TREATING INTERNAL RESORPTION USING A SYRINGEABLE COMPOSITE RESIN
TADASHA E. CULBREATH, D.M.D.,
GAIL M. DAVIS, D.D.S., M.S.,
NATHANIEL M. WEST, D.D.S., M.P.H. and
ANDREA JACKSON, D.D.S., M.S.
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ABSTRACT
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Background. Internal resorption is a pathological process initiated within the pulp space with the loss of dentin. It often is described as an oval-shaped enlargement of the root canal space and usually is asymptomatic and detectable by routine radiographs. Treatment of internal resorption has included several materials—gutta-percha, zinc oxide eugenol and amalgam alloy. These materials do not provide strength to the tooth structure.
Case Description. A 29-year-old woman was referred to a dental clinic for treatment of a large internal resorptive defect in the coronal and middle one-third of the maxillary left central incisor root with no apparent periapical pathosis, as well as a large periapical radioluency at the apex of the maxillary left lateral incisor that was associated with a necrotic pulp. The authors used a dual-cure syringable composite resin in conjunction with a bonding agent within the defect to treat it.
Clinical Implications. This technique seals the dentinal tubules and strengthens the remaining tooth structure. It also improves the outcome of resorptive defects and reduces operators’ chair time.
Restoring pathological defects that are caused by internal resorption in teeth can be challenging. The introduction of new restorative materials has improved the outcome of these defects, as well as reduced chair time for operators.
Although the etiology of internal resorption is unknown, trauma or persistent chronic pulpitis often are contributing factors.1 Several researchers describe internal resorption and believe that the resulting defects are due to inflammation.2–7 Fothergill8 describes internal resorption as a "pink spots." Mummery9 describes and discusses these "pink spots" in detail. In 1998, the American Association of Endodontics10 defined internal resorption as "a pathologic process initiated within the pulp space with loss of dentin." Trope and colleagues11 describe internal resorption as an oval-shaped enlargement of the root canal space. It usually is asymptomatic and detectable by routine radiographs. Root canal therapy is the only effective treatment and should begin as soon as possible to limit progression.
In this article, we describe a clinical procedure that uses a dentin-bonding agent in conjunction with a dual-cure syringeable hybrid composite resin to manage teeth that have undergone internal resorption.
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CASE REPORT
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A 29-year-old woman was referred to the Howard University College of Dentistry dental clinic by another dental office for treatment. We took radiographs, which revealed a large internal resorptive defect in the coronal and middle one-third of the maxillary left central incisor (tooth no. 9) root with no apparent periapical pathosis, as well as a large periapical radiolucent area at the apex of the maxillary left lateral incisor that was associated with a necrotic pulp (Figure 1
). We made a diagnosis of extensive internal resorption secondary to trauma.
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Figure 1. Preoperative periapical radiograph of the maxillary left central and lateral incisors. Note the large internal resorptive defect within the maxillary left central incisor.
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We isolated tooth no. 9 with a rubber dam and achieved access on the lingual aspect of the crown. We extirpated the pulp and determined the working length. The canal was instrumented to a size 45 file using sodium hypochlorite 2.5 percent as the irrigant. We dried the canal with paper points and tailored a size 45 gutta-percha cone to the apical segment of the canal. We then used vertical condensation to condense the canal and sealed it with a noneugenol pulp canal sealer.
Since the clinical crown was intact, we decided not to place a post core and porcelain crown. Instead, we used a dentin bonding system and a dual-cure syringable hybrid composite resin.
To prepare the canal for composite resin, we placed a rubber dam to isolate the tooth. We irrigated the canal with water, dried it with air and paper points, placed an etching gel containing 37 percent phosphoric acid in it with a syringe for 20 seconds and irrigated it with water. The canal was dried of all excess moisture using paper points and an air syringe.
