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BDS4 Periodontology > 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 3 key features of an osteoclast?

A
  1. very motile
  2. ruffled border
  3. in contact with dentine
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3
Q

What is the function of RANKL?

A

promoting develop of bone

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4
Q

What is the function of OPG?

A
  • inhibiting RANKL
    • inhibits development
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5
Q

What 4 things stimulate RANKL?

A
  1. parathyroid hormone, B3 and interleukin
  2. bacterial lipopolysaccharides
  3. trauma (physical or chemical)
  4. chronic inflammation
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6
Q

What are the 3 different surfaces of a tooth that act to prevent resorption?

A
  1. periodontal ligament
  2. cementum (particularly non-mineralised)
  3. predentine (non collagenous component)
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7
Q

What are the two subsections of root resorption?

A
  • internal
  • external
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8
Q

What are the 2 different types of internal root resorption?

A
  • inflammatory
  • replacement
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9
Q

What are the 4 different types of external root resorption?

A
  • inflammatory
  • replacement
  • cervical
  • surface
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10
Q

What should extra oral examination of a tooth with suspected root resorption involve?

A
  • smile line
    • consideration for further treatment
      • endodontic microsurgery
      • post surgical scarring
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11
Q

What should clinical examination of a tooth with expected root resorption include?

A
  • coronal integrity
    • remaining tooth tissue
      • determine restorability
  • colour
    • pink spot
  • periodontal pocketing
    • PCP12 probe
      • vertical and horizontally
    • perio communication with resorption
  • sinus
    • relation to mucogingival junction
    • internal resorption perforated canal
  • swelling
    • associated with peri-radicular disease
  • apical tenderness
    • associated with peri-radicular disease
  • tenderness to percussion
    • PDL, not necessarily peri-radicular disease
  • mobility
    • no physiological movement
    • high pitched percussion
  • occlusal contact in ICP and guidance
    • tooth function
  • integrity of adjacent teeth
    • alternative replacement options
      • bridge
  • sensibility test
    • pulp response
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12
Q

What radiographic views are required for examining root resorption?

A
  • 2 angles of periapical
    • 30 degrees mesial/distal shift
  • CBCT
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13
Q

How does internal root resorption appear radiographically?

A

disruption to the structure of the canal system

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14
Q

How does external root resorption appear radiographically?

A

disruption to root structure with root canal system unaffected

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15
Q

What are the clinical findings for teeth with internal inflammatory root resorption?

A
  • coronal integrity
    • can be unrestored
  • periodontal pocketing
    • NIL
      • unless lesion perforated root surface
  • colour
    • normal
  • sinus
    • NIL
      • unless peri-radicular disease
  • swelling
    • NIL
  • apical tenderness
    • NIL
  • tenderness to percussion
    • NIL
  • mobility
    • physiological movement
  • sensibility test
    • positive response
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16
Q

What are the radiographic findings of internal inflammatory root resorption?

A
  • lesion centred in canal
  • does not move with beam shift
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17
Q

What is the pathogenesis of internal inflammatory root resorption?

A
  • coronal pulp necrotic
  • lesion has inflammatory and vascular tissue
  • apical pulp is vital
  • lesion grows as apical pulp becomes necrotic
18
Q

What are the treatment options for internal inflammatory root resorption?

A
  • orthograde endodontics
    • possible haemorrhage
    • active irrigation
    • intervisit medicament
    • thermal obturation
19
Q

What are the clinical findings of internal replacement root resorption?

A
  • coronal integrity
    • can be unrestored
  • periodontal pocketing
    • NIL
  • colour
    • normal
  • sinus
    • NIL
  • swelling
    • NIL
  • apical tenderness
    • NIL
  • tenderness to percussion
    • NIL
  • mobility
    • physiological movement
  • sensibility test
    • positive response
20
Q

What are the radiographic findings of internal replacement root resorption?

A
  • pulp expanded
  • trabecular like pattern
  • mineral deposits and ledge formation
21
Q

When should teeth with internal replacement root resorption be treated?

A
  • very difficult to treat
    • consider leaving if asymptomatic
22
Q

How does external surface root resorption appear clinically?

A
  • coronal integrity
    • can be unrestored
  • periodontal pocketing
    • NIL
  • colour
    • normal
  • sinus
    • NIL
  • swelling
    • NIL
  • apical tenderness
    • NIL
  • tenderness to percussion
    • NIL
  • mobility
    • increased physiological movement
  • sensibility test
    • positive response
23
Q

How does external surface root resorption appear radiographically?

A
  • reduced root length
    • normal pulp
    • PDL in tact
  • trabecular pattern within root structure
24
Q

What is the aetiology of external surface root resorption?

