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Module 7 > ENDO root resorption > Flashcards

ENDO root resorption Flashcards

1
Q

what is the definition of root resorption?

A

a physiological or pathological event mainly occurring due to the action of activated clast cells

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2
Q

what is root resorption characterised by?

A

the transitory or progressive loss of cementum or cementum/ dentine

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3
Q

what is the onset of root resorption associated with?

A

significant necrosis of cementoblasts and/or injury to the PDL

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4
Q

what are the 2 phases required to cause root resorption?

A

injury and stimulation

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5
Q

what types of injury cause root resorption?

A

mechanical
infection of root canal or PDL
chemical

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6
Q

what types of mechanical injury causes root resorption?

A

trauma
surgical procedures
excessive pressure (impacted teeth, cyst tumours, ortho tx)

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7
Q

what type of chemical injury causes root resorption?

A

bleaching agents (30% hydrogen peroxide)

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8
Q

what type of stimulation causes root resorption?

A

infection
pressure
transient resorption (without a constant stimulus the process if self limiting)

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9
Q

lost systemic and endocrine disease which may cause root resorption?

A

hypo and hyperthyroidism
calcinosis
gauchers syndrome
turner syndrome
pagets disease
herpes zoster

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10
Q

what type of cells colonise damaged surfaces and initiate the resorptive process?

A

odontoclasts/ osteoclasts

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11
Q

what are howships lacunae?

A

depressions of odontoclasts/ osetoclasts

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12
Q

what cells regulate the physiological and pathological resorption of mineralised tissue?

A

receptor-ligand system RNAKL/RANK/OPG - part of the TNF family

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13
Q

what cells carry the RANK receptor?

A

osteoclast precursor cells and dendritic cells

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14
Q

what induces the fusion of osteoclast precursor cells into multinucleated cells?

A

binding of RANKL to RANK

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15
Q

what is the most common cause of resorption?

A

pulp infection

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16
Q

what are causes of resorption, based on stimulation factors?

A

pulp infection
PDL infection
ortho pressure
ankyloses
tumour
impacted pressure

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17
Q

what does EIR affect?

A

the external root surface

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18
Q

what usually causes EIR?

A

trauma - intrusion, lateral luxation and avulsion

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19
Q

how is EIR diagnosed?

A

radiographic and CBCT interpretation

20
Q

how is EIR treated?

A

removal of necrotic pulp as soon as signs of EIR
calcium hydroxide as an interappointment dressing
most cases, resorption too advanced to treat

21
Q

where do you find invasive cervical resorption?

A

on external root surface but can invade root dentine in any direction
develops immediately apical to epithelial attachment in cervical region

22
Q

what causes ICR?

A

loss of protective non-mineralised layer at the CEJ - developmental, physical/ chemical trauma
microbial stimulation from gingival sulcus

predisposing factors: ortho, trauma, surgery, intracoronal bleaching

23
Q

how is ICR differentiated from IRR?

A

ICR is a periodontally derived form of ERR

24
Q

what are the clinical features of ICR?

A

asymptomatic
tooth may look pink
positive sensibility test
tooth will be vital as pulp is protected until late in the process by a layer of dentine and predentine
eventually, the lesion will perforate the canal wall resulting in canal infection and necrosis

25
Q

what are the clinical classifications of ICR?

A

Heithersay 1999
class I - small with shallow penetration
class II - close to coronal pulp, no radicular extension
class III - deeper but not beyond coronal third
class IV - extensive beyond coronal third

26
Q

what are the radiographic features of ICR?

A

radiolucent area which can be confused with IRR

*use parallax and CBCT for further info

27
Q

what is the treatment for ICR?

A

remove granulation tissue from defect with 90% trichloracetic acid
restore with GI, composite or biodentine
RCT if communication with pulp canal

28
Q

where does IRR originate?

A

in and affects the root canal wall
follows damage to odontoblastic layer and predentine

29
Q

what is the aetiology of IRR?

A

still unknown - mostly a result of trauma

30
Q

what is required for IRR to continue?

A

pulp tissue apical to the lesion must have a viable blood supply

eventually the pulp will become necrotic and resorption will stop

31
Q

clinical appearance of IRR?

A

extensive resorption can result in pink discolouration of the crown (may be confused with ICR)

32
Q

radiographic features of IRR?

A

oval, round lesions any site along root canal usually symmetrical
the outline of the root canal cannot be traced as IRR cavity is continuous with normal root canal walls

33
Q

treatment for IRR?

A

RCT if tooth can be saved
lesion difficult to clean (bleeding) and obturate (shape) so can use thermoplastic techniques

34
Q

what happens if IRR left untreated?

A

perforation and clast cells can obtain nutrients from surrounding tissues

35
Q

what is orthodontic pressure root resorption?

A

apical root resorption can occur as a result of injury originating from the pressure applied to the roots during tooth movement

36
Q

are teeth symptomatic in the case of ortho pressure root resorption?

A

teeth are asymptomatic and pulp remains vital unless pressure is such that it disturbs the apical blood supply

37
Q

radiographic features of ortho pressure root resorption?

A

shortened roots with no signs of radiolucency in the bone

38
Q

what teeth does impacted tooth pressure resorption affect?

A

maxillary canines and mandibular third molars

39
Q

what type of tumours may cause pressure resorption?

A

slow growing cysts
ameloblastomas
giant cell tumours
fiber-osseous lesions

40
Q

what is ankylotic root resorption referred to as?

A

replacement resorption

41
Q

what type of injuries may cause ankylotic root resorption ?

A

in severe traumatic injuries: intrusive luxation, avulsion with delayed reimplantation

42
Q

how is ankylotic resorption caused?

A

injury to the root canal is so large that healing with cementum is not possible and the bone comes into contact with the root surface.

osteoclasts are in direct contact with the mineralised dentine and therefore resorption can occur without further stimulation and bone is laid down instead

43
Q

clinical findings for ankylotic root resorption?

A

teeth lack physiological mobility and sound metallic to percussion, sometimes in infra occlusion

44
Q

radiographic findings for ankylotic root resorption?

A

bone fills the resorption lacuna and there is no radiolucency

45
Q

treatment for ankylotic root resorption?

A

no stimulation factor to remove and no predictable tx
prevention - minimise damage to PDL
functional splint can be placed for 7-10 days and RCT to prevent pulpal infection and resorption

Module 7 (33 decks)

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