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4 - perio > root resorption > Flashcards

root resorption Flashcards

1
Q

What is root resorption?

A

The non-bacterial destruction of the dental hard and soft tissue due to the interaction of clastic cells

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2
Q

What are the key features of root resorption?

A

Very mobile teeth
Ruffled border - good resorbing hard tissue
In contact with dentine

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3
Q

What can cause RANKL stimulation?

A

PTH, B3 and interleukin - 1B
Bacterial lipopolysaccharides
Trauma (physical and chemical)
Chronic inflammation

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4
Q

What do RANKL and OPG do?

A

RANKL stimulates bone resorption
OPG inhibits RANKL, inhibiting the resorption of bone

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5
Q

What surfaces are affected by root resorption and why are they important in root resorption?

A

PDL - divides bone from root
Cementum - particularly non-mineralised layer
Pre-dentine (non-collagenous component)
These act to prevent resorption, however when damaged resorption can occur

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6
Q

What are the different types of internal root resorption?

A

Inflammatory
Replacement

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7
Q

What are the different types of external root resorption?

A

Inflammatory
Replacement
Cervical
Surface

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8
Q

What radiographic examination should be carried out for root resorption?

A

2 angles - 30ºmesial or distal beam shift
CBCT

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9
Q

How does internal resorption look radiographically?

A

Lose the parallel lines of the root canal as it expands

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10
Q

How does external root resorption look radiographically?

A

Nothing to do with root canal system
Area superimposed over pulp but will still be able to see the lines of the root canals

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11
Q

What is needed for resorption to occur?

A

A blood supply

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12
Q

Describe internal inflammatory root resorption

A

An incidental finding
Positive to sensibility testing
Centred on canal in radiographs and doesn’t move with beam shift
Generally doesn’t have a periapical radiolucency

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13
Q

Explain the pathogenesis of internal inflammatory resorption

A

Coronal pulp is necrotic
Lesions include inflammatory and vascular tissue - if perforated will communicate with the PDL
Apical pulp is vital
Lesion will continue to progress until apical pulp goes completely necrotic

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14
Q

How is internal inflammatory resorption treated?

A

Orthograde endodontics only

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15
Q

Describe internal replacement resorption

A

Pulp has expanded and is radiopaque radiographically
Positive to sensibility testing

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16
Q

Describe external surface resorption

A

Positive to sensibility testing
Normal to examination
Increased physiological mobility
PDL is intact
No periapical pathology
Lesion may have a trabecular pattern - has been healed with bone

17
Q

Explain the aetiology of external surface resorption

A

Orthodontics - affects 90% of teeth, 2-5% have severe, 15% moderate, usually the teeth for anchorage are worst affected
Ectopic teeth - pressure from erupting teeth
Pathological lesions - pressure from adjacent pathological lesion
Idiopathic

18
Q

How is external surface resorption treated

A

Remove the source to stop the progression
Pulp is healthy so no endodontic treatment
Splint teeth if mobile

19
Q

Describe external inflammatory resorption

A

Negative to sensibility testing - pulp is necrotic
Periapical radiolucency present
May be a history of trauma
Tooth usually previously restored

20
Q

Explain the aetiology of external inflammatory resorption

A

Necrotic pulp - bacterial or dental trauma in origin
Periapical inflammatory lesion precipitates the resorption process
Majority of teeth (81%) of teeth with periapical lesions will have microscopic areas of root resorption - only 7% of these detectable on radiographs

21
Q

How is external inflammatory resorption treated?

A

Usually orthograde endodontic re-treatment
Possibly surgical endodontics or extraction

22
Q

Describe external replacement resorption

A

Positive to sensibility testing
High pitch percussion note - due to no PDL
Pulp appears normal
No obvious periapical radiolucency
No obvious PDL
Root surface replaced by bone
Endodontic treatment has no impact on this
Commonly manifests as infra-occlusion

23
Q

Explain 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
Eg - avulsion or lateral luxation

24
Q

How is external replacement resorption treated?

A

Monitor if patient has stopped growing
Because of infra-occlusion, can add composite incisally
No endo - will not stop the resorption
Decoronation

25
Q

When should a tooth with external replacement resorption be decoronated?

A

If infra-occlusion is more than 1mm in a growing patient

26
Q

Describe external cervical resorption

A

Positive to sensibility testing
Pink spot lesion
Usually profuse bleeding on probing
CBCT very useful
Pre-dentine protects the pulp

27
Q

How is external cervical resorption classified?

A

Apical-coronal direction:
1. Crestal
2. Coronal 1/3
3. Middle 1/3
4. Apical 1/3
Circumferential:
- 1/4
- 1/2
- 3/4
- more than 3/4

28
Q

What are the risks of external cervical resorption?

A

Orthodontics
Trauma - avulsion and luxation
Historical non-vital whitening when heat was applied
Playing wind instruments
Viral infection
Systemic disturbance eg - thyroid

29
Q

How can external cervical resorption be treated?

A

Monitor - the resorption will likely continue
Extraction and prosthetic replacement
Internal repair and orthograde endodontics

30
Q

When is orthograde endodontics used to treat root resorption?

A

External inflammatory resorption
Internal inflammatory resorption

31
Q

When is surgical endodontics used to treat root resorption?

A

External cervical resorption

32
Q

When should endodontic treatment not be used for root resorption?

A

External replacement resorption
External surface resorption

4 - perio (6 decks)

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