CSAR 41 - Dental root resorption Flashcards
How does resorption occur?
- Giant cells capable of resorbing all dentoalveolar hard tissues
- Pre-dentine & pre-cementum contain potent inhibitors of resorption
How does transient root resorption occur, for example due to minor trauma?
- Whenever fully mineralised dentine or cementum becomes exposed against ST, giant cells colonise & start to resorb
- BUT giant cells need constant stimulation to continue
- If there is no additional stimulation, resorption stops in 2-3 wks
What are giant cells stimulated by in progressive inflammatory root resorption?
Pressure, infected and some metabolic disorders
What does external root resorption look like on an X-ray?
Usually tramlines of pulp lines superimposed on top of lesion
How is infected root resorption managed?
• Predictably arrests if infection is eliminated
• If restorable, shape & clean (beware open apex)
• Dress canal with calcium hydroxide for at least 1 wk to kill microbes and create alkaline environment to
o KILL GIANT CELLS
o NEUTRALISE LACTIC ACID
o INHIBIT COLLAGENASES & ACID HYDROLASES
o STIMULATE ALKALINE PHOSPHATASE SECRETION
o PROMOTE REPAIR
What systemic disorders are linked with root resorption?
Paget’s disease
Hypo/hyperparathyroidism
Benign/malignant tumours
What is cervical resorption?
- Particular form of progressive external inflammatory root resorption
- Lesions begin in cervical area of tooth and have communication with mouth
- Usually starts just below epithelial attachment (by minor trauma) of teeth and BURROWS into tooth
What is propagating stimuli in cervical resorption?
Pulp space infection
External plaque of tooth surface
Bleaching agents - diffuse though dentine
How is cervical resorption diagnosed?
- Localised gingival swelling/bleeding
- Signs of pulpitis/apical periodontitis
- Usually symptom-free until vital canal invaded
What is the management of inflammatory root resorption with a vital pulp?
Improve plaque control
Flap, clean defect, repair
Monitor
What is the management of inflammatory root resorption with a non-vital pulp?
RCT
Flap, clean defects repair communication with mouth
Monitor
What 2 events cause internal inflammatory resorption?
Chronic pulp inflammation
Trauma to tooth
How does chronic pulp inflammation result in internal inflammatory resorption?
- Death of odontoblasts and exposure of fully mineralised dentine
- Invasion by giant cells, starting transient resorption
- Persistent partial pulp infection/inflammation and favourable connection to dentinal tubules
- Progressive inflammatory root resorption
How does trauma to tooth result in internal inflammatory resorption?
- Intrapulpal haemorrhage and clotting
- Compression of pulp chamber
- Death of odontoblasts and exposure of fully mineralised dentine
- Invasion by giant cells, starting transient resorption
- Persistent partial pulp infection/inflammation and favourable connection to dentinal tubules
- Progressive inflammatory root resorption
How is inflammatory root resorption diagnosed?
Few symptoms - chronic pulp inflammation
History of trauma
May appear as pink spot
