Turkiye Klinikleri Journal of Dental Sciences

.: REVIEW
İnternal Kök Rezorpsiyonları ve Tedavi Yaklaşımları
Internal Root Resorptions and Treatment Approaches
Gözde AKBAL DİNÇERa, Ali ERDEMİRb
aÖzel Dentistanbul Diş Hastanesi Yıldız Endodonti Kliniği, İstanbul, TÜRKİYE
bKırıkkale Üniversitesi Diş Hekimliği Fakültesi, Endodonti ABD, Kırıkkale, TÜRKİYE
Turkiye Klinikleri J Dental Sci.2021;27(1):129-37
doi: 10.5336/dentalsci.2020-74381
Article Language: TR
Full Text
ÖZET
Yaşam boyunca sürekli fizyolojik remodelasyona uğrayan kemikten farklı olarak, daimi dişlerin kök rezorpsiyonu doğal olarak meydana gelmez, daimî dişte kök rezorpsiyonu patolojik bir olaydır, eğer tedavi edilmezse etkilenen dişlerin erken kaybına neden olabilir. Kök rezorpsiyonu, kök yüzeyi ile ilişkili rezorpsiyonun lokasyonuna bağlı olarak, eksternal ve internal olarak sınıflandırılabilir. Klastik hücrelerin etkisinin bir sonucu olarak, dentin kaybı ile karakterize özel bir pulpa hastalığı kategorisi olan internal kök rezorpsiyonu (İKR), hem teşhis hem de tedavi açısından her zaman bir ikilem oluşturmuştur. İKR, genellikle asemptomatiktir ve rutin radyografik incelemelerde tesadüfen fark edilmektedir. Koni ışınlı bilgisayarlı tomografi (CBCT)'nin, İKR yönetiminde bir teşhis ve tedavi planlama aracı olarak kullanımı literatürde bildirilmiştir. Günümüzde, İKR olan dişlerde tercih edilen tek tedavi kök kanal tedavisidir. Rezorpsiyon defektinin düzensiz içbükey doğası, İKR olgularında kök kanallarının kemomekanik debridmanı ve doldurulmasında farklı tedavi yaklaşımlarını zorunlu hâle getirmektedir. Prognoz, küçük lezyonlar için daha iyidir. Kök duvarının perfore olduğu durumlarda, mineral trioksid agregat perforasyonu kapatmak için tercih edilen malzeme olarak düşünülmelidir. Ancak perforasyonla ilişkili geniş rezorpsiyonlarda, diş yapısı büyük ölçüde zayıfladığından prognoz kötüdür. Bu noktada rejeneratif endodontik tedavinin, İKR görülen dişlere uygulanması avantaj sağlayabilir. Bu derlemede, İKR'nin etiyoloji, histolojik görünüm, klinik özellikler, radyografik özellikler, tanı, ayırıcı tanı, geleneksel ve son tedavi yaklaşımları hakkında bilgi vermek amaçlanmıştır.

Anahtar Kelimeler: İnternal kök rezorpsiyonu; perforasyon; rejeneratif endodontik tedavi; endodonti
ABSTRACT
Unlike bone, which undergoes continuous physiological remodeling throughout life, root resorption of permanent teeth does not occur naturally, it is a pathological event; if left untreated, it can cause premature loss of affected teeth. Root resorption can be classified as external and internal depending on the location of the resorption associated with the root surface. Internal root resorption (IRR), which is a particular category of pulp disease characterized by the loss of dentine as a result of the action of clastic cells, has been a quandary from the standpoints of both its diagnosis and treatment. It is usually asymptomatic and discovered by chance on routine radiographic examinations. The use of Cone beam computed tomography (CBCT) as a diagnostic and treatment planning tool in IRR management has been reported in the literature. Today, root canal treatment is the only treatment preferred for teeth with IRR. The irregular nature of the resorption defect necessitates different treatment approaches in chemomechanical debridement and filling of root canals. Prognosis is good for smaller lesions. In cases where the root surface is perforated, mineral trioxide aggregate should be considered as the preferred material to close the perforation. However, for those with extensive resorption associated with perforation the tooth structure is greatly weakened and the prognosis remains poor. At this point, applying regenerative endodontic treatment to teeth with IRR can be advantageous. In this review, it is aimed to give information about the etiology, histological appearance, clinical features, radiographic features, diagnosis, differential diagnosis, traditional and recent treatment approaches of IRR.

