Moffitt Restorative Dentistry

Internal Resorption

May 08 2016

Diagnosis and Treatment of Internal Resorption
Tooth resorption is defined as a physiologic or pathologic process that results in the loss of dental tissue, such as dentin and cementum. Tooth resorption is classified as either internal or external, which can be further divided into specific types. Internal resorption originates from within the pulp, while external resorption begins in the periodontal ligament.
The diagnosis of internal resorption is made through a combination of clinical and radiographic findings. For internal resorption to occur, some vital pulp tissue must be present. Pulp test (electric, cold, heat) results are suggestive of tooth vitality. It is possible to obtain a negative result, however, if coronal pulp tissue is necrotic despite the apical pulp tissue remaining vital. Patients typically present with no pain and are asymptomatic.5 Internal resorption is typically detected during recare or routine radiographic examinations. However, a tooth experiencing internal resorption may appear slightly pink due to an enlarged pulp. This is called the “pink tooth of Mummery,” after an anatomist. The condition was once considered indicative of internal resorption, but it can also be seen in some forms of external resorption.
Radiographically, a uniform, semicircular radiolucent area contiguous with the pulp is a sign of internal resorption. In order to distinguish this from external resorption that may be on the facial or lingual surface of the root, an additional, angulated radiograph (shift-shot X-ray) can be helpful. This radiograph is exposed using exaggerated horizontal angulation of approximately 20° to 30° to the mesial or distal. If the radiolucent area remains over the canal space, internal resorption is likely. Conversely, if the radiolucent area appears to move away from the pulp, it is probably external resorption.
CLINICAL TREATMENT
Increasing age is a significant risk factor for developing AD or other diseases that lead to dementia. Individuals with such cognitive problems will need support to maintain both their overall and oral health. As dementia progress, caregivers may need to assume full responsibility for a patient’s oral self-care as well as ensure patients receive timely and adequate professional care.
In summary, internal resorption is the loss of dentin contiguous to the pulp. Patients are usually asymptomatic, so an accurate diagnosis depends on a thorough radiographic examination, along with clinical observations and testing. If detected early when sufficient root structure remains, root canal treatment, followed by a restoration, can help maintain the tooth. The tooth may ultimately need to be extracted and restored with a dental implant restoration, bridge, or removable partial denture.

 

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