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BDS4 Perio > root resorption > Flashcards

root resorption Flashcards

1
Q

What is root resorption

A

Non-bacterial destruction of the dental hard and soft tissues due to the interation of clastic cells

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2
Q

What are the key features of clastic cells

A

Very motile

Ruffled boarder

In contact with dentine

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3
Q

What is meant by a cells motility

A

the capacity of cells to translocate onto a solid substratum

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4
Q

What is meant by a ruffled boarder

A

The ruffled border of an osteoclast is the folded membrane facing the side of the sealed zone playing a vital role in bone resorption

It has has a high concentration of vesicles which help acidify and secrete enzymes into the microenvironment formed by the sealed zone

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5
Q

How are clastic cells stimulated

A

RANKL promotes
development and stimulation

  1. Parathyroid hormone, B3 and interleukin -1B
  2. Bacterial
    lipopolysaccharides
  3. Trauma (physical, chemical)
  4. Chronic inflammation
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6
Q

What lies on the root surface to help prevent resorption

A
  1. Periodontal ligament
  2. Cementum (particularly the non
    mineralised layer)
  3. Predentine (non collagenous component)
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7
Q

How can internal root resorption occur

A

Inflammatory or replacement

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8
Q

How can external root resorption occur

A

Inflammatory

Replacement

Cervical

SUrface

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9
Q

When doing a radiographic of a tooth for resorption what do you need

A

2 angles (30 degrees mesial or distal beam
shift)

CBCT (Cone Beam
Computed Tomography)

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10
Q

What clinical findings would you expect to see with internal inflammatory resorption

A

Coronal integrity
-can be unrestored

Periodontal pocketing
-nil, unless lesion has perforated root surface

Colour
-normal

Sinus
-nil, unless periradicular disease

Swelling
-nil

Apical tenderness
-nil

Tenderness to precision
-nil

Mobility
-normal

Sensitivity
-positive responce

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11
Q

How would you be able to tell radiograhpically there is inflammatory internal root resorption

A

The resorption is centered in the canal and it does not move with beam shift

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12
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 completely necrotic

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13
Q

What is the treatment for internal inflammatory resorption

A

Orthograde endodontics only

-Possible haemorrhage
-Active irrigation
-Intervisit medicament
-Thermal obturation

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14
Q

What clinical findings would you expect to find in internal replacement resorption

A

Coronal integrity
-can be unrestored

Periodontal pocketing
-nil

Colour
-nil

Sinus
-nil

Swelling
-nil

Apical tenderness
-nil

Tenderness to precision
-nil

Mobility
-normal

Sensitivity
-positive

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15
Q

What radiographic findings would you get in internal replacement resoption

A

Pulpal canal olbiteration

Thinner pulpal canals

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16
Q

What clinical finding would you get in external surface resorption

A

Coronal integrity
-can be unrestored

Periodontal pocketing
-nil

Colour -nil

Sinus -nil

Swelling -nil

Apical tenderness -nil

Tenderness to precision-nil

Mobility -Increased physiological mobility

Sensitivity -Postive

17
Q

What is the aetiology of external surface resorption

A

Orthodontics
-90% of teeth have some form of ESR
-2-5% severe ESR
-15% moderate
-Usually the teeth for anchorage are worst affected

Ectopic teeth
-pressure from erupting tooth

Pathological lesions
-pressure from adjacent pathological lesion

Idiopathic

18
Q

What is the treatment for external surface resorption

A

The pup is healthy so endo treatmetn will have no effect

Must remove the source to stop the resorption

If mobile splint

19
Q

What clinical findings would you get for external root inflammatory resorption

A

Coronal integrity
-Usually restored

Periodontal pocketing -nil

Colour -nil

Sinus -possibly

Swelling -possibly

Apical tenderness
-possibly

Tenderness to precision
-possibly

Mobility
-maybe increased depending on extent

Sensitivity
-Negative the pulp is necrotic

20
Q

What is the aetiology of external inflammatory resorption

A

The pulp is necrotic
-bacterial or dental trauma in origin

The periapical inflammatory lesion precipitates the
resorption process

Majority (81%) of teeth with periapical lesions will have microscope areas of root resorption
-Only 7% of these are detectable radiographically

21
Q

What is the treatment of external inflammatory resorption

A

remove the cause of the inflammation

usually orthograde endo Tx or surigcal endo or XLA

22
Q

What would the clinical findings be in external replacement resorption

A

Coronal integrity
-can be unrestored but infra occluded

Periodontal pocketing
-nil possibly erythematous

Colour -nil

Sinus -nil

Swelling -nil

Apical tenderness -nil

Tenderness to precision
-nil but high pitched note

Mobility
-no physiological mobility

Sensitivity- positive

23
Q

What happens in external replacement resorption

A

characterized by a pathologic loss of tooth substance (cementum, dentin, and PDL) with replacement of these tissues by bone which results in fusion of the root to the surrounding bone

24
Q

What would you radiographically find in external replacement resorption

A

No PDL or lamina dura and the tooth ankylosed

25
Q

What is the aetiology of external replacement resorption

A

Trauma
-significant injuries to the periodontium such that bone (osteoclasts) is
then in contact with external root dentine to begin resorption

e.g. Avulsion or Lateral luxation

26
Q

With external replacement resorption when would you consider decoronation as a Tx option

A

If infraocclusion is more than 1mm in a growing patient

Remove crown to alveolar level and allow root to resorb

This preserves bone volume

Adjacent teeth and periodontium develop normally

Tooth replacement with denture or RBB

27
Q

What are the other treatment option for external replacement resorption

A

Monitor, has pt stopped growing? what does toth look like?

Endo will not stop the resorption

If not too infra occluded can add composite

28
Q

What clinical findings would you get in external cervical resorption

A

Coronal integrity
-can be unrestored

Periodontal pocketing
-yes if extensive & profuse BOP

Colour -pink spot

Sinus -nil

Swelling -nil

Apical tenderness -nil

Tenderness to precision
-nil

Mobility
-normal or no mobility

Sensitivity- positive

29
Q

What does external cervical resorption look like radiographically

A

Large radiolucency at the cervical area with pulp still intact

30
Q

What are the classifications of external cervical resorption

A

The apico-coronal direction and the extent of the circumferential resorption fall under the classifications:

Class 1
-crestal and 1/4 circumferential

Class 2
-coronal 1/3 and 1/2 circumferential

Class 3
-middle 1/3 and 3/4 circumferential

Class 4
-Apical 1/3 and more than 3/4 circumferential

31
Q

What gives risks of external cervical resorption

A

Orthodontics

Trauma- avulsion and luxation

Historical non-vital whitening when heat applied

Wind instruments

Viral infections

Systemic disturbance-thyroid

32
Q

What are the treatment options for external cervical resorption

A

Monitor as it will likely continue

XLA and prosthetic replacement

Internal repair and orthograde endo

33
Q

What resorption can you do orthograde endo for

A

External inflammatory

Internal inflammatory

34
Q

What resorption can you do surgical endodontics

A

External cervical

35
Q

What resorption will endo not help

A

External replacement and surface resorption

BDS4 Perio (5 decks)

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