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INTRODUCTION Internal inflammatory resorption is an uncommon pathologic condition characterized by progressive destruction of intraradicular dentin due to clastic activity within chronically inflamed pulp tissue.[1,2] The condition is often asymptomatic and may remain undetected until routine radiographic examination or crown discoloration becomes evident. Continued resorptive activity can result in extensive structural compromise and weakening of the remaining dentin.Conventional radiography provides limited two‑dimensional information and may not accurately determine lesion extent or differentiate internal inflammatory resorption from external cervical resorption.[3] Cone‑beam computed tomography (CBCT) enables three‑dimensional assessment of lesion morphology, remaining dentinal thickness, and perforation status, thereby improving diagnostic accuracy and treatment planning.[3] Management of extensive internal resorption remains challenging because progressive dentinal destruction substantially weakens the tooth, particularly in the cervical region, where stress concentration is greatest.[4] Conventional management approaches include thermoplasticized a‑percha, calcium silicate‑based materials, fiber posts, and composite restorations.[5‑7] Although these methods provide satisfactory sealing ability, they may not adequately reinforce weakened dentin or restore biomechanical integrity. Recent biomimetic restorative concepts have emphasized preservation and reinforcement of compromised tooth structure using fiber‑reinforced composite materials.[5,6] Polyethylene fibers incorporated within composite resin have been shown to improve stress distribution and reduce crack propagation by functioning as an internal splint.[6] Similarly, the Bio block or Bio‑Bulk concept using short fiber‑reinforced composite has been proposed for reinforcement of structurally compromised roots affected by internal resorption.[8‑10] However, reports describing conservative polyethylene fiber reinforcement combined with CBCT‑guided diagnosis and histopathologic correlation remain limited. Histopathologic examination may additionally provide biological confirmation of internal inflammatory resorption through identification of chronic inflammatory infiltrate, multinucleated odontoclast‑like cells, and resorptive lacunae adjacent to dentinal surfaces.[1] However, histopathologic correlation is infrequently documented in routine clinical reports of internal resorption. This report presents a multidisciplinary biomimetic approach incorporating CBCT assessment, histopathologic confirmation, and polyethylene fiber‑reinforced composite restoration for management of structurally compromised internal inflammatory resorption.

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internal inflammatory resorption CBCT fiber reinforced composite biomimetic

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internal root resorption diagnosis management cone beam computed tomography

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internal inflammatory root resorption CBCT histopathology clinical case diagram illustration

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PMID: 42434214

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PMID: 40889700

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polyethylene fiber reinforced composite tooth biomimetic root reinforcement

Generating Image

Scientific medical diagram illustrating internal inflammatory root resorption in a cross-sectioned tooth. The diagram shows: (1) a healthy tooth for comparison on the left, (2) on the right a tooth with internal inflammatory resorption showing an enlarged oval-shaped radiolucent lesion within the root canal, surrounded by multinucleated odontoclast cells and chronic inflammatory infiltrate, with resorptive lacunae in the dentinal walls, (3) a CBCT cross-section view showing 3D assessment of lesion extent and remaining dentinal thickness, (4) the treatment approach showing fiber-reinforced composite filling the resorption cavity. Clean, labeled anatomical diagram with a white background, professional journal-style illustration with clear labels for: pulp chamber, resorptive defect, odontoclasts, remaining dentin, and fiber-reinforced composite restoration.

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Suggested Illustration

Diagram of internal inflammatory root resorption showing cross-sectioned tooth with resorptive defect, odontoclast cells, CBCT view, and fiber-reinforced composite treatment
Figure 1. Schematic representation of internal inflammatory root resorption: (A) normal tooth anatomy for comparison; (B) resorptive defect within the root canal space showing multinucleated odontoclasts and inflammatory infiltrate; (C) CBCT cross-sectional assessment of remaining dentinal thickness and perforation status; (D) biomimetic rehabilitation with fiber-reinforced composite.

