartner AH, Mack T, Somerlott RG, Walsh LC. Differential diagnosis of internal and external root resorption. J Endodon 1976;2:329-34. 6. Shafer WG, Hine MK, Levy BM. Oral pathology, 4th ed. Philadelphia: WB Saunders. 1983:332. 7. Andreasen JO. Luxation of permanent teeth due to trauma. Scand J Dent Res 1970;78:273-86. 8. Bennett CG, Poleway SA. Internal resorption. Postpulpotomy type. Oral Surg 1964;17:228-34.