root resorption Flashcards
What is root resorption
Non-bacterial destruction of the dental hard and soft tissues due to the interation of clastic cells
What are the key features of clastic cells
Very motile
Ruffled boarder
In contact with dentine
What is meant by a cells motility
the capacity of cells to translocate onto a solid substratum
What is meant by a ruffled boarder
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
How are clastic cells stimulated
RANKL promotes
development and stimulation
- Parathyroid hormone, B3 and interleukin -1B
- Bacterial
lipopolysaccharides - Trauma (physical, chemical)
- Chronic inflammation
What lies on the root surface to help prevent resorption
- Periodontal ligament
- Cementum (particularly the non
mineralised layer) - Predentine (non collagenous component)
How can internal root resorption occur
Inflammatory or replacement
How can external root resorption occur
Inflammatory
Replacement
Cervical
SUrface
When doing a radiographic of a tooth for resorption what do you need
2 angles (30 degrees mesial or distal beam
shift)
CBCT (Cone Beam
Computed Tomography)
What clinical findings would you expect to see with internal inflammatory resorption
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
How would you be able to tell radiograhpically there is inflammatory internal root resorption
The resorption is centered in the canal and it does not move with beam shift
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 completely necrotic
What is the treatment for internal inflammatory resorption
Orthograde endodontics only
-Possible haemorrhage
-Active irrigation
-Intervisit medicament
-Thermal obturation
What clinical findings would you expect to find in internal replacement resorption
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
What radiographic findings would you get in internal replacement resoption
Pulpal canal olbiteration
Thinner pulpal canals
What clinical finding would you get in external surface resorption
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
What is the aetiology of external surface resorption
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
What is the treatment for external surface resorption
The pup is healthy so endo treatmetn will have no effect
Must remove the source to stop the resorption
If mobile splint
What clinical findings would you get for external root inflammatory resorption
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
What is the aetiology of external inflammatory resorption
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
What is the treatment of external inflammatory resorption
remove the cause of the inflammation
usually orthograde endo Tx or surigcal endo or XLA
What would the clinical findings be in external replacement resorption
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
What happens in external replacement resorption
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
What would you radiographically find in external replacement resorption
No PDL or lamina dura and the tooth ankylosed
What is the aetiology of external replacement resorption
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
With external replacement resorption when would you consider decoronation as a Tx option
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
What are the other treatment option for external replacement resorption
Monitor, has pt stopped growing? what does toth look like?
Endo will not stop the resorption
If not too infra occluded can add composite
What clinical findings would you get in external cervical resorption
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
What does external cervical resorption look like radiographically
Large radiolucency at the cervical area with pulp still intact
What are the classifications of external cervical resorption
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
What gives risks of external cervical resorption
Orthodontics
Trauma- avulsion and luxation
Historical non-vital whitening when heat applied
Wind instruments
Viral infections
Systemic disturbance-thyroid
What are the treatment options for external cervical resorption
Monitor as it will likely continue
XLA and prosthetic replacement
Internal repair and orthograde endo
What resorption can you do orthograde endo for
External inflammatory
Internal inflammatory
What resorption can you do surgical endodontics
External cervical
What resorption will endo not help
External replacement and surface resorption
