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BDS4 CDS Perio > Root Resorption > Flashcards

Root Resorption Flashcards

1
Q

Definition of root resorption.

A

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

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2
Q

What are the key features of dentinoclasts ?

A

Very motile i.e. jump from bone to dentine if no protection from PDL.
Ruffled border - adapted to resorbing hard tissue.
In contact with dentine - via desmosomes.

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3
Q

How are dentinoclasts stimulated ?

A

Through RANKL stimulation - upregulates and promotes dentinoclast development.
OPG down regulates and inhibits dentinoclast development.

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4
Q

What stimulates RANKL ?

A

PTH, B3 and IL-1B.
Bacterial lipopolysaccharides.
Trauma.
Chronic inflammation.

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5
Q

What three tooth surfaces act to prevent root resorption ?

A

PDL.
Cementum (particularly non-mineralised layer).
Predentine (non-collagenous component).

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6
Q

Define predentine.

A

Innermost portion of dentine, located adjacent to pulpal tissue.
Newly formed dentine before calcification and maturation.

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7
Q

What are the two types of internal root resorption ?

A

Inflammatory.
Replacement.

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8
Q

What are the four types of external root resorption ?

A

Inflammatory.
Replacement.
Cervical.
Surface.

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9
Q

What two radiographic film angles should be used to differentiate internal and external root resorption ? i.e. Parallax.

A

30 degrees medial or distal beam shift.

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10
Q

What are the radiographic features of internal root resorption ?

A

Loss of parallel lines of root canal system.
Can get ballooning.
Will not see a move using parallax.

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11
Q

What are the radiographic features of external root resorption ?

A

Maintained parallel lines of root canal system.
Will see change in location using parallax.

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12
Q

Describe pathogenesis of internal inflammatory root resorption ?

A

Coronal pulp is necrotic.
Lesion includes inflammatory and vascular tissue.
Apical pulp is vital.
Lesion will continue to progress until apical pulp becomes completely necrotic.

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13
Q

How should internal inflammatory root resorption be treated ?

A

Orthograde endodontics.
- Possibility of haemorrhage - pulp still partially vital.
- Active irrigation - remove debris and cells causing resorption.
- Intervisit medicament - CaOH acidic causes necrosis of pulpal tissues and cells causing resorption.
- Thermal obturation - warm lateral compaction to fill void in canal system.

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14
Q

What irrigant should be used in treating internal inflammatory root resorption ?

A

Sodium hypochlorite.

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15
Q

What intervisit medicament can be used to flood canal in treatment of internal inflammatory RR ? Why ?

A

Non-setting CaOH.
Will cause necrosis of pulpal tissue and remove cells causing RR (due to high pH).

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16
Q

What response would you expect from tooth with internal inflammatory RR on sensibility testing ?

A

+
Pulp is still partially vital.

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17
Q

What response would you expect from tooth with internal replacement RR on sensibility testing ?

A

+

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18
Q

What are the radiographic signs of internal inflammatory root resorption ?

A

Ballooning of root canal.

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19
Q

What are the radiographic signs of internal replacement root resorption ?

A

Expansion of pulp.
Trabecular pattern - as pulp is being replaced with mineralised tissue.

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20
Q

What is the treatment for tooth with internal replacement root resorption ?

A

Unlikely to RCT - risk of root fracture and difficulty. Likely to need XLA in future.
No need for treatment currently if asymptomatic, tooth is still vital.

21
Q

What is the rarest form of RR ?

A

Internal replacement.

22
Q

Why might a tooth with external surface resorption be mobile ?

A

Shortened root length.

23
Q

What are the common causes of external surface resorption ?

A

Orthodontic tx.
Ectopic teeth.
Idiopathic in years of growth.
Pathological lesion.

24
Q

What result would you expect from sensibility testing a tooth with external surface resorption ?

A

+
Tooth is still vital, not related to inflammatory response.

25
Q

What are the radiographic signs of external surface RR ?

A

PDL intact.
Shortened root length.
Parallelism of RC.

26
Q

What % of teeth after orthodontic treatment have some form of ESR ?

A

90%

27
Q

What % of teeth after orthodontic treatment have severe ESR ?

A

2-5%

28
Q

What % of teeth after orthodontic treatment have moderate ESR ?

A

15%

29
Q

In a patient who has had orthodontic treatment, what teeth are likely to be most affected by ESR ?

A

Teeth used for anchorage.

30
Q

What treatment should be given for tooth with external surface RR ?

A

Not endodontic tx - pulp is vital.
Remove source of resorption - i.e. stop orthodontic treatment, or extract ectopic teeth.
Splint if mobile.

31
Q

External inflammatory RR - what would you expect from sensibility testing ?

A

-
Pulp is necrotic.

32
Q

External inflammatory RR - in relation to mobility, what would you expect from these teeth ?

A

Slight mobility - depends on extent of lesion.

33
Q

External inflammatory RR - what are the characteristic radiographic findings ?

A

PA radiolucency.
Usually restored tooth.

34
Q

How should teeth with external inflammatory RR be treated ?

A

Remove cause of inflammation by endodontic tx (usually orthograde, sometimes surgical or extraction required).

35
Q

External replacement RR - what would you expect from sensibility testing this tooth ?

A

+

36
Q

External replacement RR - what would you expect from percussion of this tooth ?

A

High pitched note.
Not tender.

37
Q

External replacement RR - comment on coronal integrity of a tooth with this form of RR ?

A

Infra-occluded as alveolus continues to grow.

38
Q

External replacement RR - what radiographic findings would you expect to see ?

A

Normal pulp.
No PA pathology.
No obvious PDL space - has been replaced by bone.

39
Q

What is the main etiological factor for external replacement RR ?

A

Trauma - usually avulsion, lateral laxation or intrusion.

40
Q

How should a tooth with external replacement RR be treated in a growing patient ?

A

Decoronation in growing patients - remove the grown to alveolar level and allow root to resorb.

Why ? Allows alveolus to continue to grow to preserve bone volume, allows for adjacent teeth and periodontist to develop normally.

Tooth replacement with denture or RRB. Possibility of osteotomy for implant placement depending on bone quality.

41
Q

When should you consider decoronation in a growing patient ?

A

When infra occlusion is more than 1mm.

42
Q

What appearance of a tooth is characteristic of cervical RR ?

A

Pink spot lesion.

43
Q

What periodontal finding is characteristic of cervical RR ?

A

Increased probing depth and profuse BOP.

44
Q

What sensibility test result would you expect from tooth with cervical RR ?

A

+

45
Q

What radiographic findings would you expect from tooth with cervical RR ?

A

Apple core appearance.
Parallelism of RCS.

46
Q

Why is RCT not indicated in teeth with cervical RR ?

A

Predentine still protecting pulp.
However, still risk of perforation.

47
Q

In what two ways can cervical RR be classified ?

A

Apico-coronally - crestal, coronal 1/3, middle 1/3, apical 1/3.
Circumferentially - in quarters.

48
Q

What are the etiological factors of external cervical RR ?

A

Orthodontic tx.
Trauma - avulsion and laxation.
Viral infection.
Systemic disturbance - thyroid.

49
Q

What are the treatment options for external cervical RR ?

A

Extraction and prosthetic replacement.
Internal repair and orthograde endodontics.

BDS4 CDS Perio (5 decks)

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