Root Resorption Flashcards
What is the definition of root resorption?
The non bacterial destruction of the dental hard and soft tissue due to the interaction of clastic cells
What are the key features of osteoclast cells involved in root resorption?
- very motile
- ruffled boarder
- in contact with dentine
What can cause RANKL stimulation?
- parathyroid hormone, B3 and interleukin-1b
- bacterial lipopolysaccharides
- trauma (physical, chemical)
- chronic inflammation
What surfaces are involved in preventing the process of root resorption?
- PDL (protective element against osteoclasts)
- Cementum (particularly the non-mineralised layer)
- Predentine (non collagenous component that lies close to pulp)
How can root resorption be classified?
Internal and External resorption
What types of internal root resorption exist?
How do you examine root resorption on a radiograph?
Need 2 angles
- 30 degrees mesial or distal beam shift
How do you tell the difference between internal and external root resorption on a radiograph?
Internal
- lose the parallel lines of the root canal system
- root canal system appears wider on radiograph
External
- nothing to do with root canal system
- parallel lines still present
- diffuse radiopacities present over root but parallel lines still present
What is the pathogenesis of internal inflammatory root resorption?
- coronal pulp is necrotic
- lesion includes inflammatory and vascular tissue (if perforated will communicate with PDL)
- apical pulp is vital (important as this blood supply drives resorption)
- lesion will continue to progress until apical pulp goes completely necrotic
What treatment option is avail able for internal root resorption?
Orthograde endodontics ONLY
What types of internal root resorption exist?
- inflammatory
- replacement
What type of root resorption is this?
Internal replacement resorption
What types of external root resorption exist?
- surface
- inflammatory
- cervical
- replacement
How does the PDL appear in external root surface resorption?
PDL normal and intact
What is the common aetiology of external surface root resorption?
Orthodontics
What is seen on this PA radiograph?
Root resorption of CI root due to ectopic canine
(trabecular pattern suggests its filled in with bone after canine moved away, therefor no treatment)
What are the different causes of External Root Surface Resorption?
- orthodontics
- ectopic teeth (eg pressure on roots from these teeth)
- pathological lesions
- idiopathic
What is the treatment option for external root surface resorption?
DO NOT DO ENDO (has nothing to do with the resorption)
REMOVE THE SOURCE (eg ectopic tooth / orthodontal brackets)
What can you see on this PA radiograph?
- close proximity of restoration to pulp
- large PA radiolucency
- external inflammatory root resorption
What is the aetiology of external inflammatory root resorption?
Necrotic pulp (bacterial or dental trauma in origin)
- PA inflammatory lesion precipitates the resorption process
What is the treatment option for external inflammatory root resorption?
Remove the cause of inflammation
- orthograde endodontic (re) treatment
- possibly surgical endodontics or XLA
What happens if you percuss a tooth with external replacement root resorption?
High pitched note
How does external replacement root resorption present on a radiograph?
NO obvious periodontal ligament
- root canal system normal
- PA area normal
What is the aetiology of external replacement root resorption? Explain how it works.
Trauma (significant injury to periodontium such that bone and osteoclasts are then in contact with external root dentine and resorption begins)
If external replacement resorption occurs in a GROWING patient, what is seen?
Infraocclusion of tooth because it becomes fused to bone.
What must you do in patients that are still growing that have external replacement root resorption?
Decoronation to allow bone and periodontium to grown around - then replace space once stopped growing
How does external cervical root resorption present clinically?
pink spot colour (haemorrhages if probed)
How does external cervical root resorption present on radiographs?
- “apple core” presentation
- Parallel root canal system lines still present
What protects the pulp from external cervical root resorption destroying the pulp/root canal system?
Predentine
What are some risks for development of external cervical root resorption?
- orthodontics
- trauma
- viral infections
- non vital whitening when heat applied
What treatment options are available for external cervical root resorption?
- nothing & monitor
- XLA and prosthetic replacement
- internal repair and orthograde endodontics
