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BDS4 Operative Dentistry > Root Resorption > Flashcards

Root Resorption Flashcards

1
Q

What is root resoprtion defined as

A
  • non-bacterial destruction of dental hard and soft tissues due to interaction of clastic cells
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2
Q

What are key features of clastic cells

A
  • very motile
  • ruffled boarders - increase surface area for resorption
  • in contact with dentine
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3
Q

What promotes osteoclast formation

A

RANKL

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4
Q

What inhibits RANKL

A

OPG

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5
Q

What stimulates RANKL

A
  • PTH
  • bacterial lipopolysaccharides
  • trauma (phsyical or chemical)
  • chronic inflammation
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6
Q

What surfaces act to prevent resorption

A
  1. PDL
  2. Cementum (particularly the non-mineralised layer)
  3. predentine (non collagenous component)
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7
Q

How may damage occur to cementum that can initiate root dentine resorption

A
  • trauma can damage root surface
  • in about 20% of teeth, there is an area of exposed dentine
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8
Q

How does predentine provide protection

A

protects internal dentine from internal resorption
it has a different collagen makeup

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9
Q

What can root resorption be split into

A
  • internal
  • external
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10
Q

What can internal root resorption be classified into

A

inflammatory
replacement

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11
Q

What can external root resorption be classified into

A
  • inflammatory
  • replacement
  • cervical
  • surface
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12
Q

What do we look at in the extr aoral examination

A
  • smile line
  • external cervical resoprion tends to happen to upper incisors
  • want to know if its an aesthetic issue
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13
Q

What should we assess in the tooth in question

A
  • coronal integrity
  • colour
  • periodontal pocketing with PCP12 probe
  • sinus
  • swelling
  • apical tenderness
  • TTP
  • mobility
  • occlusal contact in ICP
  • integrity of adj teeth
  • sensitivtiy test
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14
Q

What is the implication of a high smile line

A

post surgical recession or scarring is an aesthetic risk

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15
Q

What is the implication of the coronal integrity

A

can the tooth be restored after tx

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16
Q

Why do we look at the colour of the tooth

A

do we see a pink sport

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17
Q

What is the implication of periodontal pocketing

A
  • is there a periodontal communication with the resorption
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18
Q

What is the implication of sinus

A
  • has the internal resorption perforated the root canal
19
Q

What is the implication of swellign and apical tenderness

A
  • associated with periradicular disease
20
Q

What is the implication of mobility

A
  • is there no physiological mobility
  • is there high pitched percussion
21
Q

What are the clinical findings of internal inflammatory resorption. Think of it in context of the following clinical findings
* coronal integrity
* periodontal pocketing
* colour
* sinus
* swelling
* apical tenderness
* TTP
* mobility
* sensitivity

A
  • coronal integrity - can be unrestored
  • periodontal pocketing - nil unless lesion has perfed the root surface
  • colour - normal
  • sinus - nill unless periradicular disease
  • swelling - nil
  • apical tenderness- nil
  • TTP - nil
  • mobility- nil
  • sensitivity - positive response
22
Q

What are the radiographic findings of internal inflammatory resorption

A
  • centred in canal
  • doesnt move with beam shift because it is internal
  • internal tram lines of the pulp are missing
23
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 necrotic
  • therefore if there is a PA radiolucency, this means the resorption has stopped and this reduced complications
24
Q

What are the tx options for internal inflammatory resorption

A
  • orthograde endodontics only
  • may see possible haemorrhage due to vascularity
  • active irrigation
  • intervisit medicamnet
  • thermal obturation
25
Q

What are the clinical findings of internal replacement resorption. Think of it in context of the following clinical findings
* coronal integrity
* periodontal pocketing
* colour
* sinus
* swelling
* apical tenderness
* TTP
* mobility
* sensitivity

A
  • coronal integrity - can be unrestored
  • periodontal pocketing - nil
  • colour- nil
  • sinus- nil
  • swelling- nil
  • apical tenderness- nil
  • TTP- nil
  • mobility- normal
  • sensitivity- positive
26
Q

What are the radiographic findings of internal replacement resorption

A
  • large pulp
  • RC system looks expanded
  • radiopacities within internal aspect of pulp chamber - being replaced with mineralized material
  • high risk endo tx - high risk of instrument fracture etc
  • accept, monitor and plan for definitive tx
27
Q

What are the clinical findings of external surface resorption. Think of it in context of the following clinical findings
* coronal integrity
* periodontal pocketing
* colour
* sinus
* swelling
* apical tenderness
* TTP
* mobility
* sensitivity

