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Case report: Internal root resorption rules out restoration

Based on clinical and radiographic diagnosis with conventional two-dimensional periapical radiographs, tooth #8 appears to have a large internal radiolucency in the middle of the pulp canal defined as an internal root resorption. (DTI/Photo Dr. Dov M. Almog)
Dov M. Almog and Odalys Hector, USA

Dov M. Almog and Odalys Hector, USA

Tue. 17 January 2012


For decades, case reports and scientific studies have described the condition of internal root resorption. A recent web search related to internal root resorption revealed 247 results in PubMed and more than 1 million results in Google. According to many of the studies, internal root resorption is infrequently detected in clinical or radiographic examinations of teeth, but is a frequent finding in teeth with pulp inflammation or necrosis.

Many of the published works on internal root resorption condition are in the form of case reports similar to this one. Some, though, are scientific studies that examine the histological and biological aspects of the condition.[1]

A recent scientific study revealed that teeth with healthy pulps did not exhibit the condition of internal root resorption. By comparison, half of the teeth with pulpitis, and the majority of the teeth with necrotic pulps, had internal resorption.[2] Inflammation was shown to be an important etiologic factor of internal resorption.

In our case, a 42-year-old African American male, a U.S. armed services veteran, presented for the first time to the Veterans Affairs New Jersey Health Care System Dental Service at East Orange, N.J., seeking dental care. The patient’s primary reason for coming to the Dental Service was for a complete dental exam.

This case report describes the condition of a permanent maxillary central incisor affected by internal root resorption. While the etiology of this pathology is unknown, most commonly it is associated with trauma or seen postoperatively following a large resin restoration. According to the literature, this type of progressive internal root resorption can be stimulated by ongoing inflammation from infection.[3]

A comprehensive oral and maxillofacial examination included an intraoral and extraoral exam with cancer screening, full-mouth X-rays and a panoramic radiograph.

Among other things, the examination revealed extensive internal root resorption condition in tooth #8, coupled with a buccal fistula draining purulent discharge (see image above).

After careful assessment of all the available diagnostic information, and upon further exploration of the feasibility of different treatment options to restore the patient’s tooth, the case was discussed and explained to the patient.

While root canal treatment has been the treatment of choice for this pathologic condition to date,1 after reassessing the extent of the internal resorption and describing the condition to the patient, including the potential associated postoperative ramifications, it was collectively decided to extract the tooth followed by socket preservation.

At the same visit, an immediate acrylic removable partial denture (RPD) was delivered.

Consequently, all restorative, periodontal and prosthetic needs were addressed, including a cast RPD replacing tooth #8 and other already missing bilateral teeth.


As described in this case report, for decades it has been determined that internal resorption is seen frequently in teeth associated with pulp inflammation or necrosis. Following suggested course of action in the literature, when internal root resorption condition has progressed to involve an external communication with the periodontal ligament space, this condition should not be restored and maintained.[4]

Note: This article was originally published in Dental Tribune U.S. Edition, Vol. 7 No. 1, January 2012. A complete list of references is available from the publisher.

About the authors

Dov M. Almog, DMD, is chief of the Dental Service, at the Veterans Affairs New Jersey Health Care System (VANJHCS). Odalys Hector, DMD, is a general dentist in the Dental Services at VANJHCS.


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