Radiographic diagnosis of root resorption in relation to orthodontics

The literature regarding external root resorption in relation to orthodontics and its radiographic diagnosis is reviewed, including a summary of the more common radiographic techniques available. Sample cases are presented which demonstrate the need for good radiographic technique and an awareness of the limitations of certain radiographs. A provisional diagnosis of external root resorption may need to be confirmed by further radiographic views where appropriate.     

Diagnosis, screening and treatment of root resorption in orthodontic practices in Greece and Sweden

OBJECTIVE: To evaluate the perception of Greek and Swedish orthodontic practitioners regarding the possible occurrence and prognosis of root resorption occurring during orthodontic treatment and to estimate practitioners' approaches to the diagnosis of preexisting root resorption, screening of prevalence, and treatment planning approach when moderate or severe root resorption is present. MATERIALS AND METHODS: Questionnaires were received from randomly selected Greek (n = 90) and Swedish (n = 106) practitioners. Topics of the questions included (a) the presence of history; (b) the radiographic evaluation of root resorption before, during, and after treatment; (c) the treatment approach of initial prevention and protocols in cases of radiographic diagnosis of root resorption during treatment. RESULTS: Of the respondents, 47.1% of the Swedish practitioners and 32.3% of the Greek practitioners use periapical and panoramic radiographs to diagnose root resorption, mostly in the anterior region. Both groups recognize trauma, root form, and oral habits as predisposing factors. The majority of Swedish orthodontists perform radiographic follow-up in the first 6 months. In contrast, the Greek orthodontists perform it at 1 year or at the end of treatment. The treatment approach for root resorption that is most frequently used by Swedish orthodontists is altering the treatment plan, using light forces, and allowing resting periods, while the Greek orthodontists most frequently use lighter forces and reduce the total duration of the treatment. CONCLUSIONS: Because there is no specific approach offered in the literature, the prevention and treatment reassessment in cases of root resorption relies on individual practitioner perception.     

Radiographic diagnosis of supernumerary premolars: case reviews

The literature reported prevalence of supernumerary teeth within the mandible and maxilla varies from 0.2-0.9%. This study reviews the formation and diverse clinical appearances of supernumerary premolars. We present case reports where supernumerary teeth were recognized as incidental findings during routine radiographic examination in patients with an age range of five to thirty-nine years. Cases are presented to illustrate that the initiation and development of supernumerary premolars are often delayed by a magnitude of years. Periodic examination is recommended for occurrence and clinical behavior. In the presented cases, displacement and resorption of the adjacent teeth was not evidenced. None of the supernumerary teeth demonstrated cystic transformation. The importance of differential radiographic diagnosis is discussed.     

Invasive cervical resorption: clinical and radiological diagnosis and treatment of 3 cases

Invasive cervical resorption is a relatively uncommon form of external root resorption. Etiologic factors include trauma, orthodontic treatment, intracoronal bleaching, and inflammation, but invasive cervical resorption is often idiopathic. There may be no external signs of this disorder, and the resorptive lesion is often detected by routine radiographic examination. This article describes the clinical and radiological diagnoses and treatment modalities of invasive cervical resorption in 3 patients. Two of the 3 cases were incidental radiographic findings and the teeth concerned were symptom free. One case was symptomatic due to periodontal infection. Computed tomography (CT) evaluation was performed in the 2 symptom-free patients. Thus, exact size and localization of the resorptive lesions were obtained. In 2 cases, root canal treatment was performed, and in the other case the resorptive defect was sealed with mineral trioxide aggregate.     

Resorption of the crown in impacted maxillary canine. A clinical, radiographic and histologic study.

Thirty-six maxillary impacted canines which showed coronary resorption were selected out of 252 impacted canines. Clinical, radiographic and histologic observations were performed. In the majority of the cases (31) a local inflammatory factor was present and only in five cases was the resorption idiopathic. The incidence of resorption was highest in the later decades of life. In all cases bone replacement was found.     

Idiopathic generalized apical root resorption: a report of three cases

Background.   Idiopathic apical root resorption usually presents as a chance radiographic finding. It may be widespread, affecting the majority of teeth, with implications for the longevity of the dentition.
Case report.   Three cases of significant idiopathic apical resorption resulting, respectively, in prevention, abandonment, and alternative methods of orthodontic treatment are described.
Conclusion.   Significant idiopathic resorption may present as a chance radiographic finding, as pain, or excessive mobility. The prognosis for affected teeth is often poor with very limited scope for orthodontic movement due to the likelihood of uncontrolled resorption. Definitive prosthetic rehabilitation is often best deferred until adulthood due to the potential for further resorption during adolescence in addition to vertical growth considerations.     

