10.5005/jp-journals-10015-1236 KapilaORIGINAL Arambawatta RESEARCH et al External Root Resorption of Young Premolar Teeth in Dentition with Crowding Kapila Arambawatta, Roshan Peiris, Dhammika Ihalagedara, Anushka Abeysundara, Deepthi Nanayakkara
ABSTRACT least understood type of root resorption, characterized by its The present study was conducted to investigate the prevalence FHUYLFDOORFDWLRQDQGLQYDVLYHQDWXUH7KLVUHVRUSWLYHSURFHVV of external cervical resorption (ECR) in different tooth surfaces which leads to prRJUHVVLYHDQGXVXDOO\GHVWUXFWLYHORVVRI RIPD[LOODU\¿UVWSUHPRODUVLQD6UL/DQNDQSRSXODWLRQ tooth structure has been a source of interest to clinicians A sample of 59 (15 males, 44 females) permanent maxillary 2-5 ¿UVWSUHPRODUV DJHUDQJH \HDUV ZHUHXVHG7KHWHHWK DQGUHVHDUFKHUVIRURYHUDFHQWXU\ 7KHH[DFWFDXVHRI had been extracted for orthodontic reasons and were stored (&5LVSRRUO\XQGHUVWRRG$OWKRXJKWKHHWLRORJ\DQG LQIRUPDOLQ0RUSKRORJLFDOO\VRXQGWHHWKZHUHVHOHFWHG SDWKRJHQHVLVUHPDLQREVFXUHVHYHUDOSRWHQWLDOSUHGLVSRVLQJ IRUWKHVWXG\7KHWHHWKZHUHVWDLQHGZLWKFDUEROIXFKVLQ7KH IDFWRUVKDYHEHHQSXWIRUZDUGDQGRIWKHVHWKHLQWUDFRURQDO cervical regions of the stained teeth were observed under 10× 6 PDJQL¿FDWLRQV XVLQJ D GLVVHFWLQJ PLFURVFRSH 2O\PSXV 6= bleaching has been the most widely documented factor. In WRLGHQWLI\DQ\UHVRUSWLRQDUHDV7KHUHVRUSWLRQDUHDVSUHVHQW addition, dental trauma, orthodontic treatment, periodontal on buccal, lingual, mesial and distal aspects of all teeth were WUHDWPHQWVXUJHU\LQYROYLQJWKHFHPHQWRHQDPHOMXQFWLRQ UHFRUGHG DQGLGLRSDWKLFHWLRORJ\KDYHDOVREHHQGHVFULEHG2,7-11 )LIWHHQ > PDOHV IHPDOHV @ SHUPDQHQWPD[LOODU\¿UVWSUHPRODUVVKRZHGDUHDVRIUHVRUSWLRQ Meanwhile, localized lesions of multiple root resorption RQ EXFFDO OLQJXDO PHVLDO RU GLVWDO VXUIDFHV 0HVLDO KDYHDOVREHHQUHSRUWHGWRRFFXULQWKHDEVHQFHRIHLWKHU DQGGLVWDO VXUIDFHVH[KLELWHGDUHDVRIUHVRUSWLRQPRUH systemic or local factors that contribute to root resorption.9,12 IUHTXHQWO\WKDQEXFFDO DQGOLQJXDO DVSHFWV Liang et al9UHSRUWHGWKDWFHUYLFDOURRWUHVRUSWLRQZLWK 7KHGLIIHUHQFHZDVQRWVWDWLVWLFDOO\VLJQL¿FDQW It can be speculated that the ECR of root surfaces of these unknown etiology was most frequently seen in young females young premolar teeth could have been triggered by the excess ZKLOHRWKHUVKDYHUHSRUWHGQRJHQGHUGLIIHUHQFH,QDGGLWLRQ pressure exerted on their proximal surfaces by the crowding of (&5LQGLIIHUHQWURRWVXUIDFHVVXFKDVPHVLDOGLVWDOEXFFDO WHHWK DQGOLQJXDOKDVQRWFRPSUHKHQVLYHO\LQYHVWLJDWHGWRGDWH Keywords: External root