|Year : 2012 | Volume
| Issue : 2 | Page : 129-132
Idiopathic internal resorption: Report of a case with unusual features
Santosh Hunasgi, Anila Koneru, Vanishree Manjunath, Shamala Ravikumar
Department of Oral and Maxillofacial Pathology, Navodaya Dental College, Raichur, Karnataka, India
|Date of Web Publication||17-Jan-2013|
Department of Oral Pathology, Navodaya Dental College, Raichur, Karnataka - 584103
Source of Support: None, Conflict of Interest: None
Tooth resorption can occur from the internal surface of a tooth or from the external surface of a tooth. Internal resorption is commonly termed to be "idiopathic" because of unknown cause. The aim is to report a case of idiopathic internal resorption showing unusual features. A 25-year-old female patient complains of mobility of tooth in right lower back tooth region since 2 months. Clinically, there was slight mobility in 48. Radiographically a resorptive area was seen in crown region of 48. The crown part was removed with gentle pressure using probe. A hollow crown with resorbed dentin and intact thin enamel was seen in gross specimen. A final diagnosis of idiopathic internal resorption was given. Early detection is essential for successful management of idiopathic internal resorption. This prevents further weakening of remaining tooth structure leading to crown or root perforations.
Keywords: Idiopathic, internal resorption, pathogenesis, unusual feature
|How to cite this article:|
Hunasgi S, Koneru A, Manjunath V, Ravikumar S. Idiopathic internal resorption: Report of a case with unusual features. J Orofac Sci 2012;4:129-32
|How to cite this URL:|
Hunasgi S, Koneru A, Manjunath V, Ravikumar S. Idiopathic internal resorption: Report of a case with unusual features. J Orofac Sci [serial online] 2012 [cited 2020 Sep 19];4:129-32. Available from: http://www.jofs.in/text.asp?2012/4/2/129/106210
| Introduction|| |
Resorption is an important part of a multitude of physiological and pathological processes in the human body. Resorption can affect hard tissues such as bone and dental hard tissues, but it can also involve soft tissue such as necrotic pulp tissue.  Any portion of a tooth may be resorbed as long as such surfaces are associated with other living tissues (for example, bone or pulp). Thus tooth resorption can occur from the internal surface of a tooth (pulpal surface) or from the external surface of a tooth (enamel or cementum surface). Resorption from the external enamel surface can occur only when the tooth is embedded, that is, surrounded by bone. From the standpoint of etiology, tooth resorption is classified into three categories: Physiologic, pathologic and idiopathic tooth resorption.  In physiological resorption, the roots of a deciduous tooth undergo resorption before the tooth exfoliates. This is a normal physiologic phenomenon. Resorption can occur with or without the presence of a permanent successor tooth. However, if the permanent successor tooth is absent, the resorption of the deciduous tooth is delayed. It is important to note that there is no infectious (microbiological) component in the various types of physiological resorption.  In pathological resorption, pressure exerted by an impacted tooth produces a smooth resorbed surface on theadjacent tooth and neoplasms of expansive nature tend to produce smooth tooth resorption.  Idiopathic tooth resorption is resorption that occurs either on the internal or external surface of a tooth from an obscure or unknown cause. Internal resorption is commonly termed to be "idiopathic". Idiopathic internal resorption is so uncommon that it is difficult to gather reliable data about its prevalence. It is also unknown whether there are any geographical, ages or sex-related differences in the occurrence of idiopathic internal resorption. ,
Here a case of idiopathic internal resorption showing unusual features is presented.
| Case Report|| |
A 25-year-old female patient complains of mobility of tooth in right lower back tooth region since 2 months. The patient is healthy, with non-contributory medical and family history and as well no history of any previous dental treatment.
Clinically, on intraoral examination there was a slight mobility in 48 [Figure 1]. On radiographic evaluation a resorptive area was seen in crown region of 48. The crown part of 48 is dislodged at the cervical area and displaced distally with roots intact [Figure 2]. After radiographic examination the crown part was removed with gentle pressure using probe and underneath crown soft tissue growth covering the roots was seen [Figure 3].
|Figure 1: Intraoral examination showed clinically normal 48 with slight mobility|
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|Figure 2: Radiographically a resorptive area is seen in crown region of 48 which is dislodged at the cervical area and displaced distally with roots intact|
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|Figure 3: Underneath the crown soft tissue growth covering the roots was seen|
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On gross examination a hollow crown with resorbed dentin and intact thin enamel was retained [Figure 4]. Under local anesthesia the two roots were extracted. Based on clinical and radiographic features a final diagnosis of idiopathic internal resorption was given.
|Figure 4: Gross examination showing a hollow crown with resorbed dentin and intact thin enamel|
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Soft tissue was processed and stained with H and E. The sections showed hyperplastic parakeratinized stratified squamous epithelium and underlying connective tissue stroma is fibrocellular. Few areas showed dense diffuse chronic inflammatory cell infiltrate [Figure 5].
|Figure 5: Hyperplastic parakeratinized stratified squamous epithelium with underlying connective tissue showing dense diffuse chronic inflammatory cell infiltrate (H and E, x10 magnification)|
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| Discussion|| |
Many investigators have reported that the permanent teeth may undergo a certain amount of resorption in apparently normal adults without any obvious cause. The term 'idiopathic resorption' has been applied to this phenomenon. 
