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DMD3 sem 2 > Resorption 4 - external inflammatory resorption > Flashcards

Resorption 4 - external inflammatory resorption Flashcards

1
Q

What is external inflammatory resorption?

A

An inflammatory process that results in loss of tooth structure and loss of adjacent bone

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2
Q

What is required for external inflammatory resorption diagnosis?

A

An infected RCS + Communication pathway from root canal to the PDL

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3
Q

How does external inflammatory resorption occur?

A

Bacteria/endotoxins diffuse through dentinal tubules

Leukocytes cannot reach the bacteria in the canal/tubules

Clastic cells activated to resorb bone and dentin

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4
Q

What triggers can lead to external inflammatory resorption?

A

Can occur after trauma where the pulp necroses and becomes infected + there has been damage to the PDL and the cementum

Can also occur with long-standing infected root canal systems via the apical and/or lateral canal foramina

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5
Q

What are the types of external inflammatory resorption?

A

Apical and lateral commonly

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6
Q

When does external inflammatory resorption typically occur?

A

After traum (luxation, avulsion, etc)

With long-standing infected root canals

With concurrent endo/perio diseases

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7
Q

What are the clinical features of external inflammatory resorption typically?

A

History of trauma, infected RCS, etc

Pulp sensibility tests - no response

Other signs/symptoms of an infected RCS

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8
Q

What are the radiographic features of external root resorption?

A

Loss of external tooth substance

Radiolucency in adjacent bone

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9
Q

What factors does external inflammatory resorption following trauma depend on?

A

External Inflammatory Resorption following trauma
depends on several factors:

The type of injury - especially luxations, avulsion

The severity of the injury

Stage of root development

How likely is pulp necrosis and infection

Any concurrent injury

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10
Q

How likely is damage to the PDL and cementum in traumatic injuries?

A

Depends on the type of injury in order of lowest to highest:

Concussion

Subluxation

Extrusion

Lateral luxation

Intrusion

Avulsion

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11
Q

How likely is pulp necrosis?

A

Depends on the type of injury:

Luxations, avulsions, root fractures depends on how severe the blood supply was damaged apically or at the fracture line and the pulp’s ability to revascularize.

In subluxation, concussion, and crown fractures it depends on the pulp’s ability to resist bacterial invasion and whether any pathways exist for bacteria to enter the tooth.

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12
Q

How can bacteria enter the root canal system following trauma?

A

Bacterial Pathways:

Infractions

Uncomplicated Crown Fractures

Dentine exposed

Complicated Crown Fractures

Pulp exposed

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13
Q

How can bacteria enter the root canal system following trauma?

A

Bacterial Pathways:

Infractions

Uncomplicated Crown Fractures: Dentine exposed

Complicated Crown Fractures: Pulp exposed

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14
Q

What approach should be taken in injuries where the root surface and PDL are damaged + pulp necrosis and infection are predictable?

A

A preventative approach should be taken to prevent external inflammatory resorption

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15
Q

What were the effects of doxycycline in replanted monkey incisors?

A

Increased frequency of pulp revascularization

Decreased frequency of micro-organisms in the pulp space

Decreased frequency of ankylosis, replacement resorption, and inflammatory root resorption

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16
Q

What are the non-antimicrobial actions of tetracyclines?

A

They modulate host responses:

they inhibit osteoclast function

They bond to bone and teeth which slows release and prolongs action

17
Q

How should dexamathasone be used for periodontal healing of replanted dogs’ teeth?

A

Topical use of dexamethasone enhances healing and results in fewer resorption complications

18
Q

How are dentinoclasts affected by demeclocycline and ledermix paste? what does this indicate?

A

demeclocycline: Cells are well-spread and still attached after 24 hours

Ledermix paste: Cells not spreading, more spherical shaped, no dentinoclasts evident after 18 hours

Indicates that the steroid component does the direct inhibition of dentinoclasts.

The antibiotic component contributes to the therapeutic effect on inflammatory resorption by killing bacteria in the root canal and dentine tubules

19
Q

What ratedoes ledermix paste diffuse through the dentinal tubules?

A

Rate is very high on the first day and then therapeutic release is maintained until approximately the 6 week mark in mature teeth and 4 weeks in immature teeth.

20
Q

How does ledermix paste compare to Ca(OH)2 for root resorption?

A

Teeth immediately treated with ledermix paste exhibited significantly more healing and less resorption and maintained more residual root mass than those treated with Ca(OH)2

21
Q

What was the effect of Ca(OH)2 in the experimentally-induced inflammatory resorption?