resorption, Premolar teeth, Crowding, 0RUHRYHURFFXUUHQFHRI(&5LQWKHWHHWKRI6UL/DQNDQ 6UL/DQNDQSRSXODWLRQ SHRSOHKDVQRWEHHQUHSRUWHGLQWKHOLWHUDWXUH7KHUHIRUHZH How to cite this article: Arambawatta K, Peiris R, Ihalagedara FRQGXFWHGWKLVVWXG\WRLQYHVWLJDWHWKHSUHYDOHQFHRI(&5 '$EH\VXQGDUD$1DQD\DNNDUD'([WHUQDO5RRW5HVRUSWLRQ RI INTRODUCTION 7KHVWXG\PDWHULDOZDVREWDLQHGIURPDFROOHFWLRQRI SUHPRODUWHHWKDYDLODEOHDWWKH'HSDUWPHQWRI%DVLF Root resorption is the process that may lead to a partial loss 6FLHQFHV)DFXOW\RI'HQWDO6FLHQFHV8QLYHUVLW\RI of dental hard tissues (e.g. resorption of dentin and cementum 3HUDGHQL\D7KHVDPSOHLQFOXGHV PDOHV as a result of odontoclastic action). Root resorption can be IHPDOHV SHUPDQHQWPD[LOODU\¿UVWSUHPRODUV DJHUDQJH physiological or pathological. Physiological root resorption 11-18). Only morphologically sound teeth were selected of deciduous teeth results in the exfoliation of the teeth IRUWKHVWXG\7HHWKZLWKPRUSKRORJLFDORUGHYHORSPHQWDO allowing the eruption of the permanent successors. Root abnormalities, caries, fracture/trauma, or erosions/attrition resorption which may occur in permanent teeth is due to a were excluded. Immediately after extraction, the teeth SDWKRORJLFDOLQÀDPPDWRU\DFWLRQZKLFKOHDGVWRLUUHYHUVLEOH ZHUHVWRUHGLQGLYLGXDOO\LQIRUPDOLQXQWLOWKHWLPHRI GDPDJHDQGHYHQWXDOORVVRIWHHWK1 LQYHVWLJDWLRQ7KHWHHWKZHUHFOHDQHGWDNLQJVSHFLDOFDUHWR 5RRWUHVRUSWLRQKDVEHHQFODVVL¿HGE\LWVORFDWLRQLQ DYRLGDQ\GDPDJHWRWKHH[WHUQDOURRWVXUIDFHDQGVWDLQHG relation to the root surface as external and internal resorption. ZLWKFDUEROIXFKVLQWRYLVXDOL]HWKHDUHDVRIUHVRUSWLRQ7KH External resorption is further classified into surface FHUYLFDOUHJLRQVRIWKHVWDLQHGWHHWKZHUHREVHUYHGXQGHU resorption, external inflammatory resorption, external îPDJQL¿FDWLRQXVLQJDGLVVHFWLQJPLFURVFRSH 2O\PSXV UHSODFHPHQWUHVRUSWLRQH[WHUQDOFHUYLFDOUHVRUSWLRQ (&5 6= WRLGHQWLI\DQ\UHVRUSWLRQDUHDV7KHUHVRUSWLRQDUHDV DQGWUDQVLHQWDSLFDOEUHDNGRZQ0HDQZKLOH(&5LVWKH present on buccal, lingual, mesial and distal aspects of all 224 WJD External Root Resorption of Young Premolar Teeth in Dentition with Crowding teeth were recorded DQGIUHTXHQF\RIRFFXUUHQFHRI(&5 ZDVREVHUYHGLQURRWUHVRUSWLRQEHWZHHQPDOH DQG was calculated. female 7KHWHHWKZLWKH[WHUQDOURRWUHVRUSWLRQZHUHGHFDOFL¿HG ,QVWDLQHGKLVWRORJLFDOVHFWLRQVRIWHHWKZLWK(&5OHVLRQV ZLWK('7$WUDQVYHUVHVHFWLRQVZHUHWKHQWDNHQDQG VKRZHGJUDQXORPDWRXVWLVVXHVZLWKUHVRUSWLYHODFXQDHOLNH stained with hematoxylin and eosin in order to identify the DUHDVDQGFHPHQWXPOLNHUHSDUDWLYHWLVVXHOLQLQJWKHODFXQDH