PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

Cervical resorption is an unusual form of external inflammatory root resorption,
initiated by damage to the root surface in the cervical region, and propagated either by
infected root canal contents, or by the periodontal microflora. From a very small entry
point, the resorptive process may extend widely before penetrating the pulp chamber
(753HFig. 12.42 (a and b)).



  1. Diagnosis. Extensive intracoronal extension may occasionally present cervical
    resorption as a clinically visible pink spot. More commonly, it is identified on routine
    radiographs as a characteristically sited radiolucency (754HFig. 12.42).

  2. Treatment. If the tooth is non-vital, conventional root canal therapy should be
    undertaken to eliminate the propagating stimulus. Arrangements should then be made
    to open the resorptive defect in a similar manner to cavity preparation, and to curette
    away all traces of inflammatory tissue before restoring the resultant defect (755HFig.
    12.43). Often, a flap must be raised to adequately eliminate resorptive tissue and
    contour the subgingival restoration.


If the tooth is vital, and the pulp has not been invaded, treatment may be limited to
opening and curetting the resorption lacuna before placing a setting calcium
hydroxide lining and restoring the defect with an appropriate material.


Periodic clinical and radiographic review should again be arranged.


INTERNAL INFLAMMATORY ROOT RESORPTION
Internal inflammatory root resorption is seen in the canals of traumatized teeth which
are undergoing progressive pulp necrosis. Infected material in the non-vital, coronal
part of the canal is believed to propagate resorption by the underlying vital tissue, and
rapid tissue destruction follows.



  1. Diagnosis. Large resorptive defects affecting the coronal third of the canal may
    present as a pink discoloration of the affected tooth. More commonly, it is detected as
    a chance finding on routine radiographic examination. Radiographically, internal
    resorption presents as a rounded, symmetrical radiolucency, centred on the root canal.
    The contours of the root canal walls are rarely superimposed (756HFigs. 12.44 and 757H12.45).

  2. Treatment. Internal resorption should be considered to be a form of irreversible
    pulpitis and treated without delay. Following standard access cavity preparation, the
    pulp chamber and coronal portion of the canal is usually found to contain necrotic
    debris. However, deeper penetration of the canal often provokes torrential
    haemorrhage as the vascular, resorptive tissue is entered.


Root canal preparation is undertaken in the usual manner, and following apical
enlargement, haemorrhage from the canal is greatly reduced as the blood supply to the
resorptive tissue is severed. Instrumentation of the expanded, resorbed area is
difficult, and can be greatly enhanced by the use of sonic or ultrasonic devices which
are able to throw irrigant into uninstrumented areas. The antimicrobial and tissue
solvent actions of sodium hypochlorite make it the irrigant of choice in such cases.


As in the case of external inflammatory resorption, it is usual to dress the canal with
non-setting calcium hydroxide following debridement. This may be highly

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