Periodontics Flashcards
What is the definition of a periodontal abscess?
Localised, acute exacerbation of a pre-existing pocket
What is the definition of a periapical abscess?
Localised collection of pus around apex of a non-vital tooth due to pulp necrosis
How does a periodontal abscess present?
Usually vital
Pain on lateral movements
Usually mobile
Loss of alveolar crest
Associated with generalised horizontal bone loss
How does a periapical abscess present?
Non-vital
TTP vertical
May be mobile
Loss of lamina dura
What is the definition of occlusal trauma?
Tooth mobility which is progressively increasing or tooth mobility with symptoms and radiographic evidence of increased pdl width
What is the definition of periapical periodontitis?
Periodontal disease that has reached the apex of the tooth
How does periapical periodontitis present?
Resorption of alveolar bone
Loss of attachment
How does chronic gingivitis present?
Bleeding on probing
Gingival inflammation
False pockets due to oedema
What are the contraindications for periodontal surgery?
Poor OH/plaque control
Smoker
What is the purpose of periodontal surgery?
Arrest disease by gaining access to complete RSD and regenerate lost periodontal tissues
What are the indications for periodontal surgery?
Post non-surgical periodontal treatment
Excellent OH
Inflammation resolved
Pockets >5mm persist
What are the benefits of open flap for periodontal surgery?
Helps gain access to root surface in persistent pockets
What are the benefits of a gingivectomy?
Improves aesthetics
Facilitates plaque control
What are the reasons for a gingivectomy?
Reduces overgrowth
Pseudopockets
Areas with difficult access
Gingival fibrzomatosis
What is the rate of chronic periodontitis?
10-15%
What is the clinical presentation of gingival health?
Knife-edge scalloped gingival margin
Stippled gingiva
Pink
What is the diagnostic definition of gingival health?
Absence of bleeding on probing
Absence of erythema (redness) and oedema (swelling)
Absence of patient symptoms, attachment and bone loss
What are the bone levels in gingival health?
1.0-3.0 apical to the CEJ
What is the definition of gingival health in regard to bleeding and probing depths?
<10% bleeding sites
<= 3mm proving depths
What are examples of local plaque retentive factors?
Calculus
Restoration overhangs
Crowding
Mouth breathing
What are systemic modifying factors associated with increased periodontal disease risk?
Sex hormones (puberty, pregnancy, contraception)
Medication
Smoking
Hyperglycaemia
Malnutrition
What is the minimal annual bone loss for periodontitis?
0.05-1.0mm
What is the role of MMPs in periodontitis?
Responsible for matrix degradation
What is the role of osteoclasts in periodontitis?
Immune activation of osteoclasts via RANK/RANKL causes connective tissue matrix degradation
What are anatomical periodontitis risk factors?
Enamel pearls/projections
Grooves
Furcations
Gingival recession
What are tooth position associated periodontitis risk factors?
Malalignment
Crowding
Tipping
Migration
Occlusal forces
What are iatrogenic risk factors for periodontitis?
Restoration overhangs
Defective crown margins
Poorly designed rpds
Orthodontic appliances
What are behavioural risk factors for periodontitis?
Smoking- vasoconstriction, impaired antibody production
What are genetic risk factors for periodontitis?
Twin studies showed 50% association
What are environmental risk factors for periodontitis?
Local risk factors
Local microbiome
Stress
What does the stage mean in a periodontal diagnosis?
Severity
What is stage 1 periodontitis?
Mild
<15mm/2mm
What is stage 2 periodontitis?
Moderate
Coronal 1/3 root
What is stage 3 periodontitis?
Severe
Mid 1/3 root
What is stage 4 periodontitis?
Very severe
Apical 1/3 root
What does grade mean in a periodontal diagnosis?
Susceptibility
What is the calculation for grading periodontal disease?
Bone loss/ age
What is grade A periodontitis?
Slow
<0.5
What is grade B periodontitis?
Moderate
0.5-1.0
What is grade C periodontitis?
Rapid
>1.0
What does extent mean in a periodontitis diagnosis?
Distribution
What does localised mean?
<30%
What does generalised mean?
> 30%
What does molar incisor mean?
Affects molars and incisors primarily
What are the 5 components of a periodontitis diagnosis?
Extent
Severity
Susceptibility
Stability
Risk factors
What provides a currently stable diagnosis?
No BoP at 4mm
BoP <10%
PPD <=4mm
What provides a currently in remission diagnosis?
No BoP at 4mm
BoP >=10%
PPD <= 4mm
What provides a currently unstable diagnosis?