resorption lacunae with possible resorbing cells attached )LJV$DQG% ,QDGGLWLRQRGRQWRFODVWOLNHPRQRQXFOHDU UHVRUSWLYHFHOOVZHUHVHHQLQDVVRFLDWLRQZLWKODFXQDH WRWKHPXQGHUîîPDJQLILFDWLRQXVLQJDOLJKW VHH)LJV$DQG% PLFURVFRSH 2O\PSXV%; DISCUSSION RESULTS 7KH(&5LVUHSRUWHGWREHDUHODWLYHO\XQFRPPRQFRQGLWLRQ7 +RZHYHUZKHQSUHVHQWLWLVDFKDOOHQJHWRFOLQLFLDQVGXH )LIWHHQ >PDOHV IHPDOHV @RXW WRWKHLQYDVLYHQDWXUHRIWKLVFRQGLWLRQ'LDJQRVLVRI(&5 RIWKHWRWDOVDPSOHRISHUPDQHQWPD[LOODU\¿UVWSUHPRODUV LVPDGHEDVHGRQUDGLRJUDSKLFDVVHVVPHQW+RZHYHUWKHUH stained with carbol fuchsin showed areas of resorption on DUHOLPLWDWLRQVWRWKLVSURFHVV)RUH[DPSOHLWLVGLI¿FXOWWR EXFFDOOLQJXDOPHVLDORUGLVWDOVXUIDFHV )LJV$DQG% ORFDWHVXFKUHVRUSWLYHDUHDVXQOHVVWKH\DUHIDLUO\ODUJH,Q Mesial and distal surfaces of the teeth exhibited areas of addition, it is impossible to obtained useful information on resorption more frequently than buccal and lingual aspects buccal and lingual aspect as they are undetectable due to LQERWKPDOHVDQGIHPDOHV 7DEOH +RZHYHUWKHGLIIHUHQFH roentgenographic superimpositLRQ+HQFHLWLVSRVVLEOHWKDW ZDVQRWVWDWLVWLFDOO\VLJQL¿FDQW)XUWKHUPRUHQRGLIIHUHQFH WKHLQFLGHQFHRI(&R is much higher than those of reported. Figs 1A and B: ECR seen at the cervical one-third of the mesial side of the permanent maxillary first molar stained with carbol fuchsin stain: (a)10× magnification and (b) 40× magnification Figs 2A and B: ECR lesions showing granulomatous tissues with resorptive lacunae-like areas and cementum-like reparative tissues and odontoclast-like mononuclear resorptive cells (arrowhead) in association with lacunae: (A) 20× magnification and (B) 100× magnification World Journal of Dentistry, October-December 2013;4(4):224-227 225 Kapila Arambawatta et al Table 1: The distribution of resorption sites on buccal, lingual, mesial and distal surfaces at FHUYLFDOUHJLRQRIWKHSHUPDQHQWPD[LOODU\¿UVWSUHPRODU SHUFHQWDJHVDUHLQSDUHQWKHVHV ECR present ECR absent Total B L M D 0DOH 0 (0) Female Combined male and female Present study utilizes premolar teeth extracted for 'HQXGHGPLQHUDOL]HGWLVVXHLVFRORQL]HGE\PXOWLQXFOHDWHG RUWKRGRQWLFSXUSRVHVIURP\RXQJLQGLYLGXDOV5HVXOWV FHOOVZKLFKLQLWLDWHWKHUHVRUSWLRQSURFHVV7KLVLVVXSSRUWHG UHYHDOHGWKDWDOWKRXJKQRWVWDWLVWLFDOO\VLJQL¿FDQWWKHUH E\WKHSUHVHQWVWXG\VKRZLQJUHVRUSWLYHOLNHFHOOVFORVHO\ LVDKLJKHULQFLGHQFHRIFHUYLFDOUHVRUSWLRQLQWKHIHPDOHV associated with resorption lacunae in histological sections than males. When considering the site of the resorption area VHH)LJV$DQG% +RZHYHUZLWKRXWIXUWKHUVWLPXODWLRQRI