A
  • coronal integrity - can be unrestored
  • periodontal pocketing - nil
  • colour - nil
  • sinus - nil
  • swelling - nil
  • apical tenderness - nil
  • TTP - nil
  • mobility - increased physiological mobility
  • sensitivity - positive
28
Q

What is the radiographic signs of external surface resorption

A
  • PDLs intact
  • no PA radiolucency
  • shorter roots
29
Q

What is the aetiology of external surface resorption

A

usually orthodontics
* usually anchorage teeth are worst effected
ectopic teeth
pathological lesions
idiopathic

30
Q

What is the tx of external surface resorption

A
  • pulp is healthy
  • endo tx will have no efefct
  • remove the source
  • splint if mobile
31
Q

What are the clinical findings of external inflammatory resorption. Think of it in context of the following clinical findings
* coronal integrity
* periodontal pocketing
* colour
* sinus
* swelling
* apical tenderness
* TTP
* mobility
* sensitivity

A
  • coronal integrity - usually restored
  • periodontal pocketing - nil
  • colour - nil
  • sinus - possibly
  • swelling- possibly
  • apical tenderness- possibly
  • TTP- possibly
  • mobility - maybe increased depending on extent
  • sensitivity - negative, pulp is necrotic
32
Q

What are the radiographic findings for external inflammatory resorption

A

usually a radiolucency with reduced root length

33
Q

What is the aetiology of external infammatory resorption

A
  • necrotic pulp - bacterial or dental trauma in origin
  • PA inflammatory lesion precipitates resorption process
34
Q

What is the tx of external inflammatory resorption

A
  • remove cause of inflammation
  • orthograde endo, surgical endo, XLA
35
Q

What are the clinical findings of external replacement resorption. Think of it in context of the following clinical findings
* coronal integrity
* periodontal pocketing
* colour
* sinus
* swelling
* apical tenderness
* TTP
* mobility
* sensitivity

A
  • coronal integrity - can be unrestored but infra occluded
  • periodontal pocketing - nil, possibly erythematous
  • colour - nil
  • sinus - nil
  • swelling - nil
  • apical tenderness - nil
  • TTP - nil but high pitched note
  • mobility - no physiological mobility
  • sensitivity - positive
36
Q

What are the radiographic findings of external replacement resorption

A
  • root disppearing
  • resembles bone
  • PDL lost
  • trabecular pattern of bony infill
  • 20% of root effected = high pitch note
37
Q

What is the aetiology of etxernal replacement resorption

A
  • trauma - significant injuries to periodontium such that bone (osteolcasts) are then in contact with external root dentine to begin resorption
38
Q

What is the tx for external replacement resorption

A
  • decoronation
  • monitor - until px has stopped growing
  • restore to normal height?
  • endodontic treatment will not stop the resorption
39
Q

When should we do decoronation

A
  • if infraocclusion is >1mm in a growing px
  • remove crown to alveolar level and allow root to resorb
  • this preserves bone volume
  • adj teeth and periodontium develop normally
  • tooth replacement with denture or RBB
40
Q

What are the clinical findings of external cervical resorption. Think of it in context of the following clinical findings
* coronal integrity
* periodontal pocketing
* colour
* sinus
* swelling
* apical tenderness
* TTP
* mobility
* sensitivity

A
  • coronal integrity - can be unrestored
  • periodontal pocketing - yes if extensive and profuse BOP
  • colour - pink spot
  • sinus - nil
  • swelling- nil
  • apical tenderness- nil
  • TTP- nil
  • mobility - normal or no mobility
  • sensitivity - positive
41
Q

What are the radiographic findings

A

radiolucent lesions within tooth however tram lines intact

42
Q

What is external cervical resorption classified by

A

apical coronal direction
1. crestal
2. coronal 1/3
3. middle 1/3
4. apical 1/3
circumferential
1. 1/4
2. 1/2
3. 3/4
4. more than 2/4

43
Q

What are the risk factors for external cervical resorption

A
  • orthodontics
  • trauma
  • historical non-vital whitening when heat was applied (source of trauma)
  • wind instruments
  • viral infection
  • systemic disturbance - thyroid
44
Q

What are the tx options for external cervical resorption

A
  • monitor - resorption will likely continue
  • extract + prosthetic replacement
  • internal repair and orthograde endo

BDS4 Operative Dentistry (10 decks)

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