Root Resorption Flashcards
What is root resoprtion defined as
- non-bacterial destruction of dental hard and soft tissues due to interaction of clastic cells
What are key features of clastic cells
- very motile
- ruffled boarders - increase surface area for resorption
- in contact with dentine
What promotes osteoclast formation
RANKL
What inhibits RANKL
OPG
What stimulates RANKL
- PTH
- bacterial lipopolysaccharides
- trauma (phsyical or chemical)
- chronic inflammation
What surfaces act to prevent resorption
- PDL
- Cementum (particularly the non-mineralised layer)
- predentine (non collagenous component)
How may damage occur to cementum that can initiate root dentine resorption
- trauma can damage root surface
- in about 20% of teeth, there is an area of exposed dentine
How does predentine provide protection
protects internal dentine from internal resorption
it has a different collagen makeup
What can root resorption be split into
- internal
- external
What can internal root resorption be classified into
inflammatory
replacement
What can external root resorption be classified into
- inflammatory
- replacement
- cervical
- surface
What do we look at in the extr aoral examination
- smile line
- external cervical resoprion tends to happen to upper incisors
- want to know if its an aesthetic issue
What should we assess in the tooth in question
- coronal integrity
- colour
- periodontal pocketing with PCP12 probe
- sinus
- swelling
- apical tenderness
- TTP
- mobility
- occlusal contact in ICP
- integrity of adj teeth
- sensitivtiy test
What is the implication of a high smile line
post surgical recession or scarring is an aesthetic risk
What is the implication of the coronal integrity
can the tooth be restored after tx
Why do we look at the colour of the tooth
do we see a pink sport
What is the implication of periodontal pocketing
- is there a periodontal communication with the resorption
What is the implication of sinus
- has the internal resorption perforated the root canal
What is the implication of swellign and apical tenderness
- associated with periradicular disease
What is the implication of mobility
- is there no physiological mobility
- is there high pitched percussion
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
- 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
What are the radiographic findings of internal inflammatory resorption
- centred in canal
- doesnt move with beam shift because it is internal
- internal tram lines of the pulp are missing
What is the pathogenesis of internal inflammatory resorption
- 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
What are the tx options for internal inflammatory resorption
- orthograde endodontics only
- may see possible haemorrhage due to vascularity
- active irrigation
- intervisit medicamnet
- thermal obturation
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
- coronal integrity - can be unrestored
- periodontal pocketing - nil
- colour- nil
- sinus- nil
- swelling- nil
- apical tenderness- nil
- TTP- nil
- mobility- normal
- sensitivity- positive
What are the radiographic findings of internal replacement resorption
- 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
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
- 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
What is the radiographic signs of external surface resorption
- PDLs intact
- no PA radiolucency
- shorter roots
What is the aetiology of external surface resorption
usually orthodontics
* usually anchorage teeth are worst effected
ectopic teeth
pathological lesions
idiopathic
What is the tx of external surface resorption
- pulp is healthy
- endo tx will have no efefct
- remove the source
- splint if mobile
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
- 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
What are the radiographic findings for external inflammatory resorption
usually a radiolucency with reduced root length
What is the aetiology of external infammatory resorption
- necrotic pulp - bacterial or dental trauma in origin
- PA inflammatory lesion precipitates resorption process
What is the tx of external inflammatory resorption
- remove cause of inflammation
- orthograde endo, surgical endo, XLA
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
- 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
What are the radiographic findings of external replacement resorption
- root disppearing
- resembles bone
- PDL lost
- trabecular pattern of bony infill
- 20% of root effected = high pitch note
What is the aetiology of etxernal replacement resorption
- trauma - significant injuries to periodontium such that bone (osteolcasts) are then in contact with external root dentine to begin resorption
What is the tx for external replacement resorption
- decoronation
- monitor - until px has stopped growing
- restore to normal height?
- endodontic treatment will not stop the resorption
When should we do decoronation
- 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
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
- 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
What are the radiographic findings
radiolucent lesions within tooth however tram lines intact
What is external cervical resorption classified by
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
What are the risk factors for external cervical resorption
- orthodontics
- trauma
- historical non-vital whitening when heat was applied (source of trauma)
- wind instruments
- viral infection
- systemic disturbance - thyroid
What are the tx options for external cervical resorption
- monitor - resorption will likely continue
- extract + prosthetic replacement
- internal repair and orthograde endo
