Tooth resorption

Abstract: Invasive cervical resorption (cervical resorption) is a relatively uncommon form of external root resorption whichhas been a source of interest and academic debate by clinicians and researchers for over a century. Clinical,radiologicandpathologicfeaturesofinvasivecervicalresorptionprovidethebasisforaclinicalclassificationwhichisof use both in treatment planning and for comparative clinical research. Although the etiology of this conditionremains obscure, knowledge of potential predisposing factors is important in assessing patients at risk. Treatment,whereindicated,shouldaimattheinactivationofallresorbing tissueandthereconstitutionoftheresorptivedefecteither by the placement of a suitable filing material or by the use of biological systems.Invasive cervical resorption is a clinical term used todescribe a relatively uncommon, insidious and oftenaggressive form of external tooth resorption, whichmayoccurinanytoothinthepermanentdentition(1).Characterized by its cervical location and invasivenature, this resorptive process leads to progressive andusually destructive loss of tooth structure. Resorptionof coronal dentin and enamel often creates a clinicallyobvious pinkish color in the tooth crown as highlyvascular resorptive tissue becomes visible through thinresidual enamel. Essentially, the same resorptiveprocess can occur in other tooth locations: in eruptingteethitmayarisethroughanenameldefectinthetoothcrown and may be termed invasive coronal resorption,while a more apical source may be termed invasiveradicular resorption.Invasive cervical resorption has and continues to bemisdiagnosed as a form of internal resorption, amisunderstanding that could possibly be attributed tothe descriptions of internal resorption by Gaskill (2) in1894 and by Mummery (3) in 1920 which includedteeth showing ‘pink spots’. This pathological processhas obviously intrigued clinicians and researchers forover a century, and still remains an enigma judging bythe current diversity of opinion regarding possibleetiologyandpathogenesis.Testimenttothisdiversityisthenomenclaturewhichhasbeenappliedovertheyearsto this periodontally derived form of external toothresorption. The terms include odontoclastoma (4),idiopathic external resorption (5), fibrous dysplasia ofteeth (5), burrowing resorption (6), peripheral cervicalresorption,(7)late cervical resorption (8), cervicalexternal resorption (9), extra-canal invasive resorption(10), supraosseous extra-canal invasive resorption (11),peripheral inflammatory root resorption (12), invasivecervical resorption (1), subepithelial inflammatory rootresorption (13,14),periodontalinfectionresorption (15),or simply, and most commonly, cervical resorption (16).

Abstract: A correct diagnosis and an understanding of the aetiology and dynamics of the processes involved in tooth resorption is critical to effective management. Tooth resorptions can be classified as: (1) trauma induced; (2) infection induced; or (3) hyperplastic invasive. Some transient trauma induced resorptions require no treatment but must be carefully monitored to check that there are no complicating issues such as infection. In cases of trauma induced replacement resorption, a multidisciplinary approach is usually necessary to ensure an optimal long-term solution. Infection induced tooth resorptions require the removal of the invading micro-organisms by endodontic therapy including intra-canal medication which can also facilitate repair of the resorbed tooth structure. The hyperplastic invasive tooth resorptions pose considerable challenges in management due to the complexity and aggressive nature of the resorptive process. With careful case selection and complete inactivation of resorptive tissue successful management can be achieved.