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Dentistry in a Nutshell > root resorption > Flashcards

root resorption Flashcards

1
Q

root resorption definition

A

non bacterial destruction of dental hard & soft tissue due to interaction of clastic cells

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2
Q

key features of osteoclast cell (3)

A
  1. very mobile
  2. ruffled border (well adapted to resorb hard tissue)
  3. in contact with dentine
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3
Q

what induces differentiation to osteoclasts

A

RANKL - receptor activator NF kappa b ligand
note - OPG (osteoprotegrin) downregulates therefore inhibiting RANKL & so development of osteoclasts

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4
Q

what causes stimulation of RANKL (4)

A
  1. parathyroid hormone B3 & interleukin B1
  2. bacterial lipopolysaccharides
  3. trauma (physical / chemical)
  4. chronic inflammation
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5
Q

surfaces involved (3)

A
  1. pdl
  2. cementum
  3. pre dentine
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6
Q

main categories of resorption & sub categories

A
  1. INTERNAL - inflammatory / replacement
  2. EXTERNAL - inflammatory / replacement / cervical / surface
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7
Q

o/e what probe should be used

A

PCP12 - as BPE will inhibit examination of pdl

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8
Q

radiographic examination

A

require 2 angles with 30 degree mesial / distal beam shift ( if shift in what you are looking at strong chance it is external) or CBCT

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9
Q

how does internal resorption appear on radiograph

A

comes out from middle of root canal so loses parallel lines

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10
Q

how does external resorption appear on radiograph

A

crucially can see parallel lines of root canal system

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11
Q

presentation of internal inflammatory resorption

A

positive to sensibility tests, no obvious signs, no pockets unless perforated root surface, no sinus unless peri-radicular disease
radiographically centred in canal, doesn’t move with bean shift & see ballooning of RC i.e. loss of parallel lines

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12
Q

pathogenesis of internal inflammatory resorption

A

coronal pulp necrotic
apical pulp vital
lesion inc inflammatory & vascular tissue (if perforated will communicate with pd)
lesion will continue to progress until apical pulp goes completely necrotic too

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13
Q

tx of internal inflammatory resorption

A

orthograde endodontics ONLY
- possible haemorrhage
- active irrigation
- inter visit medicament
- thermal obturation

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14
Q

presentation of internal replacement resorption

A

no clinical signs
very rare
usually incidental finding
radiographically -> radiopaque expansion of the pulp i.e. replacement element via bone / pdl / cementum (something mineralised) so RCT unpredictable & unlikely to benefit pt

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15
Q

presentation of external surface resorption

A

clinically normal, only sign may be slightly increased mobility
radiographically -> key thing to note is that PDL IS INTACT

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16
Q

aetiology of external surface resorption (4)

A
  1. orthodontics - 90% of teeth have some form of ESR; teeth used for anchorage usually worse 2-5% severe
  2. ectopic teeth - in lateral incisor which guides in canine
  3. pathological lesions - pressure from adjacent pathological lesion
  4. idiopathic
17
Q

tx of external surface resorption

A

pulp is healthy so endo tx will not have any effect so must remove source to stop the resorption i.e. remove ortho bracket & splint if mobile

18
Q

presentation of external inflammatory resorption

A

find that tooth is usually restored
may have increased mobility depending on extent
sensibility testing is NEGATIVE as pulp necrotic
radiographically -> usually has a PA radiolucency

19
Q

aetiology of external inflammatory resorption

A

pulp is necrotic from bacterial or dental trauma in origin
periapical inflammatory lesion precipitates the resorption process

20
Q

tx of external inflammatory resorption

A

remove the cause of the inflammation
this is usually via:
orthograde endo tx / re tx
possiibly surgical endo
XLA
note - apical stop can be challenging so consider hydraulic cement rather than GP

21
Q

presentation of external replacement resorption

A

historically trauma related
can be unrestored but infra occluded
not TTP but high pitched note
no physiological mobility
radiographically -> pulp appears normal, no PA radiolucency but crucially there is PDL degeneration

22
Q

aetiology of external replacement resorption

A

TRAUMA - significant injuries to periodontium such that osteoclasts then in contact with external root dentine to begin resorption e.g. avulsion or lateral luxation

23
Q

tx of external replacement resorption

A

DECORONATION
if infraocclusion >1mm in growing pt
remove crown to alveolar lever & allow root to resorb
this preserves bone volume
adjacent teeth & periodontium develop normally
tooth replacement via denture / RBB

if pt fully grown can monitor & add comp incisally if infraoccluded
endo intervention will not stop resorption

24
Q

consequence of delayed decoronation in external replacement resorption

A

no pdl so tooth fused to bone so ankylotic percussion note

25
Q

presentation of external cervical resorption

A

can be unrestored, perio pocketing if extensive and profuse BoP, notable pink spot, POSITIVE to sensibility testing
pink spot - middle of crown
can have +/- bleeding / erythematous gingivae
radiographically -> radiolucency but still maintains parallel canals

26
Q

classification of external cervical resorption

A

apico coronal direction:
1. crestal
2. coronal 1/3
2. middle 1/3
4. apical 1/3

circumferential:
1/4
1/2
3/4
> 3/4

27
Q

risk factors for developing external cervical resorption (6)

A
  1. ortho
  2. trauma - avulsion & luxation
  3. historical non vital whitening when heat was applied
  4. wind instruments
  5. viral infection
  6. systemic disturbance i.e. thyroid
28
Q

tx for external cervical resorption

A
  1. monitor - resorption likely to continue
  2. XLA - + prosthetic replacement
  3. endo - internal repair & orthograde endo
29
Q

summary of tx options

A

orthograde endo = external & internal inflammatory
surgical endo = external cervical
no endo = external replacement & surface

Dentistry in a Nutshell (30 decks)

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