The pathogenesis of idiopathic internal resorption is due to idiopathic pulpal hyperplasia leading to localized increase in the size of the pulp. The resorption may continue outwards from the pulpal surface of a crown or a root. This may result in a spontaneous fracture of the tooth. When the internal resorption occurs in a crown, the expanding pulp chamber perforates the dentin and involves the enamel, giving the enamel a pinkish discoloration. This clinical feature is used to describe it as a "pink tooth" of Mummery. Internal idiopathic resorption usually involves only one tooth in the dentition. , Kinomoto et al., in 2002 adds that internal resorption can also happen due to the inflammation of dental pulp of unknown cause. These annoying facts stimulate the pulp tissue, thus the inflammatory process starts and then some undifferentiated cells of the pulp can convert themselves to osteoclasts or macrophages, which results in dentinal resorption.  The actual incidence of this form of resorption was not appreciated until the study of Massler and Perreault, in which it was found that 301 young patients had idiopathic resorption. The majority of idiopathic resorption is mild. Although the etiology remains unknown, several possibilities present themselves. According to Shafers et al., the resorption may be related to one or more systemic disorders, the most obvious being some form of endocrine disturbance. A genetic characteristic governing the resorption potential of bone and tooth has also been demonstrated in animals and is conceivable in human beings. Idiopathic internal resorption is usually asymptomatic and is first recognized clinically through routine radiographs. 
The patient in this case was medically fit and had no history of any past dental treatment. Knowing the nature of disease and its radiographic features, the case was thus diagnosed as 'Idiopathic internal resorption'. However the present case showed unusual features like the crown being dislodged from roots, displaced distally from roots, roots were covered by the soft tissue, and the crown part showed a thin layer of enamel with resorption of whole dentin.
Ozdabak et al., in 2011 reported a case of 27-year-old woman complaining that her maxillary left central incisor was "turning pink" and also was bleeding near gingiva. The patient did not give any trauma history. Clinical examination revealed a pink discoloration and a small defect on the labial surface of the tooth. Radiographic examination showed a resorption area on the coronal portion of the central incisor with no apparent periapical pathosis. After the clinical and radiographic examination, a diagnosis of idiopathic internal resorption was given. 
Ashouri et al., in 2012 reported a case of 22-year-old female was admitted to the postgraduate endodontic clinic for treating her right maxillary central incisor. She had no remarkable medical history and her chief complaint was tooth mobility and yellowish discoloration. Radiographic examination showed an extensive internal resorption defect with root perforation and finally diagnosed idiopathic internal resorption. 
The early diagnosis and therapy of internal resorption is very important. After diagnosis has been made, the endodontic treatment is required. This is the only way to stop further development of resorption.  However in the present case, crown was fractured with roots retained within the jaw bone and as well, it was a third molar, extraction of the retained roots was thought to be the correct treatment. Tooth resorption may go unnoticed for many years; often the patient may be unaware of it because of the lack of symptoms.  In the present case, since the crown part was mobile, it was a concern for the patient. If the patient delayed to report to a dental clinic, crown part would have been completely fractured and swallowed in a rare instance. Thus it is very important to know about idiopathic resorption showing unusual features.
Inaddition radiographic investigations are very much necessary for resorptive lesions. But the very low risk of developing idiopathic internal resorption does not justify taking additional radiographs. However, every radiographic investigation carried out for general examination or diagnostic purposes should be routinely checked for idiopathic lesions. 
| Conclusion|| |
Idiopathic internal resorption is a complex process with unknown etiology. It is a relatively uncommon condition but for patients affected by this pathological process, can cause greater concern. Early detection is essential for successful management of idiopathic internal resorption. This prevents further weakening of remaining tooth structure leading to crown or root perforations. However, idiopathic internal resorption is difficult to predict and control. Further research into the pathogenesis of this resorptive process will provide the basis for improved understanding of this entity with unusual features.
| References|| |
|1.||Haapasalo M, Endal U. Internal inflammatory root resorption: The unknown resorption of the tooth. Endodontic Topics 2006;14:60-79. |
|2.||Shafer WG, Hine MK, Levy BM. Benign and malignant tumours of the oral cavity. In: A textbook of oral cavity. 6 th ed. Philadelphia: W.B. Sounders Company; 2010. p. 580-5. |
|3.||Maria R, Mantri V, Koolwal S. Internal resorption: A review and case report. Endodontology 2010;22:100-8. |
|4.||Neville BW, Damm DD, Allen CM, Bouquot JE. In: Oral and Maxillofacial Pathology. 3 rd ed. Philadelphia: W B Saunders Company; 2009. p. 65-9. |
|5.||Kinomoto Y, Noro T, Ebisu S. Internal root resorption associated with inadequate caries removal and orthodontic therapy. J Endod 2002;8:405-7. |
|6.||Ozdabak N, Akgül N, Karaoðlanoðlu S, Seven N. Pink spot in internal resorption. J Dent Fac Atatürk Univ 2011;4:99-102. |
|7.||Ashouri R, Rekabi AR, Parirokh M. Surgical intervention for treating an extensive internal resorption with unfavorable crown-to-root ratio. J Conserv Dent 2012;15:388-91. |
|8.||Škaljac-Staudt G, Katunariæ M, Iviæ-Kardum M. Internal resorption, therapy and filling. Acta Stomat Croat 2000;34:431-3. |
|9.||DatanaS, Radhakrishnan CV. Internal resorption: An unusual form of tooth resorption. MJAFI 2011;67:364-6. |
|10.||Patel S, Kanagasingam S, Ford TP. External cervical resorption: A Review. J Endod 2009;35:616-25. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]