Keywords: Internal root resoption; perforation; regenerative endodontic treatment; endodontics
REFERENCES:
  1. Patel S, Ford TP. Is the resorption external or internal? Dent Update. 2007;34(4):218-29.[Crossref] [PubMed] 
  2. Bille ML, Kvetny MJ, Kjaer I. A possible association between early apical resorption of primary teeth and ectodermal characteristics of the permanent dentition. Eur J Orthod. 2008;30(4):346-51.[Crossref] [PubMed] 
  3. Bille ML, Nolting D, Kvetny MJ, Kjaer I. Unexpected early apical resorption of primary molars and canines. Eur Arch Paediatr Dent. 2007;8(3):144-9.[Crossref] [PubMed] 
  4. Harokopakis-Hajishengallis E. Physiologic root resorption in primary teeth: molecular and histological events. J Oral Sci. 2007;49(1):1-12.[Crossref] [PubMed] 
  5. Yildirim S, Yapar M, Sermet U, Sener K, Kubar A. The role of dental pulp cells in resorption of deciduous teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(1):113-20.[Crossref] [PubMed] 
  6. Andreasen JO, Andreasen J. Review of root resorption systems and models. Etiology of root resorption and the homeostatic mechanisms of the periodontal ligament.In: Davidovitch D, ed. The biological mechanisms of tooth eruption and root resorption. Birmingham: EBSCO Media; 1988. p.9-21.[Link] 
  7. Tronstad L. Root resorption--etiology, terminology and clinical manifestations. Endod Dent Traumatol. 1988;4(6):241-52.[Crossref] [PubMed] 
  8. Bell T. The Anatomy, Physiology and Diseases of The Teeth. Philadelphia: Carey & Lea; 1831.
  9. Levin L, Trope M. Root resorption. In: HargreavesKM, Goodis HE, eds. Seltzer and Bender's Dental Pulp. 1st ed. Chicago, IL: Quintessence Publishing Co Inc; 2002. p.425-48.
  10. Patel S, Ricucci D, Durak C, Tay F. Internal root resorption: a review. J Endod. 2010;36(7):1107-21.[Crossref] [PubMed] 
  11. Gulabivala K, Searson LJ. Clinical diagnosis of internal resorption: an exception to the rule. Int Endod J. 1995;28(5):255-60.[Crossref] [PubMed] 
  12. Haapasalo M, Endal U. Internal inflammatory root resorption: the unknown resorption of the tooth. Endod Topics. 2006;14(1):60-79.[Crossref] 
  13. Patel S, Dawood A, Wilson R, Horner K, Mannocci F. The detection and management of root resorption lesions using intraoral radiography and cone beam computed tomography - an in vivo investigation. Int Endod J. 2009;42(9):831-8.[Crossref] [PubMed] 
  14. Patel S, Kanagasingam S, Pitt Ford T. External cervical resorption: a review. J Endod. 2009;35(5):616-25.[Crossref] [PubMed] 
  15. Wedenberg C, Lindskog S. Evidence for a resorption inhibitor in dentin. Scand J Dent Res. 1987;95(3):205-11.[Crossref] [PubMed] 
  16. Wedenberg C, Lindskog S. Experimental internal resorption in monkey teeth. Endod Dent Traumatol. 1985;1(6):221-7.[Crossref] [PubMed] 
  17. Wedenberg C, Lindskog S. Macrophage colonization of infected and non-infected dental tissues in vitro. Scand J Dent Res. 1986;94(4):311-9.[Crossref] [PubMed] 
  18. Andreasen JO. Luxation of permanent teeth due to trauma. A clinical and radiographic follow-up study of 189 injured teeth. Scand J Dent Res. 1970;78(3):273-86.[Crossref] [PubMed] 
  19. Ashrafi MH, Sadeghi EM. Idiopathic multiple internal resorption: report of case. ASDC J Dent Child. 1980;47(3):196-9.[PubMed] 