Effect of non-erupted third molars on roots of approximal teeth. A radiographic, clinical and histologic study

This study was undertaken to evaluate clinically and histologically root resorption in extracted human second molars in close proximity to non-erupted third molars. The control group consisted of extracted second molars that were proximal to fully erupted third molars. Eight out of the 11 teeth in the study group presented different degrees of radiographic root resorption nine presented clinical resorption, and all 11 had histologic evidence of root resorption. In the control group, no signs of root resorption were seen radiographically or clinically. Histologically, limited sites of resorption were identified in all teeth, which were partially repaired by cellular cementum. Histologic observation of study specimens revealed root surface resorption in 10 out of the 11 teeth, one showing replacement resorption as well. Inflammatory resorption was observed in the three most advanced cases in the study group. Reparative cementum partially lining resorbed areas was evident to all teeth with surface resorption. Within the limits of this study, radiographic identification of distal root resorption of second molars in close proximity to non-erupted third molars appears reliable. The findings may support the hypothesis that the presence of a non-erupted third molar in close proximity to the distal root of the second results in root resorption.     

Outcome of formocresol/ZOE sub-base pulpotomies utilizing alternative radiographic success criteria

PURPOSE: The purposes of this investigation were to 1) measure success of a primary tooth pulpotomy technique that applies formocresol in the sub-base without the common five-minute application of a formocresol impregnated cotton pellet; and 2) compare success rates of the pulpotomy procedure using traditional criteria found throughout the literature with new criteria recently established, excluding internal resorption as a radiographic failure. METHODS: Clinical and radiographic data were collected from a retrospective chart review of patients receiving formocresol pulpotomies with the application of formocresol in the zinc oxide-eugenol sub-base. RESULTS: Clinical and radiographic data were available for 196 primary molars in 122 children (followup=six to 103 months; mean=49 months). Traditional assessment of radiographic success and failure yielded a success rate of 79%. Alternative assessment excluding internal resorption as a failure yielded a 99% success rate. Most frequently observed pulpal responses were calcific metamorphosis and internal resorption. Overall clinical success was 99%. Two of the 196 teeth were extracted due to failure. A survival analysis demonstrated that the overall probability of survival remained high over time with a cumulative survival of over 95% after six years. CONCLUSIONS: The overall success rates in this study indicate that the formocresol pulpotomy technique incorporating formocresol in the zinc oxide-eugenol sub-base is a very successful treatment modality for primary molars requiring pulp therapy.     

Calcifying odontogenic cyst: a survey of 23 cases in the Japanese literature

The clinical, radiographic and histological characteristics of the calcifying odontogenic cyst were studied in 23 well-documented cases in the Japanese literature. The cysts occurred equally in males and females whose mean age was 21 years. The appeared as a painless swelling with cortical expansion and involved the maxilla three times more often than the mandible. There was no report of the lesion involving the soft tissues. Radiographically, the lesions were unilocular in most cases and contained aggregates or dispersed foci in the radiolucencies which were diagnosed as odontomes in 5 cases. Unerupted teeth and root resorption of the adjacent teeth were noted in approximately half of the cases. Except for one case, they were simply enucleated under a diagnosis of cyst or odontome and recurrence was encountered in no case. The excised specimens consisted of cystic sacs mostly containing calcified materials with or without tooth-like structures which were histologically diagnosed as odontomes in 10 cases. An intimate relationship between the cysts and the unerupted teeth was observed in 4 out of 10 cases. The pathogenesis of the lesion is discussed.     

Multiple idiopathic resorption in the primary dentition: review of the literature and case report.

Resorption of primary teeth is a normal physiologic process, except when it occurs prematurely. Resorption of permanent teeth is considered abnormal, and multiple etiologic factors have been implicated. A significant number of cases are represented by idiopathic resorption. Multiple idiopathic root resorption stands as a separate physiologic entity that has been described as affecting the entire permanent dentition. Multiple idiopathic resorption of primary teeth has not been previously reported. A case is described and a differential diagnosis is provided. The specific radiographic diagnostic criteria for this condition affecting the primary dentition are outlined.     