A

It raises the pH and so reduces the attachment and growth of human PDL ligament fibroblasts (Attachment and growth decrease >7.8 pH) this favours bone healing response leading to ankylosis and replacement resorption

Induced necrosis of all cells (both resorbing and reparative cells)

This favours ankylosis and replacement resorption

22
Q

Ca(OH)2 effect summary:

A

Calcium hydroxide almost entirely eliminated
established inflammatory resorption elicited
by bacterial contamination in the replanted
teeth with a necrotic PDL

BUT the resultant healing was characterised
by ankylosis which gradually developed into
replacement resorption

23
Q

Why is Ca(OH)2 normally used?

A

Mainly because of its anti-bacterial activity

Stimulates hard tissue formation

Helps dissolve necrotic tissue

Detoxifies bacterial endotoxin (LPS)

24
Q

Does biomechanical preparation and irrigation inactivate LPS?

A

No, Ca(OH)2 is necessary to inactivate LPS

25
Q

What are the management strategies for external inflammatory resorption?

A

Preventative approach: After injuries where pulp necrosis and infection
PLUS root surface and PDL damage are likely

Interceptive approach: When inflammatory resorption is already present

26
Q

What are the aims of prevention of external inflammatory resorption?

A

Reduce PDL inflammation

Inhibit clastic cells

Stop bacteria entering the
root canal

Kill any bacteria that
entered the canal during
the injury

27
Q

What are the aims of interception of external inflammatory resorption?

A

Reduce PDL inflammation

Inhibit clastic cells

Kill all bacteria that are
already in the root canal

Encourage healing with
hard tissue

28
Q

When does PDL inflammation start?

A

IMMEDIATELY

As soon as the injury has occurred

29
Q

What are the 2 principles of preventive management of external inflammatory resorption?

A
  1. Immediate systemic antibiotics for 1 week (penicillin and tetracycline)
  2. Immediate pulp removal and placement
    of a CS-AB intracanal medicament (CS-AB dressing)
30
Q

What is the systemic immediate drug for prevention of external inflammatory resorption?

A

Tetracycline such as doxycycline

31
Q

What are the steps in preventive management of external inflammatory resorption in mature teeth?

A

Remove the pulp

Prepare canal if time is available

Place CS-AB dressing

After 6 weeks:

Redress canal with CS-AB paste

Take PA.

After further 2 months:

Take PA radiograph (If no resorption complete RCF)

32
Q

When taking the PA radiograph after 6 weeks what do we look at?

A

If resorption is present: Redress canal with CS-AB paste

If no resorption present: Place new dressing using 50:50 CS-AB + Ca(OH)2

33
Q

What are the steps in preventive management of external inflammatory resorption in immature teeth?

A

Immediate systemic ABs + pulp removal after replanting/repositioning and splinting.

After 4 weeks:

Redress canal with CS-AB

After another 4 weeks:

Redress canal with CS-AB

After another 4 weeks:

Take PA:

If resorption present redress canal with CS-AB
If no resorption present place new 50:50 dressing CS-AB + Ca(OH)2

After 2 months:

Take PA radiograph:

If no resorption: An apical tissue barrier is desirable (re-dress canal with Ca(OH)2 paste, change Ca(OH)2 dressing every 3 months until hard tissue is repaired

Complete RCF

34
Q

When should clinical and radiograph reviews be done?

A

Clinical and radiographic reviews are essential at 6 months after the RCF is completed then every 3-4 years for as long as possible

35
Q

Why is it important for treatment to be immediate?

A

IMMEDIATE Endodontic treatment (when indicated)
also avoids problems of facial swelling, discomfort,
apprehension, etc that are associated with delayed
treatment - even if only delayed for a few days

36
Q

What are the differences between the preventive management and the interceptive management?

A

2 main differences:

Systemic ABs are not indicated (they will not stop the resorption) only prescribe if the patient presents with acute apical abscess with systemic signs or facial cellulitis/spreading infection

Long term Ca(OH)2 intercanal dressings will be required to stimulate hard tissue repair since hard tissue has been lost.

37
Q

What are the steps to the interceptive management of external inflammatory resorption?

A

Commence root canal treatment

Remove the cause(s) of the disease: i.e. remove the caries, cracks, old restorations

Prepare & disinfect the root canal system: i.e. WL, instrumentation, irrigants, etc.

Place a CS-AB paste dressing

After 6 weeks - Re-dress canal with the CS-AB paste

After another 6 weeks take a PA radiograph. If resorption present CS-AB. If no further resorption present CS-AB + Ca(OH)2 50:50

After a further 2 months

Take PA radiograph

If repair evident / no further resorption: Dress canal with Ca(OH)2

Every 3 moths after change the Ca(OH)2 dressing until there is hard tissue repair/apexification

After 9 - 12 months, Take PA radiograph to assess healing

When hard tissue repair is evident complete the RCF

DMD3 sem 2 (69 decks)

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