Root Resorption Flashcards
What is root resorption?
The non bacterial destruction of the dental hard and soft tissues due to the interaction of clastic cells
What are the 3 key features of the clastic cells which cause root resorption?
Very motile
Ruffled border
In contact with dentine
What is the effect of RANKL on the clastic cells?
Upregulates resorption
What is the effect of OPG on resorption?
Down regulates resorption
What type of cells cause resorption
Osteoclasts which, when on root surface, arre referred to as dentinoclasts (multi nucleated giant cells)
What is the function of the ruffled border of clastic cells?
Well adapted to resorbing hard tissue
What are risk factors for root resorption?
Bacterial endotoxins
Physical trauma (luxation and avulsion)
General chronic inflammation
What are the 3 protective surfaces against root resorption?
Periodontal ligament
Cementum
Pre dentine
What are the 6 types of root resorption?
Internal inflammatory
Internal replacement
External inflammatory
External replacement
External cervical
External surface
What instrument is used to examine root resorption?
PCP12 probe in periodontal pocket to find portal of entry of resorption
What is the difference between internal and external root resorption on radiograph?
Internal - ballooning of pulp chamber
External - pulp canal has parallel walls
How does internal inflammatory restoration present with parallax?
Doesn’t move with beam shift as in center of canal
What is the pathogenesis of internal inflammatory?
Coronal pulp is necrotic, this lesion induces inflammatory and vascular tissue.
Apical pulp is vital
If perforated, will communicate with pdl
Lesion will progress until completely necrotic
What is the treatment for internal inflammatory resorption?
Endo treatment
Be aware of possible haemorrhage as part of pulp is still vital. Place Inter visit medicament and use thermal obturation (may not be able to achieve moisture control).
What is the radiographic presentation of internal replacement resorption?
Trabecular pattern in enlarged pulp (mineralised tissue).
what is the treatment for internal replacement resorption?
Often the patient has no symptoms and RCT is unpredictable so is not likely to benefit the patient.
No active management
Why does internal inflammatory resorption have a positive sensibility result?
Because part of the pulp is still vital.
What are the clinical presentations of external surface resorption?
Increased mobility
Positive sensibility
What are the radiographic presentations of external surface resorption?
PDL intact
Normal pulp
Shortened roots
What is the most likely cause of external surface resorption?
Orthodontic treatment
Or from ectopic tooth
what is the main concern with external surface resorption?
Progression of periodontal disease (pt more at risk of losing teeth)
What is the treatment for external surface resorption?
Deboned ortho/ remove ectopic tooth
Can splint teeth if become mobile
No endo as not from microorganism source (pulp is healthy)
What is the clinical presentation of external inflammatory resorption?
May have increased mobility
Negative sensibility test as pulp is necrotic
May have swelling/ sinus/ TTP
What is the radiographic presentation of external inflammatory resorption?
Periapical radiolucency
What is the aetiology of external inflammatory resorption?
Necrotic pulp (bacterial or dental trauma origin), PA inflammation precipitates resorption.
What is the treatment for external inflammatory root resoprtion?
Remove the cause of inflammation - endo tx/re endo tx.
What are the clinical findings of external replacement resorption?
May be infraoccluded
High pitch percussion
No physiological mobility
What are the radiographic presentations of external emplacement resorption?
Normal pulp
No obvious PDL
Root surface replaced by bone
What is the aetiology of external replacement root resorption?
Trauma - significant injury to periodontium such that bone (osteoclasts) are then in contact with external root dentine and begin to resorb.
Eg avulsion/ intrusion/ luxation
What is the treatment for external replacement resorption?
Decoronate the tooth - if infraocclusion >1mm in growing patient. This preserves bone volume for future treatment options.
If pt has stopped growing, monitor. Can add incisal composite
What are the clinical features of external cervical resorption?
Periodontal pocketing and profuse bleeding
Pink spot
Positive sensibility
Normal or no mobility
What are the radiographic findings of external cervical resorption?
Apple core effect - radiolucency from portal of entry
Parallel lines of pulp walls still intact - spares the pulp due to presence of pre dentine.
What is the role of parallax for external cervical resorption?
Can use parallax to identify where the portal of entry is for resorption
What is the treatment for external cervical resorption?
Internal repair and orthograde endo
Monitor as the resorption will likely continue
Decoronate if extensive as not good prognosis for tooth- save surrounding bone for future treatment options.
Which types of resorption would orthograde endo be the primary treatment?
External inflammatory
Internal inflammatory
Which types of resorption would surgical endo be the primary treatment?
External cervical resorption
Which types of resorption would endo not be the primary treatment strategy?
External replacement and external surface
Internal replacement
