CASE 10865 Published on 06.07.2013

Multiple teeth internal resorption


Head & neck imaging

Case Type

Clinical Cases


Ilda Cekaj (Beno)1, Elton Cekaj2

(1) Private dental clinic
(2) Regional Hospital of Durres

30 years, male

Area of Interest Head and neck ; No Imaging Technique
Clinical History
The patient, a 42-year-old man, presented for routine check up for the first time at our clinic. Because of multiple teeth caries and severe periodontitis a panoramic plain film was requested.
Imaging Findings
The most important radiographic finding was irregular widening of the pulp chamber and canal at teeth 44, 46 (both radixes) and 26 both radixes (red arrows). Furthermore in the same patient the main radiographic differential diagnoses were found: neck caries at teeth 45, 47 and 35 and external resorption at tooth 14. Radiographic diagnosis was compatible with internal resorption at multiple teeth. In addition, there were apical radiolucencies in 35, 44, 45, 46 teeth (white arrows) and a generalised loss of bone. The loss of bone was most pronounced at the level of missing tooth 15 resulting in infraposition of 16 tooth (red arrowhead). To better understand compare the normal internal and periapical image of 48 tooth (green arrow) with the pathological findings mentioned above.
Resorption is the removal of tooth structure by osteoclasts, referred to as odontoclasts when they are resorbing tooth structure. Resorption is classified as internal or external on the basis of the surface of the tooth being resorbed. External resorption affects the outer tooth surface, and internal resorption affects the inner surface of the pulp chamber and canal. These two types differ in their radiographic appearance and treatment. The resorption discussed here is not that associated with the normal loss of deciduous teeth. The aetiology of resorptive lesions (internal & external) remains unknown, at least presumptive evidence exists that some lesions are the sequelae of chronic infection (inflammation), excessive pressure and function, or factors associated with local tumours and cysts.
Internal resorption occurs within the pulp chamber or canal and involves resorption of the surrounding dentin. This results in enlargement of the size of the pulp space at the expense of tooth structure. This condition may be transient and self-limiting or progressive. The aetiology is unknown but may be related to inflammation of the pulpal tissues. Internal resorption has been reported to be initiated by acute trauma to the tooth, direct and indirect pulp capping, pulpotomy, and enamel invagination [1, 2, 4].Radiographs can reveal symptomless early lesions of internal resorption. The lesions are radiolucent and round, oval, or elongated within the root or crown and continuous with the image of the pulp chamber or canal. The outline is sharply defined and smooth or slightly scalloped. The result is an irregular widening of the pulp chamber or canal. It is characteristically homogeneous, without bony trabeculation or pulp stones. However, the internal structure may seem to be apparent, if the surface of the resorbed tooth structure is very irregular and has a scalloped texture. In some cases virtually the whole pulp may enlarge within a tooth, although more commonly the lesion remains localised.
The most common lesions to be confused with internal root resorption are dental caries on the buccal or lingual surface of a tooth and external root resorption. Carious lesions have more diffuse margins than lesions caused by internal root resorption. Clinical inspection quickly reveals caries on the buccal or lingual surface of a tooth. Also, the mesial and distal surfaces of the pulp chamber and canal may usually be separated from the borders of the carious lesion. The internal resorption can be stopped by pulp extirpation procedure, use of calcium hydroxide and plasticised gutt-percha to obturate the open canals [3].
Differential Diagnosis List
Internal resorption of teeth 26, 44, 46
External root resorption
Bucal or lingual surface dental caries
Final Diagnosis
Internal resorption of teeth 26, 44, 46
Case information
DOI: 10.1594/EURORAD/CASE.10865
ISSN: 1563-4086