PPD >= 5mm
BoP at 4mm
What is a BPE of 0?
Pockets <3.5mm
No BoP
No calculus/overhangs
What is a BPE of 1?
Pockets <3.5mm
BoP
No calculus/overhangs
What is a BPE of 2?
Pockets <3.5mm
Calculus/Overhangs
What is a BPE of 3?
Pockets 3.5-5.5mm
What is a BPE of 4?
Pockets >5.5mm
What is * in a BPE?
Furcation involvement
What should be done when a patient has a BPE 3?
Radiographs
Initial therapy
then 6ppc of that sextant (BSP)
6ppc before and after treatment (SDCEP)
What should be done when a patient has a BPE 4?
Radiographs
6ppc of full dentition
What is the force on the probe during a BPE exam?
20-25g
What are the sextants for BPE?
17-14 | 13-23 | 24-27
47-44 | 43-33 | 34-37
What is plaque?
Sticky colourless biofilm deposit
What is is calculus?
Calcified deposits of plaque attached to tooth surface
Can be covered in biofilm (plaque), sub or supra gingival, detected by vision, probing or radiographs
What is the manifestation of plaque induced gingivitis?
Change in gingiva colour
Marginal gingival swelling
Loss of contour of the dental papilla (blunting)
BoP
Plaque at gingival margin
No clinical attachment loss/ bone loss
Gingival sulcus <= 3mm
What are the clinical manifestations of periodontitis?
Loss of attachment
Gingival sulcus >3mm
Alveolar bone loss
What is step 1 of periodontal treatment?
Control of local and systemic risk factors (diabetes, smoking, medication, diet)
Oral hygiene instruction (OHI)
Professional mechanical plaque removal (PMPR)
What is step 2 of periodontal treatment?
Step 1 and
Subgingival instrumentation +/- adjunctive measures
What is step 3 of periodontal treatment?
Repeated sub gingival instrumentation
Periodontal surgery: access flap, resective, regenerative
What is step 4 of periodontal treatment?
Supportive periodontal therapy
Risk adaptive intervals ( 3-12 months)
Continuous monitoring of local and systemic risk factors
What are the further investigations radiographs?
Aids diagnosis
Aids prognosis
Assess morphology of affected teeth
Pattern and degree of alveolar bone loss
Monitoring disease stability
What are the benefits of horizontal bitewings in periodontics?
Can show early, localised bone loss
What are the benefit of vertical bitewings in periodontics?
Difficult to position, provides good visualisation of bone loss
What is the gold standard of radiographs for periodontal disease?
Periapical
What are the benefits of periodicals in periodontics?
Shows bone levels, root length, furcation involvement and possible endodontic complications
What are the benefits of panoramic in periodontics?
More comfortable, but supplementation often needed
What do plaque and bleeding scores assess?
Oral hygiene and patient compliance
What are the Ramfjord teeth?
16 21 24
44 41 36
What surfaces are included in the modified plaque score?
Interproximal
Buccal
Palatal
What are the scores for a modified plaque score?
0: no visible
1: no visible but seen with probe
2: visible
What surfaces are included in the modified bleeding score?
Mesial
Distal
Buccal
Palatal
What are the scores for a modified bleeding score?
0: no
1; yes
What is the maximum score for a modified plaque score?
36
What is the maximum score for a modified bleeding score?
24
When is the code N used in a modified plaque and bleeding score?
Tooth is missing and there is no suitable replacement
How is the probe ran when carrying out a modified bleeding score?
Probe ran 45 degrees to the sulcus and bleeding checked after 3o seconds
What are the three considerations when measuring patient engagement?
<35% bleeding score and <30% plaque score
Greater than 50% improvement in both
Patient meets target agreed by patient and clinician
What happens to non-engaged patients?
Subgingival PMPR is delayed
Patient is informed
Barriers identified
Continue with oral health education, motivation and behaviour change
What does probing depth indicate?
Difficulty of treatment and likelihood of reoccurrence
What do attachment levels indicate?
Measure of tissue destruction and extent of repair
What are the scores for furcation involvement?
1: <3mm (<1/3 tooth)
2: >3mm (>1/3 tooth)
3: through and through
What probe is used to measure furcations?
Nabers
Where are the black bands on Nabers probes?
3-6mm
9-12mm
What are the scores for tooth mobility?
0: physiological (0.1-0.2mm)
1: <1mm
2: 1-2mm
3: >2mm and horizontal/rotational depression
What is included in the patient education phase of periodontal treatment?