Improved Introduction

Internal Inflammatory Resorption: A Biomimetic Management Approach with CBCT-Guided Diagnosis and Histopathologic Correlation
Internal inflammatory resorption (IIR) is an uncommon pathologic condition of the permanent dentition characterized by progressive destruction of intraradicular dentin mediated by clastic activity within chronically inflamed pulp tissue.[1,2] The process is driven by multinucleated odontoclast-like cells that erode dentinal walls from within, generating resorptive lacunae and an expanding radiolucent defect within the root canal space. Because the condition is frequently asymptomatic, it often remains undetected until routine radiographic examination reveals the characteristic oval or fusiform radiolucency continuous with the canal outline, or until pink crown discoloration (the "pink tooth of Mummery") signals advanced structural involvement.[3]
Conventional periapical radiography, while useful for initial detection, is inherently limited by two-dimensional projection geometry. Superimposition of anatomical structures can obscure lesion boundaries, underestimate resorptive extent, and make differentiation from external cervical resorption unreliable.[4] Cone-beam computed tomography (CBCT) overcomes these limitations by providing three-dimensional assessment of lesion morphology, measurement of residual dentinal thickness in all planes, and reliable identification of root perforation - information that is directly actionable for treatment planning and prognosis.[4,5] Recent evidence confirms that CBCT significantly alters clinical decision-making compared to conventional radiography in complex resorption cases.[5]
Management of extensive IIR presents a substantial biomechanical challenge. Progressive dentinal destruction weakens the root, particularly at the cervical level where occlusal stress concentration is greatest, rendering the tooth susceptible to vertical fracture even after successful endodontic treatment.[6] Conventional obturation strategies, including thermoplasticized gutta-percha and calcium silicate-based cements, achieve adequate biological sealing of the resorptive defect but do not meaningfully restore the flexural strength or fracture resistance of compromised dentin.[6,7] This limitation has driven interest in biomimetic restorative strategies that aim to preserve and reinforce residual tooth structure rather than simply fill the void.
Fiber-reinforced composite materials represent a clinically promising approach within this paradigm. Ultra-high molecular weight polyethylene fiber networks incorporated within composite resin distribute tensile stresses more uniformly across the root, resist crack propagation, and function as an internal splint - a mechanical behavior that closely mimics the natural stress distribution of intact dentin.[7,8] The Bio-block or Bio-bulk concept, employing short fiber-reinforced composite in bulk placement, has been proposed specifically for reinforcement of structurally compromised roots affected by IIR and has shown encouraging results in early reports.[9,10] However, detailed documentation combining CBCT-guided diagnosis, conservative polyethylene fiber reinforcement, and histopathologic correlation remains limited in the literature.
Histopathologic examination provides biological confirmation of IIR through identification of a chronic inflammatory infiltrate, multinucleated odontoclast-like cells lining resorptive lacunae, and irregular resorption fronts at the dentinal surface.[1] Despite its diagnostic value, histopathologic correlation is infrequently reported in clinical IIR case series, leaving a gap between radiographic findings and the underlying cellular biology.
This report presents a multidisciplinary biomimetic approach to the management of structurally compromised IIR, integrating pre-operative CBCT assessment for three-dimensional lesion characterization, histopathologic confirmation of the resorptive process, and polyethylene fiber-reinforced composite restoration for biomechanical rehabilitation of the weakened root.

Key Improvements Made

ElementOriginalImproved
OpeningPassive, generic definitionActive framing of the cellular mechanism and clinical trigger
CBCT rationaleBrief mentionExpanded with specific diagnostic advantages and clinical impact
Biomechanical contextLimited explanation of why fibers helpMechanism of stress distribution and fracture resistance explained
Literature gapVague statementPrecisely identifies what is missing (CBCT + fibers + histology)
HistopathologyTacked on at endIntegrated logically as a diagnostic validation tool
FlowAbrupt transitionsEach paragraph builds on the preceding one
CitationsNot updatedKey 2022-2026 references incorporated (PMIDs: 42434214, 40889700, 36862198)

New References to Add

  • Mercante HS et al. (2026) - PMID 42434214 - comprehensive review of IIR etiology, diagnosis, and CBCT
  • Lu G et al. (2026) - PMID 40889700 - perforating IIR management with CBCT
  • Volom A et al. (2023) - PMID 36862198 - RCT on fiber reinforcement of endodontically treated teeth

Restoratiin should in dentin not in pulp images are not relevant

Generating Image

Precise dental anatomy diagram showing internal inflammatory root resorption and its biomimetic restoration. Four panels side by side labeled A, B, C, D. Panel A: Normal tooth cross-section showing enamel, dentin, narrow pulp canal, cementum, and periodontal ligament - all labeled. Panel B: Internal inflammatory resorption - the DENTIN walls are being destroyed from within, showing an irregular oval-shaped cavity eroded INTO THE DENTIN surrounding the canal, with multinucleated odontoclast cells on the dentin surface inside the cavity, and chronic inflammatory tissue filling the enlarged resorptive cavity - the key point is the defect is within the dentin layer, not in the pulp. Remaining thin dentin walls visible. Panel C: CBCT axial cross-section view of the same tooth showing the resorptive cavity within dentin, residual dentin thickness measurements, and whether the outer root surface is perforated. Panel D: Treatment completed - the resorptive cavity within the dentin has been filled with fiber-reinforced composite (shown with fiber strands embedded in composite), reinforcing and replacing the lost dentin. The pulp canal space is obturated separately with gutta-percha. White background, clean scientific illustration style, all anatomical structures clearly labeled.

Diagram showing internal inflammatory resorption within dentin walls and fiber-reinforced composite restoration of the dentin defect
Figure 1. (A) Normal tooth anatomy; (B) Internal inflammatory resorption - the resorptive defect is within the dentin layer, where odontoclasts erode the dentinal walls creating an expanding cavity; (C) CBCT axial view showing the dentin defect, residual wall thickness, and perforation assessment; (D) Biomimetic restoration - fiber-reinforced composite placed within the resorbed dentin cavity to reinforce and replace lost dentin structure, with separate canal obturation.
Key correction reflected in this diagram:
  • The defect is in the dentin - odontoclasts destroy dentinal walls from inside outward
  • The fiber-reinforced composite replaces lost dentin - it fills the resorptive cavity within the dentin layer
  • The pulp canal is obturated separately (gutta-percha) - it is a distinct step from the dentin restoration
  • CBCT measures residual dentin thickness - which determines fracture risk and treatment feasibility
Would you like me to also refine the written introduction text to better reflect this dentin-centered pathology, or adjust the diagram further?
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