We selected the Tenure AB (Den-Mat Corp.) dentin-bonding system and applied the composite resin to the defect according to the manufacturer’s directions. The canal and orifice were gently air dried for 10 seconds after each application of the adhesive. We applied the Tenure S Bond Enhancer (Den-Mat Corp.) to the entire length of the unfilled root canal and orifice and then gently air-dried it. To prevent accumulation of the bond enhancer in the canal, we did not light-cure the enhancer.
We mixed together equal amounts of the dual-cure syringeable composite resin, Marathon (Den-Mat), shade paste and initiator for about 30 seconds, placed the mixture in a tip with plunger and slowly injected it into the resorptive defect from the apex to the occlusal surface to avoid void formation within the canal. We cured the composite resin with a light source that transmitted light facially and lingually on the tooth for 40 seconds in each direction until polymerization occurred. We then filled the remaining canal space and coronal access of the tooth with composite resin in two increments and cured it (Figure 2). The lingual surface of the tooth was finished with an ultrafine diamond bur and a composite finishing kit.
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Figure 2. Postoperative periapical radiograph showing the maxillary left central incisor root canal space filled with a syringeable composite material.
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CONCLUSION
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Several materials have been used to treat teeth that have undergone internal resorption. They include a hydrophilic plastic polymer (2-hydroxyethyl methacrylate with barium sulfate), zinc oxide eugenol and zinc acetate cement, amalgam alloy and thermoplasticized gutta-percha administered either by injection or condensation techniques.5,12 Some of these materials, however, do not provide strength to the remaining tooth structure. The clinician has several alternative procedures and materials from which to choose for the final restoration. Which the clinician chooses will depend on the amount of remaining tooth structure and the extent and location of the defect.
We used Tenure AB and Marathon because they are easy to insert, and because of their their autopolymerization properties and ability to help prevent pathological fractures that can occur with the separation of the crown and root at the defect level.
The clinician has several alternative procedures and materials from which to choose for the final restoration.
Using this technique prevented voids within the canal space. Although Marathon is a dual-cure material, we used a visible light-curing unit after the orifice was completely filled to maximize polymerization. Composite resin used in conjunction with Tenure is a stronger material than composite resin alone and adds strength and reinforcement to the tooth.
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FOOTNOTES
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Dr. Culbreath is an instructor, Department of Fixed Prosthodontic and Restorative Dentistry, Howard University College of Dentistry, Washington. Address reprint requests to Dr. Culbreath at 2205 Rollins Drive, Alexandria, Va. 22307.
Dr. Davis is an assistant professor, Department of Endodontics, Howard University College of Dentistry, Washington.
Dr. West is a professor, Department of Endodontics, Howard University College of Dentistry, Washington.
Dr. Jackson is the director, Department of Fixed Prosthodontics and Restorative Dentistry, Howard University College of Dentistry, Washington.
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REFERENCES
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- Bell, T. The anatomy, physiology, and diseases of the teeth. 3rd ed. Philadelphia: Carey, Lea and Blanchard; 1837:171–2.
- Brown CE Jr., Steffel CL, Morrison SW. A case indicative of rapid, destructive internal resorption. J Endod 1987;13(10):516–8.[Medline]
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- Sweet AP. Internal resorption: a chronology. Dent Radiogr Photogr 1965;38(4): 75–81.[Medline]
- Fothergill JA. Casual communications: pinkspot. Trans Odontol 1900;32:213.
- Mummery JH. The pathology of pink spots on teeth. Br Dent J 1920;41:301–11.
- American Association of Endodontics. Glossary of contemporary terminology for endodontics. 6th ed. Chicago: American Association of Endodontics; 1998:19.
- Trope M, Chivian N, Sigurdsson A. Traumatic injuries. In: Cohen S, Burns RC, eds. Pathways of the pulp. 6th ed. St. Louis: Mosby; 1994:552–99.
- Mandor RB. A tooth with internal resorption treated with a hydrophylic plastic material: a case report. J Endod 1981;77(9): 430–2.
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