8.2
Internal Inflammatory Resorption
Shanon Patel
Objectives
At the end of this case the reader should have an appreciation of the diagnosis and management of internal inflammatory root resorption.
Introduction
A 43‐year‐old female presented as a new patient. She was asymptomatic; however, she gave a history of intermittent discomfort localised to her upper right central incisor (UR1) for several months, which she managed with over‐the‐counter analgesics.
Chief Complaint
The UR1 was tender to chewing for three to four months and the patient also complained of an occasional spontaneous throbbing ache from the upper right incisor region. These symptoms resolved approximately four months ago.
Medical History
Asthmatic.
Dental History
The patient’s upper anterior teeth were traumatically injured in a car accident 19 years ago; these teeth were subsequently restored with crowns. Approximately one year ago the patient had these crowns replaced to improve the appearance of her smile.
Clinical Examination
Extraoral examination was unremarkable. Intraoral examination revealed a moderately restored dentition, with good oral hygiene with periodontal probing depths of 1–3 mm.
The upper incisor teeth were restored with well‐adapted and contoured crowns. The UR1 was tender to percussion and palpation and did not respond to thermal (cold) or electric pulp testing. There were no other signs of endodontic or periodontal disease associated with the upper anterior teeth.
What did the radiographs reveal?
- Alveolar bone height within normal limits (Figure 8.2.1a).
- UR2 was root filled and there appeared to be a small amount of sealer extrusion apically. The tooth was restored with a well‐adapted crown that was retained in placed with a fibre post.
- UR1 was restored with a well‐adapted crown, there was a well‐demarcated, symmetrical radiolucency in the coronal third of the canal and the periphery was slightly more radiopaque. The periodontal ligament space appeared to be a normal width and the canal apical to the radiolucency was sclerosed. The cone beam computed tomography (CBCT) scan confirmed that the root was not perforated, meaning that root canal treatment was potentially viable (Figure 8.2.1b, c).
Radiographically, internal inflammatory resorption lesions may be round or oval, with a circumscribed border and radiolucent. The resorptive defect is always a continuity (or ballooning out) of the root canal (Table 8.2.1).
Table 8.2.1 Features of internal inflammatory resorption.
| Clinical features |
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| Sensitivity testing |
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| Radiographic features |
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Is a cone beam computed tomography scan indicated?
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