Explain disease
Modifiable risk factors
Plaque control
Behavioural change: risk factor management, effective plaque control
What does the patient information leaflet for periodontal disease include?
Patient agreement form and treatment consent form
What does SOLER stand for?
Square on to patient
Open posture
Lean forward
Eye contact
Relaxed demeanor
What can you use to aid communication with patient when discussing periodontal diagnosis?
Pictures and diagrams
Radiographs
Disclosing tablets
Sites of inflammation
See and modify tooth brushing
Check patients understanding
What is the Modified Bass technique?
Brush at 45 degrees to gingival sulcus
Short back and forth vibrating motions
Medium soft brits
Wait 30 minutes before eating
What does TIPPS stand for?
Talk
Instruct
Practice
Plan
Support
What is Step 1 of perio treatment?
Risk Factor Modification
OHI
PMPR: removal of supra and sub gingival plaque and calculus deposits, powered and hand instruments can be used
MP+BS can be carried out to assess patient engagement
When should a patient be moved onto stage 2 of perio treatment?
If they stage 1 is completed and they are engaged
What is Step 2 of perio treatment?
Risk factor modification
OHI
PMPR: subgingival instrumentation on root surface
Optional adjuvant therapy: chlorhexidine
What are the features of the mini sickle?
Double ended
Single blade on each end
Point scaler
What colour is the mini sickle?
Red
Where is the mini sickle used?
Supra gingival
Buccal and lingual embrasures
Limited used in pockets
What are the features of the universal (Columbia 4L-4R) scaler?
Double ended
Two bladed on each end
What colour is the universal (Columbia 4L-4R) scaler?
Red
Where is the universal (Columbia 4L-4R) scaler used?
Subgingival
Anywhere in mouth
What are the features of the Gracey curettes?
Double ended
One blade on each end (70 degree angle to shank)
Triangular cross section
What are the gracey curettes used for?
Subgingival fine scaling
What colour is the gracey 1-2?
Grey
Where is the gracey 1-2 used?
Anterior teeth
What colour is the gracey 7-8?
Green
Where is the gracey 7-8 used?
Buccal/Lingual of posteriors
What colour is the gracey 11-12?
Orange
Where is the gracey 11-12 used?
Mesial of posteriors
What colour is the gracey 13-14?
Blue
Where is the gracey 13-14 used?
Distal of posteriors
What are the features of the Hoe scalers?
Double ended
Single blade on each end
What are the Hoe scalers used for?
Gross sub and subragingival deposits
What colour is the Hoe 134-135?
Orange
Where is the Hoe 134-135 used?
Buccal/Lingual
What colour is the Hoe 156-157?
Red
Where is the Hoe 156-157 used?
Mesial/Distal
What angle is the sickle scalers shank to the blade?
90 degrees
What angle is the face of the graceys offset to the lower shank?
100 degrees
What is the blade of the hoe scaler to the shank?
100 degrees
What is the cutting edge of the hoe bevelled at?
45 degrees
What is the cutting edge of the hoe angulated at?
90 degrees
What is the risk if the hoe scaler is not properly angled?
Root surface damage
What angle should the universal curette be to the teeth?
90 degrees
What are the differences between powered and hand instruments?
Powered may leave a rougher surface
Powered may produce aerosols
Powered may have better furcation access
Powered may have less unwanted tooth tissue removal
Powered causes less fatigue
What is the effect of supra and subginigival PMPR on the microflora?
Reduces levels and prevalence of pathogens
What is the effect of supra and sub gingival PMPR on the tissues?
Decreases gingival inflammation
Shrinkage of tissues leading to recession
Increase in collagen fibres in connection tissue
Formation of long junctional epithelium attachment
Decreased pocket depth and increased attachments
What are the ideal outcomes of periodontal treatment?
Plaque scores <15%
Bleeding on probing <10%
No pockets >4mm
When should you move onto step 3 of perio treatment?
When step 2 is completed and the patient is unstable
When should you move onto step 4 of perio treatment?
When step 2 is completed and the patient is stable
What is step 3 of perio treatment?
Reinforce OHI
Subgingival instrumentation
Consider referral to surgery
What is step 4 of perio treatment?
Supportive care
OHI, risk factor control, behavioural change
What triggers the oral microbiome to cause inflammation?
Poor oral hygiene
Accumulation of plaque bacteria
What is gingival crevicular fluid?
Fluid found within the gingival sulcus and periodontal pockets
What does gingival crevixular fluid contain?
