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Internal root resorption: understanding the pink tooth of mummery and its clinical implications
Halex de Souza Mercante1, Gabriel Pereira Nunes2, Priscila Toninatto Alves de Toledo2
1Department of Dentistry, Integrated School of Três Lagoas, Association for Education and Culture of Mato Grosso do Sul (AEMS), Três Lagoas, MS, Brazil.
Background:
Root resorption may be physiological or pathological. Physiological resorption occurs in deciduous teeth to allow replacement by permanent successors. In permanent dentition, resorption is pathological and classified as external (ERR) or internal (IRR), depending on its origin. IRR begins within the root canal and may lead to progressive dentin destruction. Although often asymptomatic, advanced cases may present as a pink discoloration of the crown, known as Pink Tooth of Mummery (PTM). To review current scientific evidence regarding the etiology, pathogenesis, classification, diagnosis, and treatment of IRR, as well as its clinical association with PTM.
Material And Methods:
This review was conducted using a structured search of PubMed, Scopus, LILACS, and SciELO. Studies addressing IRR in human teeth and aspects related to its etiology, pathogenesis, classification, diagnosis, or treatment were included. Reports involving PTM associated with internal or external resorptive processes were also considered. Data were extracted and qualitatively synthesized.
Results:
A total of 62 articles were selected for analysis. Trauma was the most frequently reported etiological factor, followed by orthodontic movement, pulpotomy procedures, pulp infections, and tooth autotransplantation. IRR is classified as internal surface, internal inflammatory, or internal replacement resorption, based on biological and pathological features. Diagnosis relies on clinical examination and imaging, with cone beam computed tomography improving assessment of lesion location and extent. Conventional endodontic treatment remains the primary management strategy in favorable cases. PTM is not exclusive to IRR and may also occur in external or physiological resorption. The literature on PTM consists predominantly of case reports.
Conclusions:
Early diagnosis is essential for the appropriate management of IRR. While bioactive materials and regenerative approaches have been explored, current evidence remains limited, particularly regarding PTM, highlighting the need for further clinical studies.
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