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Zahnmedizin up2date 2015; 9(06): 565-586
DOI: 10.1055/s-0033-1358197
Endodontologie
Georg Thieme Verlag KG Stuttgart · New York

Interne Resorptionen – Ätiologie, Pathogenese, Diagnostik und Therapie

Michael Arnold
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Publication Date:
01 December 2015 (online)

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Einleitung

Resorptionen an Zahnhartgeweben treten physiologisch im Verlauf des Zahnwechsels an Milchzähnen auf. Das Vorkommen resorptiver Prozesse an bleibenden Zähnen stellt einen pathologischen Prozess dar, der zu einem Abbau von Zahnhartgeweben führt. Unterschieden werden Resorptionen nach ihrer Pathogenese in externe und interne Resorptionen. Interne Resorptionen können nur auftreten, solange die Pulpa noch vital ist. Die Resorptionslakunen können erst im fortgeschrittenen Stadium radiografisch differenziert werden. In der Phase der aktiven Resorption sind die Lakunen gefüllt mit Granulationsgewebe. In Abhängigkeit zur Ausprägung können interne Resorptionen aufgrund ihres kontinuierlichen Zuwachses die Wurzel perforieren.

Entscheidend für den Erfolg der Zahnerhaltung ist die frühzeitige Diagnostik und Differenzialdiagnostik, sodass eine adäquate Therapie bestimmt werden kann. Insbesondere die Abgrenzung von primär externen Wurzelresorptionen hat einen entscheidenden Einfluss auf die prognostische Einschätzung und die therapeutischen Risiken.

Die Nutzung eines Dentalmikroskops oder stark vergrößernde Lupenbrillen sind Voraussetzungen einer differenzierten minimalinvasiven Therapie bei guter Prognose für einen langfristigen Zahnerhalt.

Mit der internen Resorption wird der Ab- und Umbau von Zahnhartsubstanz bezeichnet. Die interne Resorption ist ein pathologischer fortschreitender Prozess, der an eine teilweise vitale Pulpa gekoppelt ist. Erstmalig wurde eine interne Resorption an einem unteren bleibenden Molaren von Bell im Jahr 1830 beschrieben [1], [2].

Die im Verlauf der Resorption sich entwickelnden Zahnhartsubstanzdefekte variieren in Form, Ausdehnung und Lokalisation, sodass interne Resorptionen mit Karies oder externen Resorptionen verwechselt werden können [3] (Abb. [1]). Je nach Lage und Ausprägung interner Resorptionen wird die erforderliche endodontische Therapie erschwert. Mit der Analyse der pathomorphologischen und mikrobiologischen Grundlagen wird eine ätiologische Einteilung interner Resorptionen vorgestellt. Differenzierte Konzepte der antimikrobiellen Therapie und Verfahren, die den Langzeiterhalt betroffener Zähne ermöglichen, sollen vorgestellt werden.

Zoom Image
Abb. 1 Zahn 36 mit Verdacht auf eine Karies. Die etwa 4 mm große, kreisrunde, unregelmäßige Aufhellung lässt sich als interne Resorption differenzieren.
 

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