Root Resoprton Flashcards
Define root resorption
Non-bacterial destruction of the dental hard and soft tissue due to the interaction of clastic cells
Classification of root resorption
Internal
- inflammatory
- replacement
External
- inflammatory
- replacement
- cervical
- surface
How can RR be assessed radiographically
CBCT
Parallax to determine if resorption accessed better buccal or lingual/palatal
Typical clinical presentations in internal inflammatory root resorption?
Completely normal unless presence of peri-radicular disease or perforation
What radiographic presentation would internal inflammatory root resorption show?
Centred in canal, no move with beam shift
Pathogenesis of internal inflammatory RR?
Necrotic coronal pulp
- lesion includes vascular and inflammatory tissue
- apical pulp is vital
Lesion will continue to progress until apical pulp goes completely necrotic
Tx of internal inflammatory RR?
Orthograde endo only
Clinical findings of internal replacement RR?
None, tooth normal to clinical findings
Radiographic findings for internal replacement RR?
Dentine and root canal space replaced with bone / mineralised tissue
Clinical findings in external surface RR?
Increased physiological mobility
- all other tests are normal
Radiographic findings in external surface RR?
PDL intact!
Loss of apical tissue in an apical to coronal direction
Aetiology of external surface resorption
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!
Tx for external surface resorption?
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
Clinical findings in external inflammatory resorption?
Usually a restored tooth
- possibly sinus
- possibly swelling
- possibly apical tenderness / TTP
- possible increase in mobility
Negative sensibility testing due to necrotic pulp
Radiographic findings for external inflammatory resorption?
Existing restorations close to pulp / pulp horn
Deep carious lesion close to pulpal involvement
Periapical radiolucency if communication via apical foramen
Aetiology external inflammatory resorption?
Necrotic pulp
- bacterial
- trauma
Periapical inflammatory lesion precipitates the resorption process or via communication to peri-radicular tissues via furcal / accessory canal
Tx of external inflammatory resorption?
Remove cause of inflamamtion
- usually orthograde endodontic tx, surgical endo or extraction
Clinical findings for external replacement resorption
Can be unrestored but infra occluded
- possibly erythematous gingiva
- high pitched percussion note
- no physiological mobility at all
Radiographic findings of external replacement resorption?
Cementum and dentine irregularly resorbed
- replaced with trabecular bone
Irregular root outline
No PDL
No lamina dura
Aetiology external replacement resorption?
Trauma
- typically avulsion or lateral luxation
Tx options for external replacement resorption?
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
Clinical findings in external cervical resorption?
Profuse BOP, sometimes pus and sometimes periodontal pocketing
Pink spot on tooth crown
Normal / no mobility
Radiographic findings external cervical resorption?
Canal barriers still intact, but radiolucency can be over the canal, use parallax to determine if buccal / palatal to canal
Risk factors for external cervical resorption
Ortho tx
Trauma - avulsion and luxation
Non-vital internal bleaching
Wind instruments
Viral infection
Systemic disturbance - thyroid
Tx options for external cervical resorption?
Monitor - will likely continue though
Extract and prosthetic replacement
Internal repair and orthograde endo