  20. Cabrini RL, Manfredi EE. Internal resorption of dentine; histopathologic control of eight cases after pulp amputation and capping with calcium hydroxide. Oral Surg Oral Med Oral Pathol. 1957;10(1):90-6.[Crossref] [PubMed] 
  21. Rabinowitch BZ. Internal resorption. Oral Surg Oral Med Oral Pathol. 1972;33(2):263-82.[Crossref] [PubMed] 
  22. Walton RE, Leonard LA. Cracked tooth: an etiology for "idiopathic" internal resorption? J Endod. 1986;12(4):167-9.[Crossref] [PubMed] 
  23. Calişkan MK, Türkün M. Prognosis of permanent teeth with internal resorption: a clinical review. Endod Dent Traumatol. 1997;13(2):75-81.[Crossref] [PubMed] 
  24. Wedenberg C, Zetterqvist L. Internal resorption in human teeth--a histological, scanning electron microscopic, and enzyme histochemical study. J Endod. 1987;13(6):255-9.[Crossref] [PubMed] 
  25. Solomon CS, Coffiner MO, Chalfin HE. Herpes zoster revisited: implicated in root resorption. J Endod. 1986;12(5):210-3.[Crossref] [PubMed] 
  26. Ramchandani PL, Mellor TK. Herpes zoster associated with tooth resorption and periapical lesions. Br J Oral Maxillofac Surg. 2007;45(1):71-3.[Crossref] [PubMed] 
  27. Wadden JV. Extensive endodontic involvements following herpes zoster attack to facial area; report of a case. Northwest Dent. 1991;70(2):31.[PubMed] 
  28. Urban D, Mincik J. Monozygotic twins with idiopathic internal root resorption: a case report. Aust Endod J. 2010;36(2):79-82.[Crossref] [PubMed] 
  29. Ricucci D. Apical limit of root canal instrumentation and obturation, part 1. Literature review. Int Endod J. 1998;31(6):384-93.[Crossref] [PubMed] 
  30. Andreasen JO, Andreasen FM. Root resorption following traumatic dental injuries. Proc Finn Dent Soc. 1992;88 Suppl 1:95-114.[PubMed] 
  31. Lyroudia KM, Dourou VI, Pantelidou OC, Labrianidis T, Pitas IK. Internal root resorption studied by radiography, stereomicroscope, scanning electron microscope and computerized 3D reconstructive method. Dent Traumatol. 2002;18(3):148-52.[Crossref] [PubMed] 
  32. Gartner AH, Mack T, Somerlott RG, Walsh LC. Differential diagnosis of internal and external root resorption. J Endod. 1976;2(11):329-34.[Crossref] [PubMed] 
  33. Ne RF, Witherspoon DE, Gutmann JL. Tooth resorption. Quintessence Int. 1999;30(1):9-25.[PubMed] 
  34. Bhuva B, Barnes JJ, Patel S. The use of limited cone beam computed tomography in the diagnosis and management of a case of perforating internal root resorption. Int Endod J. 2011;44(8):777-86.[Crossref] [PubMed] 
  35. Lin LM, Pascon EA, Skribner J, Gängler P, Langeland K. Clinical, radiographic, and histologic study of endodontic treatment failures. Oral Surg Oral Med Oral Pathol. 1991;71(5):603-11.[Crossref] [PubMed] 
  36. Siqueira JF Jr. Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J. 2001;34(1):1-10.[Crossref] [PubMed] 
  37. Fabricius L, Dahlén G, Sundqvist G, Happonen RP, Möller AJ. Influence of residual bacteria on periapical tissue healing after chemomechanical treatment and root filling of experimentally infected monkey teeth. Eur J Oral Sci. 2006;114(4):278-85.[Crossref] [PubMed] 
  38. Nair PN, Henry S, Cano V, Vera J. Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after "one-visit" endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(2):231-52.[Crossref] [PubMed] 
  39. Siqueira JF Jr, Rôças IN, Santos SR, Lima KC, Magalhães FA, de Uzeda M, et al. Efficacy of instrumentation techniques and irrigation regimens in reducing the bacterial population within root canals. J Endod. 2002;28(3):181-4.[Crossref] [PubMed] 