AMPs (antimicrobial peptides)
Cytokines
Chemokines
Lactoferrin
IgG (immunoglobin G)
What is the role of antimicrobial peptides (AMPs)?
Eliminate pathogenic microorganisms
What is the role of cytokines?
Signalling molecules
What is the role of chemokines?
Specific cytokines that make immune cells move to a target
What is lactoferrin?
Iron-binding molecule
What is the role of IgG?
High levels indicate infection?disease
What is the role of the oral mucosa during periodontal disease?
Express TLR which detect MAMPS/PAMPs which cause the release of AMPS, cytokines and chemokines
What does saliva contain?
S-IgA
Lysozyme
Peroxidase
Lactoferrin
Mucin
Agglutinins
Cystatins
Histatins
What is the role of S-IgA?
High levels indicate activated immune response
What is the role of lysozyme?
Antimicrobial enzyme that cleaves bacteria
What is the role of peroxidase?
Enzyme that catalyses oxidative reactions involving H2O2
What are the red complexed for periodontal disease?
P gingivalis
T denticola
T forsythia
What is the immunological cause of periodontal disease?
Polymicrobial dysbiosis
What are the virulence factors of p gingivitis?
Inflammophillic (inflammation leaded to virulence)
Atypical liposaccharide
What are some example causes of dysbiosis?
Smoking
Oral hygiene
Disease
Diet
Antibiotics
Genetics
Salivary proteins
Salivary flow
Innate/adaptive factors
What is the aetiology of periodontal disease?
Plaque bacteria accumulates
Periodontal pathogen presence
Polymicrobial dysbiosis
What are the hallmarks of periodontitis?
Attachment loss
Alveolar bone loss
What is the immunological development of periodontitis?
TLR stimulation
Increased pro-inflammatory mediators
Acute inflammatory response
What are examples of pro-inflammatory mediators?
Neutrophils
Monocytes
Lymphocytes
What are the features of an acute inflammatory response?
Increased vasodilation
Increased redness, swelling, bleeding
Increased immune cell migration
What is the role of neutrophils in the periodontium?
Maintain a healthy periodontium
Release degenerative enzymes like MMPs that contribute to attachment loss
What does leukocyte adhesion deficiency lead to?
Neutrophils cannot leave the blood to enter tissues
What is periodontal health dependant on a balance of?
OPG and RANKL
What is the role of osteoblasts?
Synthesise and secrete bone matrix
What is the role of osteoclasts?
Resorbs bone
Macrophage lineage
What are the immunological stages of periodontitis development?
- Bacterial products bind TLRs on epithelium (cytokine, chemokine and AMP secretion)
- Vasodilation and selective leukocyte recruitment (neutrophils, monocytes and lymphocytes)
- Bacteria activates neutrophils (further pro-inflammatory mediator release)
- Activated lymphocytes lead to RANKL/OPG balance destruction (increase RANKL, decrease OPG)
- RANKL binds RANK on monocytes leading to osteoclast differentiation and alveolar bone resorption
- Pro-inflammatory cytokines contribute to bone resorption: IL-1, IL-6, IL-17, TNF-alpha
- Elevated MMP activation leads to connective tissue destruction
How does periodontal bone loss occur in regard to the adaptive immune response?
B and T cells secrete RANKL
RANKL binds RANK (osteoclast differentiation)
OPG prevents RANKL binding RANK (inhibits osteoclast differentiation
Inflammation leads to an increase in RANKL, decrease in OPG and increased monocyte recruitment
What are examples of conditions linked to periodontitis?
Cardiovascular disease
Alzheimer’s disease
Rheumatoid arthritis
Pregnancy complications
Diabetes
What are the assocaitions between periodontitis and type 2 diabetes?
Periodontitis is associated with higher HbA1c fasting blood glucose levels
Severe periodontitis is associated with increased diabetes risk
What is the increased risk of periodontitis in patients with diabetes?
2-3x more likely
What is the associated risk of periodontitis on a diabetic?
Increased HbA1c levels
Worse complications
What is the diabetes threshold for improved response to Perio tx?
HbA1c reductions of 3-4mmol/mol (0.3-0.4%) in 3-4 months post treatment
What guidelines recognised periodontitis as a complication of diabetes?
NICE
What is the dentally relevant guideline that discusses the negative impact of diabetes on periodontitis?
SDCEP Prevention and Treatment of Periodontal Diseases in Primary Care- 2024
What questions should you ask a patient with diabetes in regard to Perio?
Is it controlled?
What was your last HbA1c reading and when was it measured?
