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BDS4 Restorative > Root Resorption > Flashcards

Root Resorption Flashcards

1
Q

What is root resorption?

A

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

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2
Q

What are the key features of Osteo/dentinoclasts?

A
  1. Very motile
  2. Ruffled boarder- good at getting into lacunae
  3. In contact with dentine- large surface area
  4. Integrins
  5. Intracellular vesicles
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3
Q

What causes RANKL stimulation? (results in bone resorption)

A
  1. Parathyroid hormone, B3 and interleukin -1B
  2. Bacterial lipopolysaccharides
  3. Trauma (physical, chemical)
  4. Chronic inflammation
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4
Q

How are dentinoclasts influenced by OPG and RANKL?

A
  • Up regulated by RANKL
  • Down regulated by OPG
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5
Q

What are the surfaces that protect a tooth from resorption?

A

PDL

Cementum

Predentine- protects from internal resorption

-> if these are intact then dentino/osteoclast cannot come into contact with dentine

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6
Q

What are the types of root resorption?

A

Internal
-> inflammatory
-> replacement

External
-> surface
-> inflammatory
-> replacement
-> cervical

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7
Q

What are the aspects to assess on examination in cases with suspected root resorption and why? pt 1

A

Smile line - if there is a consideration for Endodontic Microsurgery
-> aesthetic risk from scarring/recession

Coronal integrity of remaining tooth and restoration quality
-> can tooth be restored predictably

Colour
-> Pink spots

Periodontal pocketing with a PCP12 probe both vertically and horizontally
-> Communication between periodontium and resorption (6PPC for tooth)

Sinus including location in relation to mucogingival junction
-> has internal resorption perforated the canal

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8
Q

What are the aspects to assess on examination in cases with suspected root resorption and why? pt 2

A

Swelling/Apical tenderness
-> Associated with periradicular disease

Tenderness to percussion
-> Checking PA tissue

Mobility

Occlusal contact in ICP and guidance
-> Is the tooth functional and prudent to retain

Integrity of adjacent teeth
-> alternative replacement options like bridge

Sensitivity test
-> check for pulp response

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9
Q

What radiographs are taken for root resorption?

A

PA
-> Parallax (30 degrees M/D beam shift)
-> helps determine whether buccal or lingual or int/external (if resorption moves- EXTERNAL)

CBCT

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10
Q

How does internal and external inflammatory resorption appear on radiographs?

A

Internal- balloons out from internal aspect of canal
-> Parallel lines of RCS have been lost

External- superimposition of resorption but can still see tramlines of the root canals

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11
Q

What are the clinical findings with internal inflammatory resorption? (Very little signs and symptoms)

A

Coronal integrity- may be unrestored

Perio pocketing- nil unless lesion has perforated root surface

Colour- normal

No sinus- unless PA disease

No Swelling, apical tenderness TTP

Normal mobility

Positive to sensibility tests (mostly)

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12
Q

How does internal inflammatory resorption appear radiographically?

A

Centred in canal, doesn’t move with beam shift

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13
Q

What is the pathogenesis of internal inflammatory resorption?

A

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

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14
Q

What does a periapical lesion in a tooth with suspected internal inflammatory resorption suggest?

A

PA radiolucency suggests loss of vitality of the tooth (resorption has topped)

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15
Q

What is the issue with treatment of internal inflammatory resorption?

A

Possible haemorrhage

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16
Q

How is internal inflammatory resorption treated?

A

Active irrigation- M activator

Intervisit medicament- Ca/Iodoform paste (esp if not happy with disinfection)

Thermal obturation
-> seal below CEJ with flowable and composite (if unrestored)

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17
Q

What colour is necrotic pulp?

A

Black

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18
Q

What are the clinical findings for Internal Replacement Resorption?

A

May be unrestored

NO:
Perio pocketing, colour change, sinus, swelling, apical tenderness, TTP, mobility

Positive to sensibility tests

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19
Q

How does internal replacement resorption appear on radiograph?

A
  • Pulp is enlarged with radiopacities (pulp is being replaced by mineralised mixed hard tissue- dentine, cementum, bone, PDL)
  • RCS has expanded
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20
Q

How is internal replacement resorption managed?

A

Chances of instrument fracture are high- very difficult to negotiate pulp chamber

-> Accept, monitor, plan for definitive restoration

21
Q

What are the features of external surface resorption?

A

Patient presents with mobile teeth

PDL remains intact, No PA radiolucency

Pulp is vital

22
Q

What are the causes of External surface resorption?

A

Ortho

Ectopic canines/teeth- resorb roots of adjacent teeth (resorption pattern follows shape of ectopic tooth)

Ameloblastoma (refer to OMFS)- suggest which teeth need extracted

Idiopathic/Incidental

Occurs in deciduous teeth as permanent successor erupts

23
Q

What does a trabecular pattern developing in the area of resorption suggest?