  40. Nair PN. On the causes of persistent apical periodontitis: a review. Int Endod J. 2006;39(4):249-81.[Crossref] [PubMed] 
  41. Ricucci D, Siqueira JF Jr, Bate AL, Pitt Ford TR. Histologic investigation of root canal-treated teeth with apical periodontitis: a retrospective study from twenty-four patients. J Endod. 2009;35(4):493-502.[Crossref] [PubMed] 
  42. Burleson A, Nusstein J, Reader A, Beck M. The in vivo evaluation of hand/rotary/ultrasound instrumentation in necrotic, human mandibular molars. J Endod. 2007;33(7):782-7.[Crossref] [PubMed] 
  43. Byström A, Sundqvist G. Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res. 1981;89(4):321-8.[Crossref] [PubMed] 
  44. Byström A, Sundqvist G. Bacteriologic evaluation of the effect of 0.5 percent sodium hypochlorite in endodontic therapy. Oral Surg Oral Med Oral Pathol. 1983;55(3):307-12.[Crossref] [PubMed] 
  45. Sjögren U, Figdor D, Persson S, Sundqvist G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. Int Endod J. 1997;30(5):297-306. Erratum in: Int Endod J 1998;31(2):148.[Crossref] [PubMed] 
  46. McGurkin-Smith R, Trope M, Caplan D, Sigurdsson A. Reduction of intracanal bacteria using GT rotary instrumentation, 5.25% NaOCl, EDTA, and Ca(OH)2. J Endod. 2005;31(5):359-63.[Crossref] [PubMed] 
  47. Siqueira JF Jr, Guimarães-Pinto T, Rôças IN. Effects of chemomechanical preparation with 2.5% sodium hypochlorite and intracanal medication with calcium hydroxide on cultivable bacteria in infected root canals. J Endod. 2007;33(7):800-5.[Crossref] [PubMed] 
  48. Bystrom A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol. 1985;1(5):170-5.[Crossref] [PubMed] 
  49. Sjögren U, Figdor D, Spångberg L, Sundqvist G. The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing. Int Endod J. 1991;24(3):119-25.[Crossref] [PubMed] 
  50. Ricucci D, Siqueira JF Jr. Apical actinomycosis as a continuum of intraradicular and extraradicular infection: case report and critical review on its involvement with treatment failure. J Endod. 2008;34(9):1124-9.[Crossref] [PubMed] 
  51. Ricucci D, Siqueira JF Jr. Anatomic and microbiologic challenges to achieving success with endodontic treatment: a case report. J Endod. 2008;34(10):1249-54.[Crossref] [PubMed] 
  52. Gencoglu N, Yildirim T, Garip Y, Karagenc B, Yilmaz H. Effectiveness of different gutta-percha techniques when filling experimental internal resorptive cavities. Int Endod J. 2008;41(10):836-42.[Crossref] [PubMed] 
  53. Goldberg F, Massone EJ, Esmoris M, Alfie D. Comparison of different techniques for obturating experimental internal resorptive cavities. Endod Dent Traumatol. 2000;16(3):116-21.[Crossref] [PubMed] 
  54. Stamos DE, Stamos DG. A new treatment modality for internal resorption. J Endod. 1986;12(7):315-9.[Crossref] [PubMed] 
  55. Wilson PR, Barnes IE. Treatment of internal root resorption with thermoplasticized gutta-percha. A case report. Int Endod J. 1987;20(2):94-7.[Crossref] [PubMed] 
  56. Torabinejad M, Hong CU, Pitt Ford TR, Kaiyawasam SP. Tissue reaction to implanted super-EBA and mineral trioxide aggregate in the mandible of guinea pigs: a preliminary report. J Endod. 1995;21(11):569-71.[Crossref] [PubMed] 
