Case reports/root resorption secondary to impacted teeth.
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Cellular colonization of denuded root surfaces on replanted teeth was examined with scanning electron microscopy. The dentin surface was rapidly colonized by a few macrophage-like cells which resorbed dentin in limited areas. They had well-developed ruffled borders but no clear zones. The resorptive activity was gradually inhibited by the ingrowth of a monolayer of fibroblast-like cells from the periphery of the denuded area. At the advancing front, the ingrowing fibroblast-like cells were long and slender, with long tail-like projections trailing the nuclear domain. The invading cells behind these were well-spread and tightly packed. They had a granulated surface and showed morphological signs of fibre synthesis. After 6 weeks, the entire cavity was covered by a monolayer of these cells. Removal of the cells with sodium hypochlorite revealed that a cementum-like tissue had been formed under the invading cells, indicating that they were cementoblasts. It was concluded that wound repair on the root surface is dependent upon the differentiation and proliferation of pre-cementoblasts in the periphery of the wound and that cells in the main body of the periodontal membrane are of little significance in the healing process on the root surface.
Although it has been discussed since 1920, the entity of extracanal invasive resorption (EIR) remains misunderstood from a nomenclature, diagnostic, and treatment standpoint. At least 10 terms for it have been published in the dental literature. The key to diagnosis is that the pulp canal space has not been invaded by the resorption. Therefore, the pulp will respond to vitality testing. From a treatment standpoint, a differentiation must be made between the three types of EIR--intraosseous, crestal, or supraosseous. The latter condition may not require endodontic treatment, whereas it is necessary for the other two conditions. Regardless of the EIR's site, its successful treatment requires the debridement and obliteration of the external portal of entry and the resorptive defect.
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A review of prognosis studies has examined success rates between samples of teeth, both with and without radiolucent lesions, treated conventionally. The presence of a lesion predisposes the endodontic case to a lower success rate. On the basis of experimental data on the use of calcium hydroxide, investigation of increasing success with placement of calcium hydroxide in the canals of teeth with periapical lesions for 3 to 10 months prior to conventional filling is proposed.
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A case of extensive internal resorption of the left mandibular first premolar in a 24 year old man is reported. The case presented with slight discolouration and mobility of the tooth. On radiological examination extensive internal resorption and a fracture line at the cemento enamel region was observed, separating the crown and root. The case was treated endodontically after surgical removal of the fractured fragment of the crown.
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