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Abstract: Internal inflammatory root resorption (IIRR) is a rare, but significant consequence of dental trauma. Previous cases often focus on two-dimensional imaging. More widespread use of cone beam computed tomography (CBCT) has seen improved diagnostic accuracy of these defects leading to more appropriate management. In this case report, an adolescent male patient complained of a missing front tooth (UR1). Dental history revealed intrusive trauma to the predecessor as a child. The UR1 was impacted with a dilacerated root. CBCT imaging revealed severe internal root resorption, and due to its extensive nature, extraction was advised.
CPD/Clinical Relevance: Readers should be aware of the consequences of internal inflammatory root resorption and understand the importance of early detection with appropriate special investigations.
Article
Inflammatory root resorption (IRR) is a common sequela of dental trauma. IRR can occur on the external or internal surfaces of the affected teeth, with the latter being less common.1 IRR can be classified as apical or intra-radicular depending on the location of the anatomical defect, with apical internal resorption occurring frequently in teeth with peri-apical pathology, often in combination with external inflammatory apical resorption.2 Internal IRR is caused by accelerated osteoclastic activity, resorbing the intra-radicular dentine layer within the root canal, and can lead to critical damage to the tooth.3 Initially, the pulp complex has some level of vitality, although it may have been contaminated with bacterial ingress at the coronal level and subsequently suffer from chronic pulp inflammation. Internal IRR can present transiently whereby the odontoblast layer and predentin are affected before spontaneous resolution, although this is rare.4 However, as the internal IRR is often asymptomatic, it can also continue undiagnosed, to the extent that perforation of the canal can occur. Careful monitoring of all previously traumatized teeth is therefore advised. Management of internal resorption requires prompt endodontic treatment, including removal of the entire pulp tissue, canal irrigation and creation of an aseptic environment. This is most commonly achieved with sodium hypochlorite, followed by placement of calcium hydroxide until there is evidence the process has ceased, and the canal can be definitively restored.5 More recently, MTA (mineral trioxide aggregate) has demonstrated to be the material of choice for restoring perforated lesions, due to its biocompatibility and superior sealing properties.2 Treatment may be combined with a surgical approach to gain direct access to the defect. Unfortunately, in severely affected cases, the extent of resorption can be such that extraction is considered the preferred option.2,6
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