Apical resorption in teeth with periapical lesions: Correlation between radiographic diagnosis and SEM examination

This study correlated the radiographic findings and scanning electron microscopy (SEM) images of external apical resorption (EAR) in teeth with periapical lesions. Standard radiographs were taken from 45 teeth with periapical lesions before their extraction. Using a radiographic examination, the root apex of each tooth was classified according to the EAR into the following categories: radiographic external apical resorption (REAR) absent, superficial and deep. The apical root surface was also examined with SEM. Photomicrographs of EARs were classified as periforaminal (PEAR) and foraminal (FEAR) in three degrees: 0, 1 and 2. REAR was present in 72.5% of cases, of which 20% were deep. Based upon SEM analysis, PEAR and FEAR occurred in 75.6% and 66.7% of cases respectively; 51.2% and 59% respectively, of these teeth received a score of 2. Only 15.4% of the specimens were unaffected by EAR. When teeth with periapical lesions were examined for EAR with both radiography and by SEM, there was no correlation between the findings.     

Root resorption.

Several types of resorption affect teeth: internal, external, invasive, pressure, and idiopathic resorption. Diagnosis depends on an accurate medical and dental history, and radiographic and clinical examination. Because trauma appears to be a major factor associated with resorption, questions regarding past traumatic events may provide good leads to a likely cause. Treatment is determined based on a correct diagnosis. Root canal therapy is very beneficial in cases of internal resorption and external, inflammatory resorption. In cases of invasive resorption, it may or may not be necessary, whereas in replacement and pressure resorption, root canal therapy is not indicated at all (unless unrelated pulpal conditions necessitate endodontic intervention). Prevention of resorption includes appropriate treatment of traumatically injured teeth with frequent evaluation visits during the first year following an injury. Early detection of pressure-producing agents such as cysts, tumors, and impacted teeth can allow timely treatment to minimize the resorptive destruction.     

Resorption of maxillary lateral incisors caused by ectopic eruption of the canines : A clinical and radiographic analysis of predisposing factors

Factors predisposing to resorption of adjacent permanent lateral incisors caused by ectopic eruption of maxillary canines were evaluated. The subjects consisted of two groups: one with 40 lateral incisors with resorption caused by ectopic eruption and a control group of 118 ectopic eruption cases with no lateral incisor resorption. The mean age of the children in the two groups differed by only 0.7 of a year and ranged from 10.0 to 15.0 years, covering the normal eruption period of the maxillary canine. Resorption of lateral incisors was three times as common in girls as in boys. The resorption cases showed a more advanced dental development, a more medial canine position in the dental arch, and a slightly more mesial horizontal path of eruption (an average of 10 degrees) than that of the control cases. Factors such as the width of the dental follicle and proclination or distal tilting of the lateral incisor showed no correlation to the resorption. Potential resorption cases are always those in which the canine cusp in periapical and panoramic films is positioned medially to the midline of the lateral incisor. Such situations should be carefully investigated with polytomography if necessary. The risk of resorption also will increase with a more mesial horizontal path of eruption. From 10 years of age or younger, annual clinical examination by palpation of the canine eruption path is recommended. This clinical examination should be supplemented with a stepwise extended radiographic procedure in cases in which ectopic eruption of the maxillary canines is suspected.     

Federal University of Santa Catarina endodontic treatment of traumatized primary teeth – part 2

Abstract –  This research sought to evaluate periapical repair in 28 traumatized deciduous teeth that had suffered endodontic intervention due to the presence of internal or external inflammatory resorption or replacement root resorption. After obtaining endodontic access, work length and biomechanical preparation, the root canals were filled with calcium hydroxide and propylene glycol under the form of a dense slurry, during 12 months. Replacement of the intracanal dressing was performed when monthly radiographic examinations showed its absence. After 12 months the teeth were obturated with zinc oxide and eugenol cement . Halting of the inflammatory and replacement root resorption (64.3%; n  = 28) occurred 9 months after the use of calcium hydroxide dressings, in a total of 18 successful cases. Fisher's test was applied to relate success with the type of trauma, work length time, child's age and pulpal condition. The test did not present statistical significance ( P  < 0.05). However, in the qualitative analysis, failure was observed in those cases (35.7%) where replacement resorption was already present at the moment of treatment (up to two-thirds) associated with severe trauma cases. The authors concluded that endodontic treatment must be initiated at an early stage, and must be coincident with the radiographic signs of resorption. Success of the treatment is directly related to the seriousness of the sequelae at the moment of the first examination or the endodontic treatment.     

Prognosis of permanent teeth with internal resorption: a clinical review

Abstract This study was performed in order to report the clinical features of internal resorption cases and evaluate their prognosis after endodontic treatment. Twenty-seven patients with 28 teeth with internal resorption were referred to our clinic and 20 teeth were treated endodontically. Sixteen teeth had non-perforating internal resorption and were treated by conventional root canal therapy. The remaining 4 teeth had perforating internal resorption and were initially treated by remineralization therapy with calcium hydroxide. The teeth treated by conventional root canal therapy showed clinical and radiographic evidence of healing. However, the remineralization therapy was successful in only one case. The three failed cases were subsequently treated by endodontic surgery. The surgical therapy was unsuccessful in one case due to extensive loss of marginal alveolar bone and increased tooth mobility.     

