Root Resorption: Dental Therapy

Conventional nonsurgical therapeutic procedures

Prophylaxis of infection-related resorptions.

• After severe dental trauma (dental accident)/dislocation (displacement): endodontic treatment (treatment of the tooth interior) as promptly as possible within the first few days to prevent germ invasion – starting from infected pulp necrosis (death of the pulp/tooth pulp) – via the dentinal tubules (“tubules in the dentin”) into the damaged areas of the root surface

Infection-related external resorptions

• Goal: Elimination of root canal infection.
  • Endodontic therapy (“therapy of the inside of the tooth”).
    • Calcium hydroxide inlay for one month
      • Dentine embrittlement with longer duration of use.
      • Antibacterial
      • Neutralization of acids
      • Inactivation of acid hydrolases (cathepsin)
      • Activation of alkaline phosphatase
    • Definitive root canal filling
• Objective: gap closure after tooth loss due to resorption.
  • Prosthetic solution

Internal resorptions

• Goal: Stop progression (progression) by depriving the resorptive inflammatory soft tissue of intracanal blood flow.
  • Endodontic therapy
    • Complete removal of soft tissue in the resorption area.
    • Intensive cleaning
      • Sodium hypochlorite rinses
      • Ultrasonic activation
    • Calcium hydroxide insert
    • Definitive root filling – obturation with warm gutta-percha.
    • In case of perforation intracanal coverage with MTA (mineral trioxide aggregate).

Internal metaplastic root resorption (root canal replacement resorption).

• Endodontic therapy

Invasive cervical resorptions

• Objective: removal of the resorptive tissue.
• In combination with curettage/periodontal therapy.
• If necessary, in combination with orthodontic extrusion.
• Class I and II:
  • Coagulation necrosis of resorptive tissue with topical 90% TCA (trichloroacetic acid).
  • Defect care by means of filling therapy
• Class III:
  • Endodontic therapy
  • Trichloroacetic acid (TCA)
  • Perforation closure with MTA (mineral trioxide aggregate).
• Class IV:
  • Conventional therapy attempt carries a high failure rate