Root Resoprton

Question 1

Define root resorption

Answer 1

Non-bacterial destruction of the dental hard and soft tissue due to the interaction of clastic cells

Question 2

Classification of root resorption

Answer 2

Internal
- inflammatory
- replacement

External
- inflammatory
- replacement
- cervical
- surface

Question 3

How can RR be assessed radiographically

Answer 3

CBCT

Parallax to determine if resorption accessed better buccal or lingual/palatal

Question 4

Typical clinical presentations in internal inflammatory root resorption?

Answer 4

Completely normal unless presence of peri-radicular disease or perforation

Question 5

What radiographic presentation would internal inflammatory root resorption show?

Answer 5

Centred in canal, no move with beam shift

Question 6

Pathogenesis of internal inflammatory RR?

Answer 6

Necrotic coronal pulp

• lesion includes vascular and inflammatory tissue
• apical pulp is vital

Lesion will continue to progress until apical pulp goes completely necrotic

Question 7

Tx of internal inflammatory RR?

Answer 7

Orthograde endo only

Question 8

Clinical findings of internal replacement RR?

Answer 8

None, tooth normal to clinical findings

Question 9

Radiographic findings for internal replacement RR?

Answer 9

Dentine and root canal space replaced with bone / mineralised tissue

Question 10

Clinical findings in external surface RR?

Answer 10

Increased physiological mobility

• all other tests are normal

Question 11

Radiographic findings in external surface RR?

Answer 11

PDL intact!

Loss of apical tissue in an apical to coronal direction

Question 12

Aetiology of external surface resorption

Answer 12

Orthodontic movement is the main cause
- 2-5% have severe ESR
- 15% have moderate
- usually teeth used for anchorage are worst affected

Ectopic teeth
- pressure from erupting tooth cause resorption and bone deposition in place of root resorption

Pathological
- adjacent pathological lesion

Idiopathic!

Question 13

Tx for external surface resorption?

Answer 13

Pulp is Healthy so endo wont work!

Must remove the source of resorption to stop the issue
- stop ortho
- tx ectopic tooth
- remove pathology

Etc….

Splint if teeth mobile

Question 14

Clinical findings in external inflammatory resorption?

Answer 14

Usually a restored tooth
- possibly sinus
- possibly swelling
- possibly apical tenderness / TTP
- possible increase in mobility

Negative sensibility testing due to necrotic pulp

Question 15

Radiographic findings for external inflammatory resorption?

Answer 15

Existing restorations close to pulp / pulp horn

Deep carious lesion close to pulpal involvement

Periapical radiolucency if communication via apical foramen

Question 16

Aetiology external inflammatory resorption?

Answer 16

Necrotic pulp
- bacterial
- trauma

Periapical inflammatory lesion precipitates the resorption process or via communication to peri-radicular tissues via furcal / accessory canal

Question 17

Tx of external inflammatory resorption?

Answer 17

Remove cause of inflamamtion

• usually orthograde endodontic tx, surgical endo or extraction

Question 18

Clinical findings for external replacement resorption

Answer 18

Can be unrestored but infra occluded

• possibly erythematous gingiva
• high pitched percussion note
• no physiological mobility at all

Question 19

Radiographic findings of external replacement resorption?

Answer 19

Cementum and dentine irregularly resorbed
- replaced with trabecular bone

Irregular root outline

No PDL

No lamina dura

Question 20

Aetiology external replacement resorption?

Answer 20

Trauma
- typically avulsion or lateral luxation

Question 21

Tx options for external replacement resorption?

Answer 21

Monitor - has pt stopped growing?

Add composite Incisally - infraocclusion

Decoronation of tooth - allow root to resorb to preserve alveolar bone volume, followed by tooth replacement

Endodontic intervention wont stop resorption

Question 22

Clinical findings in external cervical resorption?

Answer 22

Profuse BOP, sometimes pus and sometimes periodontal pocketing

Pink spot on tooth crown

Normal / no mobility

Question 23

Radiographic findings external cervical resorption?

Answer 23

Canal barriers still intact, but radiolucency can be over the canal, use parallax to determine if buccal / palatal to canal

Question 24

Risk factors for external cervical resorption

Answer 24

Ortho tx

Trauma - avulsion and luxation

Non-vital internal bleaching

Wind instruments

Viral infection

Systemic disturbance - thyroid

Question 25

Tx options for external cervical resorption?

Answer 25

Monitor - will likely continue though

Extract and prosthetic replacement

Internal repair and orthograde endo