Idiopathic root resorption of the entire permanent dentition: systematic review and report of a case

Abstract –  A rare case of idiopathic root resorption affecting the entire dentition was described. Root resorptions of all of the maxillary and mandibular teeth were coincidentally diagnosed on patient's radiographic examination. The patient's medical and dental findings were non-contributory, other than the increased mobility of upper incisors. No significant familial findings could be identified. Detailed radiographic examination revealed resorption affecting the apical part of the roots, resulting in vertical shortening of the teeth. The character of the resorption was as if a tapering occurred throughout the lateral root surfaces. Involved teeth were endodontically treated and the patient was subsequently followed-up for 18 months. Following endodontic therapy, all periapical lesions demonstrated clinical and radiographic evidence of healing. Endodontic therapy resulted in a high degree of success to stop resorption process and maintain the dentition.     

Treatment of invasive cervical resorption with sandwich technique using mineral trioxide aggregate: a case report

This article presents two cases of large invasive cervical resorption (ICR) with maintenance of pulp vitality after treatment with mineral trioxide aggregate (MTA) in a sandwich technique.Invasive cervical resorption is a relatively uncommon but aggressive form of external resorption, primarily caused by dental trauma or injury of the cervical periodontal attachment. The resorptive process does not penetrate into the root canal, and the pulp is not involved in the first phase of the resorption. This feature differentiates external resorption from internal resorption. In most cases, invasive cervical resorption is found during routine radiographic or clinical examination. Different materials have been proposed for the treatment of external cervical resorption. Therapy can be effective when it 1) removes the etiological factors and 2) interrupts the progressive resorption mechanism.The key learning points of this article are the following: treatment strategy to arrest the cervical resorption process and to prevent further resorption without changing pulpal vitality and successful seal of invasive cervical resorption defect using MTA with a sandwich technique.     

Early radiographic diagnosis of inflammatory root resorption

Inflammatory root resorption (IRR) is a common sequelae to oral trauma. Anticipating root resorption after trauma and taking some preventive measures may avoid this outcome. Endodontics and radiographic examination play an important role in the early diagnosis and treatment of root resorption. Subtle radiographic clues can lead to timely implementation of appropriate treatment (if any) according to the kind of resorption discovered. This article describes the most current classification of inflammatory root resorption (usually following trauma) and utilizes a clinical study to provide radiographic clues for its early detection.     

Randomized controlled trial of mineral trioxide aggregate and formocresol for pulpotomy in primary molar teeth

AIM: To compare the outcome after 6 months of the application of formocresol (FC) or mineral trioxide aggregate (MTA) during pulpotomy in primary molar teeth. METHODOLOGY: A maximum of 126 children (aged 5-9 years) with carious primary teeth that required pulpotomy were selected. Following randomization, a standard pulpotomy preparation was undertaken, and the coronal pulp removed and bleeding arrested. In the FC group, cotton balls, soaked in FC, were placed for 5 min, and then the pulp chamber was filled with Zonalin, a pulpotomy agent. In the MTA group, a 1-mm-thick paste of MTA was used as a pulpotomy agent. The crowns in both groups were restored with amalgam or glass ionomer. The teeth of 100 patients were evaluated and compared clinically and radiographically after 3 and 6 months. RESULTS: No signs of clinical failure were observed at the 3- and 6-month follow-up appointments in either group. There were no significant differences in the radiographic findings of the teeth and surrounding tissue at the 3-month follow-up. However, at the 6-month follow-up, significantly more cases (P = 0.036) with root resorption were seen in the FC group; no cases of resorption occurred amongst the MTA cases. The surrounding tissue showed radiographic signs of post-treatment disease in four FC cases; none was seen in the MTA cases. CONCLUSION: After 6 months, pulpotomy with MTA was associated with fewer cases of root resorption and post-treatment disease. MTA appears to be a reliable alternative material for pulpotomy in primary molar teeth.     

External multiple invasive cervical resorption with subsequent arrest of the resorption

Abstract – A rare, the uncommon, case of multiple invasive cervical resorption (MICR) with subsequent arrest of the resorption involving eight teeth of the mandible (tooth 46 to tooth 32) is presented. This case is noteworthy because of the characteristics of its clinical evolution. There have only been a few cases in the literature were found presenting involvement of such a large number of teeth. Furthermore, noreports on cases of MICR with arrest of the resorption, as described in this report, were found.