Internal resorption. Diagnosis and treatment.
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The role of successional tooth germ and occlusal force in root resorption of mandibular second deciduous molars was studied in 24 beagle dogs by means of radiographic and histologic evaluations. 70 days after birth their mandibular right third permanent premolar germs were surgically removed, and in 10 of the dogs the maxillary right and left second deciduous molars were extracted to decrease the occlusal force on the mandibular second deciduous molars. 1) When successional tooth germs were present, whether the occlusal force was normal or decreased, the alveolar bone and deciduous tooth adjacent to the tooth germ were resorbed, accompanied by eruption of the permanent tooth. After the resorption of the deciduous tooth reached half of the root, many odontoclasts were observed in the dental pulp of the deciduous tooth. The root resorption was hastened by internal resorption. 2) When successional tooth germs were removed, whether the occlusal force was normal or decreased, the root resorption was delayed. The resorption from the root surface progressed very slowly, but shortly after this resorption reached the pulp, internal resorption occurred and the deciduous tooth was resorbed in short time. 3) When the occlusal force was decreased, in the deciduous teeth in which successional tooth germs were present, the tooth resorption tended to delay to a later time. However in the deciduous teeth from which the successional tooth germs were removed, the processes of tooth resorption was very different in individuals, the difference between tooth resorption in normal occlusal force and in decreased occlusal force was not clear. 4) In all groups, shallow resorption on the deciduous root surface was observed before the successional tooth started to erupt, and this resorption was apart from the tooth germ. By repeating resorptive periods and resting periods, this resorption progressed according to the increase in age, and in the resting period, resorption was repaired by new deposits of cementum.
Resorption of alveolar bone around erupting teeth is known to be independent of tooth eruption. However, the failure of tooth eruption and reduction in bone resorption in the osteopetrotic rat mutation, incisors absent (ia), suggest that tooth eruption depends upon bone resorption. This hypothesis was tested by determining the effects of neonatal restoration of bone resorption in ia rats on eruption of first molars. Newborn ia rats were treated with irradiation and spleen cells and tooth eruption and bone resorption were examined 30 days later. In 24 treated ia rats at least two molars erupted in every rat and all four molars erupted in 14. In 24 untreated ia littermates, no molars erupted in 21, one molar erupted in two and two molars erupted in one rat. All molars erupted in 38 untreated normal littermates. Alveolar bone overlying unerupted first molars in untreated ia rats was not present in treated mutant littermates. Neonatally treated ia rats had osteoclasts with ruffled borders and no skeletal sclerosis by 30 days. Within 48 hours after treatment two types of osteoclasts could be found in treated rats. One type resembled those found in untreated ia littermates and the other those found in normal rats. These data suggest that failure of tooth eruption in ia rats is directly related to the reduction in bone resorption and that alveolar bone resorption is required for tooth eruption.
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The aim of this investigation was to study the hyalinization of the periodontal ligament with time and its relationship to root surface resorption after the application of an orthodontic force, reactivated weekly, of 50 cN (approximately 50 g). Fifty-six patients (18 boys and 38 girls, mean age 13.8 years) were divided into 7 groups of 8. In each patient, one premolar was moved buccally 161 with a fixed orthodontic appliance. The contralateral premolar served as a control. The experimental periods ranged from 1 to 7 weeks. Local areas of overcompression in the periodontal ligament were recorded in 33 test teeth (59%) and 2 controls (4%). Hyalinization was seen in all experimental groups, more often after the first 4 weeks of force application. Hyalinized areas were recorded opposite an intact root surface (54%) or close to and just apical or coronal to an area of root resorption (45%), and were usually located buccocervically and linguoapically, corresponding to expected pressure zones of the periodonal ligament.
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The Author presents a clinical case of a maxillary central incisor where the periapical radiograph revealed a process of fusion, an internal resorption, the presence of a "dens invaginatus" and an important periapical radiolucency. In this tooth was located, treated and filled three different root canals.
Replantation and semi-rigid fixation were performed on canine immature permanent teeth, and one week after replantation the teeth were treated by root filling with calcium hydroxide. The root apex and periodontium of the teeth with replantation were examined for changes regularly during the experiment by microradiographic, fluorescence microscopic, polarizing microscopic and X-ray observation of undecalcified horizontal continual ground sections. The results obtained were as follows: 1) Immediately after replantation, root formation was observed, but its formation was found to cease at a relatively early time. No site of the root showed any inflammatory resorption. 2) The dentine of the teeth with replantation was narrow, and the whole tooth substance showed discoloration due to penetration of calcium hydroxide. 3) the periodontal space surrounding the teeth with replantation was decreased daily by new bone actively formed from the alveolar bone proper and by a thin cementum layer added on the periodontal surface. This change occurred from one week after replantation. 4) The width of the periodontal space of the teeth with replantation, which had been wider than that of a control tooth, was increased and decreased daily at the cervix and root apex and the central part of the root, respectively. 5) Collagen fibers of the periodontal membrane were present in the periodontal space of the teeth with replantation, together with regeneration of the periodontal membrane that had been cut by extraction. 6) There were no changes due to replantation in the two teeth adjacent to the tooth with replantation or the lateral jaw.
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