A

Healing

24
Q

What are the incidences of ESR in ortho patients?

A

Occurs in 90%
-> 15% have moderate
-> 2-5 % have sever

Teeth used for anchorage are worst affected

25
Q

How is ESR treated?

A

The PULP is HEALTHY - Endodontic treatment will NOT have any effect REMOVE the SOURCE to stop the resportion
-> splint if mobile

26
Q

What are the clinical findings in External inflammatory resorption?

A

Usually restored teeth

No pocketing

No colour change

Possible- sinus, swelling, apical tenderness, TTP

Mobility may be increased

Negative to sensibility testing as pulp is necrotic

27
Q

What causes External Inflammatory resorption?

A

Necrotic pulp - bacterial or dental trauma in origin
-> periapical inflammatory lesion precipitates the resorption process

Restorations encroaching on pulp horns

Inflammation from adjacent teeth

28
Q

What % of teeth with PA radiolucency have External inflammatory resorption?

A

81% of teeth with PA radiolucency will have microscopic areas of EIR
 Uncommon to be very large size
 7% seen on radiographs

29
Q

How is EIR treated?

A

Remove cause of inflammation (necrotic pulp)
-> Usually orthograde RCT (re)
-> possibly surgical endodontics or extraction

30
Q

What is the issue with RCT in teeth with EIR?

A

Apical constriction may not be present

Apical control may not be possible

31
Q

What are the clinical findings for External Replacement Resorption?

A

Can occur in unrestored tooth

Infra-occlusion (if patient still growing)

Erythematous gingivae

No colour change, swelling, apical tenderness, sinus

High pitched noise on percussion (if 20% of root surface affected)

No physiological mobility

Positive to sensibility testing

32
Q

What happens to root in External replacement resorption?

A

Root disappears and becomes filled in with bone
-> Lost PDL

33
Q

What commonly causes External replacement resorption?

A

Trauma - significant injuries to the periodontium such that bone (osteoclasts) is then in contact with external root dentine to begin resorption
-> Avulsion
-> Intrusion/lateral luxation injury

34
Q

How are infra occluded teeth which have occurred due to ERR treated in growing patients? Why?

A

If infraocclusion is more than 1mm in a growing patient
-> Remove crown to alveolar level and allow root to resorb
-> preserves bone volume
-> Adjacent teeth and periodontium develop normally
-> Tooth replacement with denture or RBB

35
Q

How are infra occluded teeth which have occurred due to ERR treated in non-growing patients?

A

Add composite to restore to normal height

36
Q

What are the restorative issues with infra-occluded teeth?

A
  • Teeth tip in- cannot replace with restoration of same shape
  • Significant hard and soft tissue defect- asymmetrical implant crown
37
Q

Why is RCT not done for ERR?

A

Resorption continues after endodontic treatment (will not stop it)
-> Difficult to remove GP from bone when replacing with implants

Do not do endo for this issue

38
Q

What should be done with canals in avulsed teeth in adults?

A

Do not obturate, fill with CaOH instead of GP (this will resorb with tooth)

39
Q

What are the clinical findings in teeth with external cervical resorption? (high incidence, high variation between cases)

A

Can be unrestored

Gingival inflammation- profuse BOP

Pink spots

Subgingival cavities- may give transparent look if underlying cavity

Pus

Usually normal mobility
-> Infra-occlusion may occur- no mobility

Positive to sensibility testing

40
Q

How does ECR appear radiographically?

A

Apple core shape radiographically- from level of CEJ (still see tramlines too)

41
Q

What additional imaging can be helpful for ECR?

A

CBCT

42
Q

What are the pico-coronal classifications of ECR?

A

▸ 1. crestal
▸ 2. coronal 1/3
▸ 3. middle 1/3
▸ 4. apical 1/3

43
Q

What are the circumferential classifications of ECR?

A

1/4

1/2

3/4

More than 3/4

44
Q

What are the risks for ECR?

A

Orthodontics

Trauma - avulsion and luxation

Historical non vital whitening when heat was applied

Wind instruments

Viral infection

Systemic disturbance - thyroid

45
Q

How does ECR appear histologically?

A

Irregular front of resorption
-> Predentine remains intact- protects pulp (resorption goes around- pulp not involved)

46
Q

What can be done to remove areas of ECR?

A

Hypochlorite on a micro brush can cause coagulation necrosis and help remove strands of resorptive cells

47
Q

What are the treatment options for ECR?

A

Monitor

Extraction and prosthetic replacement

Internal repair with orthograde endo

48
Q

Why is GIC used for cavities caused by ECR?

A
  • Subgingival- allows moisture control
  • Not on occlusal loading
  • Good with PDL
49
Q

How may proximal ECR be treated?

A

Cannot access surgically
 Treated internally like perforation repair
 Try to seal resorption of from gingivae
 Flowable composite into defect

BDS4 Restorative (12 decks)

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