  57. Regan JD, Gutmann JL, Witherspoon DE. Comparison of Diaket and MTA when used as root-end filling materials to support regeneration of the periradicular tissues. Int Endod J. 2002;35(10):840-7.[Crossref] [PubMed] 
  58. Main C, Mirzayan N, Shabahang S, Torabinejad M. Repair of root perforations using mineral trioxide aggregate: a long-term study. J Endod. 2004;30(2):80-3.[Crossref] [PubMed] 
  59. Jacobovitz M, Vianna ME, Pandolfelli VC, Oliveira IR, Rossetto HL, Gomes BP, et al. Root canal filling with cements based on mineral aggregates: an in vitro analysis of bacterial microleakage. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(1):140-4.[Crossref] [PubMed] 
  60. Hsien HC, Cheng YA, Lee YL, Lan WH, Lin CP. Repair of perforating internal resorption with mineral trioxide aggregate: a case report. J Endod. 2003;29(8):538-9.[Crossref] [PubMed] 
  61. Jacobovitz M, de Lima RK. Treatment of inflammatory internal root resorption with mineral trioxide aggregate: a case report. Int Endod J. 2008;41(10):905-12.[Crossref] [PubMed] 
  62. Abdullah D, Eziana Hussein F, Abd Ghani H. Management of Perforating idiopathic internal root resorption. Iran Endod J. 2017;12(2):257-60.[PubMed] [PMC] 
  63. Subay RK, Subay MO, Tuzcu SB. Endodontic management of root perforating internal replacement resorption. Eur J Dent. 2018;12(3):450-3.[Crossref] [PubMed] [PMC] 
  64. Cotti E, Mereu M, Lusso D. Regenerative treatment of an immature, traumatized tooth with apical periodontitis: report of a case. J Endod. 2008;34(5):611-6.[Crossref] [PubMed] 
  65. Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod. 2009;35(10):1343-9.[Crossref] [PubMed] 
  66. Ding RY, Cheung GS, Chen J, Yin XZ, Wang QQ, Zhang CF, et al. Pulp revascularization of immature teeth with apical periodontitis: a clinical study. J Endod. 2009;35(5):745-9.[Crossref] [PubMed] 
  67. Trope M. Treatment of the immature tooth with a non-vital pulp and apical periodontitis. Dent Clin North Am. 2010;54(2):313-24.[Crossref] [PubMed] 
  68. Iwaya S, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with periradicular abscess after luxation. Dent Traumatol. 2011;27(1):55-8.[Crossref] [PubMed] 
  69. Chaniotis A. The use of MTA/blood mixture to induce hard tissue healing in a root fractured maxillary central incisor. Case report and treatment considerations. Int Endod J. 2014;47(10):989-99.[Crossref] [PubMed] 
  70. Santiago CN, Pinto SS, Sassone LM, Hirata R Jr, Fidel SR. Revascularization technique for the treatment of external inflammatory root resorption: a report of 3 cases. J Endod. 2015;41(9):1560-4.[Crossref] [PubMed] 
  71. Priya M H, Tambakad PB, Naidu J. Pulp and periodontal regeneration of an avulsed permanent mature incisor using platelet-rich plasma after delayed replantation: a 12-month clinical case study. J Endod. 2016;42(1):66-71.[Crossref] [PubMed] 
  72. Saoud TM, Mistry S, Kahler B, Sigurdsson A, Lin LM. Regenerative endodontic procedures for traumatized teeth after horizontal root fracture, avulsion, and perforating root resorption. J Endod. 2016;42(10):1476-82.[Crossref] [PubMed] 
  73. Kaval ME, Güneri P, Çalışkan MK. Regenerative endodontic treatment of perforated internal root resorption: a case report. Int Endod J. 2018;51(1):128-37.[Crossref] [PubMed] 

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4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com