How often does your doctor check your diabetes control?
Do you have any complications of diabetes?
What HbA1c levels indicated good control of diabetes?
48-58mmol/mol (6.5-7.5%)
What is a HbA1c >58 associated with?
Increased risk of diabetes related complications
How is untreated periodontitis associated with increased diabetes complications?
Untreated periodontitis —> Circulating bacteria and bacterial antigens —> Elevated circulating levels IL-6, TNF-alpha, CRP, oxygen radicals —> Systematic inflammatory state, impaired insulin signalling and resistance —> Elevated HbA1c levels, exacerbation of diabetes
What is PISA?
Periodontal inflammed surface area
What is PISA?
Periodontal inflammed surface area
What are the aims of periodontal therapy?
To arrest the disease process
To regenerate lost tissue
To maintain periodontal health long term
What is the role of periodontal therapy as an aid to restorative dentistry?
Improves soft tissue management
Establishes stable gingival margin position
Contributes to aesthetics
Reduces tooth mobility
Informs prognosis
What is the effect of an inflamed gingival margin in regards to restorative treatment?
Bleeds during operative procedures
Unstable in its apico-coronal location
Makes effective restorative dentistry impossible
When will the position of the gingival margin be stable?
When it is healthy
How should you manage gingival margins in regards to restorative treatment?
Monitor gingival margin for 3-6 months after completion of periodontal treatment to check that it is stable.
Once stable- place restorations
What are the prosthodontics options for the partially dentate?
FPD with natural abutments
RPD with natural abutments
Implant supported prosthesis
Combination of the above
What are the damages associated with crowns and bridges?
Plaque retention- location and fit of restoration margins, contour of retainers and pontics
Unfavourable transmission of occlusal forces
Pulp damage
What are the risks of damage with RPDs?
Plaque retention- gingival margin coverage
Direct trauma from components
Unfavourable transmission of forces- occlusal, insertion and removal
What are the supracrestal attached tissues?
Histologically composed of the junctional epithelium and supracrestal connective tissue attachment.
Term replaces biological width
What is the outcome of restoration margins that encroach on the supracrestal attachment?
Persistent inflammation
Loss of attachment- pocketing, recession
What are the effects of overhanging restorations?
Associated with more inflammation and bone loss than non-restored sites
The larger the overhang the greater the bone loss
Development of pathogenic flora
What is the ideal shape for restorations?
The same shape as the teeth
What does inadequate tooth preparation lead to?
Overcontoured crowns
What are the keys to periodontally successful indirect restorations?
Start with healthy tissue
Adequate tooth preparation
Precise margin location
Excellent provisional restorations
Careful tissue handling and impression technique
What is Ante’s Law?
The combined periodontal area of the abutment teeth should be equal to or greater than the periodontal area of the tooth or teeth to be replaced
What happens to abutments which are periodontlaly compromised?
They will be overloaded
What are the factors of soft tissue harmony?
Gingival health
Gingival display
General gingival inclination
Gingival outline and symmetry
What is the definition of root resorption?
The non bacterial destruction of the dental hard and soft tissues due to the interaction of clastic cells
What are the key features of osteoclasts?
Very motile
Ruffled border
In contact with dentine
Huge surface area
What 4 things may stimulate RANKL?
Parathyroid hormone, B3, and interleukin 1B
Bacterial lipopolysaccharides
Trauma (chemical/physical)
Chronic inflammation
What are the surfaces that act to prevent root resorption?
Periodontal ligament
Cementum
Predentine
What are the types of internal root resorption?
Inflammatory
Replacement
What are the types of external root resorption?
Inflammatory
Replacement
Cervical
Surface
What are the extra oral features of a clinical examination in regard to root resorption?
Smile line
What are the features of clinical examination of a root with root resorption?
Coronal integrity of remaining tooth and restoration quality
Colour
Periodontal pocketing (vertically and horizontal)
Suus
Swelling
Apical tenderness
TTP
Mobility
Occlusal contact in ICP and guidance
Integrity of adjacent teeth
Sensitivity test
What are the implications associated with root resorption?
Post surgical recession is an aesthetic risk
Can the tooth be predictable restored following tx
Pink spot
Is there periodontal communication
Has the internal resorption perforated the root canal
Association with perioradicular disease
No physiological mobility and high pitched percussion
Is the tooth in function and prudent to retain
Alternative replacement options ie bridge
Pulp response
What is the ideal radiographic examination of root resorption?