A
  • orthodontics
    • 90% of teeth have some ESRR
    • 15% have moderate
    • 2-5% have severe
    • usually anchorage teeth most affected
  • ectopic teeth
    • pressure from erupting tooth
  • pathological lesions
    • pressure from pathological lesion
  • idiopathic
24
Q

How is external surface root resorption managed?

A
  • not progressive
    historic
  • no active management
    • cannot RCT due to bone deposition
  • pulp is healthy
    • endodontic treatment has no effect
    • source removed to stop resorption
  • splint teeth if mobile
25
Q

How does external inflammatory root resorption present clinically?

A
  • coronal integrity
    • usually restored
  • periodontal pocketing
    • NIL
  • colour
    • normal
  • sinus
    • possibly
  • swelling
    • possibly
  • apical tenderness
    • possibly
  • tenderness to percussion
    • possible
  • mobility
    • may be increasing
      • depends on extent
  • sensibility test
    • negative response
      • pulp is necrotic
26
Q

How does external inflammatory root resorption present radiographically?

A
  • peri-apical radiolucency
  • apex of root resorbed
27
Q

What is the aetiology of external inflammatory root resorption?

A
  • necrotic pulp
    • bacteria or trauma origin
  • periapical inflammatory lesion
    • precipitate resorption process
28
Q

How is external inflammatory root resorption treated?

A
  • remove cause of inflammation
    • orthograde endodontics
      • obturation challenging
      • apical construction
    • surgical endidintics
    • extraction
29
Q

How does external replacement root resorption appear clinically?

A
  • coronal integrity
    • can be unrestored
    • infra occluded
  • periodontal pocketing
    • NIL
    • possible erythematous
  • colour
    • normal
  • sinus
    • possibly
  • swelling
    • possibly
  • apical tenderness
    • possibly
  • tenderness to percussion
    • NIL
    • high pitched note
  • mobility
    • no physiological mobility
  • sensibility test
    • positive response
30
Q

How does external replacement root resorption present?

A
  • pulp appears normal
  • no periapical radiolucency
  • no obvious PDL
31
Q

How is external replacement root resorption managed?

A
  • endodontic treatment has no impact
  • must remove GP before any surgery
  • decoranation
    • if infra occlusion more than 1mm
      • in growing patient
    • remove crown to alveolar level
      • allows root to resorb
      • preserves bone volume
    • adjacent teeth and periodontium
      • develop normally
    • replacement with denture or RRB
  • monitor
    • work out if patient has stopped growing
  • incisal composite
32
Q

What is the aetiology of external replacement root resorption?

A
  • trauma
    • significant injuries to the periodontist
    • bone in contact with external root dentine
      • lateral luxation
      • avulsion
33
Q

How does external cervical root resorption present clinically?

A
  • coronal integrity
    • can be unrestored
    • incisal edge discrepancy
  • periodontal pocketing
    • yes if extensive
    • profuse bleeding on probing
      • not always present
  • colour
    • pink spot
      • not always present
  • sinus
    • NIL
  • swelling
    • NIL
  • apical tenderness
    • NIL
  • tenderness to percussion
    • NIL
  • mobility
    • normal or no physiological mobility
  • sensibility test
    • positive response
34
Q

How does external cervical root resorption present radiographically?

A
  • root canal not affected
  • irregular shaped defect
    • apple core appearance
35
Q

What protects the pulp from obliteration in external cervical root resorption?

A

pre-dentine

36
Q

What are the ways in which external cervical root resorption can be classified?

A
  • apiece-coronal direction
  • circumferential
37
Q

What are the risks of external cervical root resorption?

A
  • orthodontics
  • trauma
    • avulsion
    • luxation
  • historical non-vital whitening
  • wind instruments
  • viral infection
  • systemic disturbance
    • thyroid
38
Q

What are the treatment options for external cervical root resorption?

A
  • monitor
    • resorption will likely continue
  • decoration
    • maintains hard and soft tissue
      • good for aesthetics
      • options for restoration
  • extraction
    • prosthetic replacement
    • usually unrestorable
      • pulp perforated
      • sub-crestal
      • limited prognosis
  • internal repair
    • orthograde endodontics
39
Q

For what types of root resorption is orthograde endodontics an appropriate treatment?

A
  • external inflammatory
  • internal inflammatory
40
Q

For what types of root resorption is surgical endodontics an appropriate treatment?

A
  • external cervical
41
Q

For what types of root resorption is no endodontics appropriate treatment?

A
  • external replacement
  • external surface

BDS4 Periodontology (3 decks)

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