DKLJKHUSHUFHQWDJHLVVHHQLQSUR[LPDOVXUIDFHV PHVLDO UHVRUSWLYHFHOOVWKHSURFHVVZLOOHQGVSRQWDQHRXVO\5HSDLU GLVWDO LQYROYLQJWKHFHUYLFDOUHJLRQWKDQ with cementum-like tissue will occur within 2 to 3 weeks EXFFDO DQGOLQJXDO VXUIDFHV VHH7DEOH LIWKHGDPDJHGVXUIDFHGRHVQRWFRYHUDODUJHVXUIDFHDUHD $OWKRXJKWKHSUHFLVHHWLRORJ\RIURRWUHVRUSWLRQLV VHH)LJV$DQG% ,IWKHGDPDJHGURRWVXUIDFHLVODUJH XQNQRZQVHYHUDOSRWHQWLDOIDFWRUVKDYHEHHQSURSRVHG bone cells will attach to the root before the cementum RUWKRGRQWLFWRRWKPRYHPHQWRUDOVXUJLFDOSURFHGXUHV producing cells, and ankylosis is the result of this process. periodontal root scaling and planning, tooth bleaching, &RQWLQXDWLRQRIWKHDFWLYHUHVRUSWLRQSURFHVVLVGHSHQGHQWRQ WUDXPDEUX[LVPWRRWKIUDFWXUHGHYHORSPHQWDOGHIHFWVRU a common stimulation factor of the osteoclastic cells, either a combination of these predisposing factors.13 It is reported LQIHFWLRQRUSUHVVXUH7KHUHIRUHWKHYDULRXVW\SHVRIURRW WKDW(&5RIWHHWKLVLQLWLDWHGE\DQLQÀDPPDWRU\FRQGLWLRQ UHVRUSWLRQVKRXOGEHLGHQWL¿HGDFFRUGLQJWRWKHVWLPXODWLRQ mechanical stimulation or by pressure in the periodontal IDFWRUV:KHQWKHVHVWLPXODWLRQIDFWRUVDUHLGHQWL¿HGLWZLOO ligament as a result of neoplastic process or unerupted EHSRVVLEOHWRUHYHUVHWKHSURFHVVE\UHPRYLQJWKHHWLRORJLFDO teeth. Pressure-induced external root resorption occurs IDFWRUV$OWKRXJKWKHSUHVHQWVWXG\UHSRUWVWKH(&5LQ in association with impacted teeth, exerting pressure on PD[LOODU\¿UVWSUHPRODUVLWPD\SUHVHQWLQRWKHUWHHWKRI URRWVRIDGMDFHQWWHHWKRUDVDUHVXOWRIVSDFHRFFXS\LQJ WKHFURZGHGGHQWLWLRQDVZHOO7KHUHIRUHLWLVLPSRUWDQWDQG pathological lesions.+RZHYHUWKHSUHVHQWVDPSOHRI HVVHQWLDOWRHQVXUHWKDWWKHVHWHHWKDUHDIIHFWHGE\(&5EHIRUH teeth has not been exposed to none of the factors mentioned. DQGDIWHURUWKRGRQWLFWUHDWPHQW+RZHYHUIXUWKHUVWXGLHVDUH 7KHUHIRUHLWFDQEHVSHFXODWHGWKDW(&5RIURRWVXUIDFHVRI warranted in order to explore the precise etiology, diagnosis these young premolar teeth may be triggered by the pressure and management of this condition. exerted on their proximal surfaces by the crowding of teeth since they were extracted for the orthodontic treatment in REFERENCES RUGHUWRUHOLHYHWKHFURZGLQJRUJDLQVSDFH)XUWKHUPRUH 3DWHO63LWW)RUG7,VWKHUHVRUSWLRQH[WHUQDORULQWHUQDO"'HQW during eruption of the permanent teeth, pressure resorption 8SGDWH of maxillary lateral incisors by the canine and mandibular +HLWKHUVD\*6&OLQLFDOUDGLRJUDSKLFDQGKLVWRSDWKRORJLFDO second molar by the third molar are commonly reported. 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