Minimum- up to date PA
Consider 2 angles (30 degree medial or distal beam shift)
CBCT
What are the clinical findings associated with internal inflammatory root resorption?
Coronal integrity- may be unrestored
Perio pocketing - nil unless perforated root
Colour- normal
Swelling- nil
Sinus- nil unless periradicular disease
Apical tenderness- nil
TTp- nil
Mobility- normal
Sensitivity- positive
What are the radiographic features of internal inflammatory root resorption?
Centred in canal, does not move with beam shift
What is the Pathogenesis of internal inflammatory root resorption?
Coronal pulp is necrotic
Lesion includes inflammatory and vascular tissue- if perforated will communicate with PDL
Apical pulp is vital
Lesion will continue to progress until apical pulp goes completely necrotic
What is the treatment of internal inflammatory root resorption?
Orthography endodontics only- possible haemorrhage, active irrigation, inter visit medicamento, thermal obturation
What are the clinical features of internal replacement root resorption?
Coronal integrity- can be unrestored
Perio - nil
Colour- nil
Sinus- nil
Apical tenderness- nil
TTP- nil
Mobility- normal
Sensitivity- positive
What are the clinical features of external surface resorption root resorption?
Coronal integrity- can be unrestored
Perio pocketing- nil
Colour- nil
Sinus- nil
Swelling- nil
Apical tenderness- nil
TtP- nil
Mobility- Increasee physiological mobility
Sensitivity- positive
What are the radiographic findings for external surface resorption root resorption.
PDL intact
Normal pulp chamber
Reduced root length
What is the aetiology of external surface resorption?
Orthodontics-
90% of teeth have some form of ESR
2-5% have severe EST
15% have moderate EST
The anchorage teeth are worst affected
Extopic teeth- pressure from erupting teeth
Pathological lesions- pressure from adjacent pathological lesion
Idiopathic
What is the treatment for external surface resorption root resorption?
The pulp is healthy- endodontic tx will not have any effect
Remove the source to stop the resorption
Splint if mobile
What are the clinical findings for external inflammatory root resorption?
Coronal integrity- usually restored
Periodontal pocketing- nil
Colour- nil
Sinus- possibly
Swelling- possibly
Apical tenderness- possibly
TTP- possibly
Mobility- may be increased depending on extent
Sensitivity- negative (tooth is necrotic)
What is the aetiology of external inflammatory resorption root resorption?
The pulp is necrotic- bacterial or dental trauma in origin
The periapical inflammatory lesion precipitates the resorption process
81% of teeth with periapical lesions will have microscopic areas of root resorption (only 7% can be detected radiographically)
What is the treatment of external inflammatory resorption?
Remove the cause of the inflammation
Usually orthography endodontics ( re)treatment, possibly surgical endodontics or extraction
What are the clinical findings of external cervical resorption?
Coronal intergrity- can be unrestored
Periodontal pocketing- yes if extensive and profuse BOP
Colour- pink spot
Sinus- nil
Swelling- nil
Apical tenderness- nil
Tenderness to percussion- nil
Mobility- normal or no mobility
Sensitivity- positive
What is the aetiology of external cervical resorption?
Orthodontics
Trauma- avulsion and location
Historical non vital whitening ( heat applied)
Wind instruments
Viral infection
Systemic disturbance- thyroid
What is the classification of external cervical resorption in apico-coronal direction?
1- crestal
2- coronal 1/3
3- middle 1/3
4- apical 1/3
What is the classification of external cervical resorption circumferentially?
1/4
1/2
3/4
More than 3/4
What are the treatment options for external cervical resorption?
Monitor- resorption will likely continue
Extraction and prosthetic replacement
Surgical repair and orthograde endodontics
Internal repair and orthographic endodontics
What are the clinical features of external replacement resorption?
Coronal integrity- can be unrestored but infra occluded
Periodontal pocketing- nil but possibly erythematous
Colour - nil
Sinus- nil
Swelling- nil
Apical tenderness- nil
TTP- nil but high pitched note
Mobility- normal physiological mobility
Sensitivity- positive
What is the aetiology of external replacement resorption?
Trauma- significant injuries to the periodontitis such that the bone (osteoclasts) is then in contact with external root dentine causing resorption ( avulsion or lateral luxation)
What are the treatment options of external replacement resorption?
Decoronation- if infraocclusion more than 1mm in growing pt (remove crown to alveolar level and allow root to resort- preserves bone levels and allows adjacent teeth and periodontitis to develop normally)
Tooth then replaced with denture or RRB
Or monitor and add composite to balance incisal level
