Clinical Management of Two Root Resorption Cases in Endodontic Practice

Radiological and Histopathological Features of Internal Tooth Resorption

BACKGROUND

Internal root resorption is an endodontic disease characterized by progressive resorption of dentin from the inside of the pulp chamber. It is a comparatively rare finding in the permanent dentition, and the underlying pathology is not fully understood.

CASE REPORT

A 45-year-old patient was referred to our Department for the evaluation of the lower right canine and the upper left wisdom tooth. Pulp sensitivity tests, cone-beam tomography, and magnetic resonance imaging were used to determine the extent of lesions of the affected teeth. The teeth were subsequently extracted due the extent of the lesions. The same was the case for the upper right canine, which developed a severe internal resorption 10 months later. Micro-computed tomography of the extracted teeth revealed that all lesions had a well-defined border with no evidence of sclerosis or hypomineralization. Pulp stones were evident inside the pulp chamber. Ground sectioning of the upper right canine revealed pulp necrosis and an acute infection that had gradually moved in the apical direction. Large multi-nucleated resorbing cells were found on the dentin surface. Importantly, the apical half of the pulp exhibited comparatively normal tissue without substantial inflammatory changes. Decalcified histology of the upper left wisdom tooth demonstrated a completely different histopathological appearance characterized by chronically inflamed granulation tissue with pseudoepitheliomatous hyperplasia and massive bacterial colonization.

CONCLUSION

Our analyses demonstrate that internal root resorption is a multifaceted dental disease with considerable variability in the rate of the underlying inflammatory changes. Oral surgeons should take this into consideration when evaluating the need for extraction of teeth with internal root resorption.

Endodontic management of a tooth with apical overfilling and perforating external root resorption: A case report

Successful non-surgical orthograde retreatment of a tooth with external root resorption in apical third of root and overfilling material beyond the apical barrier which was diagnosed with the help of cone beam computed tomography (CBCT), was reported. Biodentine was used as the treatment of choice for obturation of resorption area.

Mechanical stress induced S100A7 expression in human dental pulp cells to augment osteoclast differentiation

OBJECTIVES

Mechanical injury of dental pulp leads to root resorption by osteoclasts/odontoclasts. S100 proteins have been demonstrated to be involved in inflammatory processes and bone remodeling. This study aimed to investigate the effect of mechanical stress on S100A7 expression by human dental pulp cells (HDPCs) and the effect of S100A7 proteins on osteoclast differentiation.

MATERIALS AND METHODS

Isolated HDPCs were stimulated with compressive loading (2 and 6 hr), or shear loading (2, 6, and 16 hr). S100 mRNA expression and S100A7 protein levels were determined by real-time PCR and ELISA, respectively. Osteoclast differentiation was analyzed using primary human monocytes. The differentiation and activity of osteoclasts were examined by TRAcP staining and dentine resorption. In addition, the expression of S100A7 was analyzed in pulp tissues obtained from orthodontically treated teeth.

RESULTS

Compressive and shear mechanical stress significantly upregulated both mRNA and protein level of S100A7. Dental pulp tissues from orthodontically treated teeth exhibited higher S100A7mRNA levels compared to non-treated control teeth. S100A7 promoted osteoclast differentiation by primary human monocytes. Moreover, S100A7 significantly enhanced dentine resorption by these cells.

CONCLUSIONS

Mechanical stress induced expression of S100A7 by human dental pulp cells and this may promote root resorption by inducing osteoclast differentiation and activity.

Clinical Management of Root Resorption: A Report of Three Cases

Root resorption is a pathological condition that may be an endodontic challenge if not diagnosed and treated correctly. The recent advances in the imaging technologies and material science have enabled the clinician to visualize the structural changes accurately and repair them with materials providing favourable seal ability. In this article, we report three cases of root resorption with different presentations which were diagnosed with the help of cone beam computed tomography (CBCT) and successfully managed. The series highlights the importance of diagnosis in unusual clinical situations and recommends early commencement of optimal management for longevity of tooth for health and function.