Root Resorption Flashcards
What is root resorption?
the non bacterial destruction of the dental hard and soft tissue due to the interaction of clastic cells
What are the 3 key features of an osteoclast?
- very motile
- ruffled border
- in contact with dentine
What is the function of RANKL?
promoting develop of bone
What is the function of OPG?
- inhibiting RANKL
- inhibits development
What 4 things stimulate RANKL?
- parathyroid hormone, B3 and interleukin
- bacterial lipopolysaccharides
- trauma (physical or chemical)
- chronic inflammation
What are the 3 different surfaces of a tooth that act to prevent resorption?
- periodontal ligament
- cementum (particularly non-mineralised)
- predentine (non collagenous component)
What are the two subsections of root resorption?
- internal
- external
What are the 2 different types of internal root resorption?
- inflammatory
- replacement
What are the 4 different types of external root resorption?
- inflammatory
- replacement
- cervical
- surface
What should extra oral examination of a tooth with suspected root resorption involve?
- smile line
- consideration for further treatment
- endodontic microsurgery
- post surgical scarring
- consideration for further treatment
What should clinical examination of a tooth with expected root resorption include?
- coronal integrity
- remaining tooth tissue
- determine restorability
- remaining tooth tissue
- colour
- pink spot
- periodontal pocketing
- PCP12 probe
- vertical and horizontally
- perio communication with resorption
- PCP12 probe
- 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
- alternative replacement options
- sensibility test
- pulp response
What radiographic views are required for examining root resorption?
- 2 angles of periapical
- 30 degrees mesial/distal shift
- CBCT
How does internal root resorption appear radiographically?
disruption to the structure of the canal system
How does external root resorption appear radiographically?
disruption to root structure with root canal system unaffected
What are the clinical findings for teeth with internal inflammatory root resorption?
- coronal integrity
- can be unrestored
- periodontal pocketing
- NIL
- unless lesion perforated root surface
- NIL
- colour
- normal
- sinus
- NIL
- unless peri-radicular disease
- NIL
- swelling
- NIL
- apical tenderness
- NIL
- tenderness to percussion
- NIL
- mobility
- physiological movement
- sensibility test
- positive response
What are the radiographic findings of internal inflammatory root resorption?
- lesion centred in canal
- does not move with beam shift
What is the pathogenesis of internal inflammatory root resorption?
- coronal pulp necrotic
- lesion has inflammatory and vascular tissue
- apical pulp is vital
- lesion grows as apical pulp becomes necrotic
What are the treatment options for internal inflammatory root resorption?
- orthograde endodontics
- possible haemorrhage
- active irrigation
- intervisit medicament
- thermal obturation
What are the clinical findings of internal replacement root resorption?
- 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
What are the radiographic findings of internal replacement root resorption?
- pulp expanded
- trabecular like pattern
- mineral deposits and ledge formation
When should teeth with internal replacement root resorption be treated?
- very difficult to treat
- consider leaving if asymptomatic
How does external surface root resorption appear clinically?
- 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
How does external surface root resorption appear radiographically?
- reduced root length
- normal pulp
- PDL in tact
- trabecular pattern within root structure
What is the aetiology of external surface root resorption?
- 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
How is external surface root resorption managed?
- 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
How does external inflammatory root resorption present clinically?
- 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
- may be increasing
- sensibility test
- negative response
- pulp is necrotic
- negative response
How does external inflammatory root resorption present radiographically?
- peri-apical radiolucency
- apex of root resorbed
What is the aetiology of external inflammatory root resorption?
- necrotic pulp
- bacteria or trauma origin
- periapical inflammatory lesion
- precipitate resorption process
How is external inflammatory root resorption treated?
- remove cause of inflammation
- orthograde endodontics
- obturation challenging
- apical construction
- surgical endidintics
- extraction
- orthograde endodontics
How does external replacement root resorption appear clinically?
- 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
How does external replacement root resorption present?
- pulp appears normal
- no periapical radiolucency
- no obvious PDL
How is external replacement root resorption managed?
- 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
- if infra occlusion more than 1mm
- monitor
- work out if patient has stopped growing
- incisal composite
What is the aetiology of external replacement root resorption?
- trauma
- significant injuries to the periodontist
- bone in contact with external root dentine
- lateral luxation
- avulsion
How does external cervical root resorption present clinically?
- 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
- pink spot
- sinus
- NIL
- swelling
- NIL
- apical tenderness
- NIL
- tenderness to percussion
- NIL
- mobility
- normal or no physiological mobility
- sensibility test
- positive response
How does external cervical root resorption present radiographically?
- root canal not affected
- irregular shaped defect
- apple core appearance
What protects the pulp from obliteration in external cervical root resorption?
pre-dentine
What are the ways in which external cervical root resorption can be classified?
- apiece-coronal direction
- circumferential
What are the risks of external cervical root resorption?
- orthodontics
- trauma
- avulsion
- luxation
- historical non-vital whitening
- wind instruments
- viral infection
- systemic disturbance
- thyroid
What are the treatment options for external cervical root resorption?
- monitor
- resorption will likely continue
- decoration
- maintains hard and soft tissue
- good for aesthetics
- options for restoration
- maintains hard and soft tissue
- extraction
- prosthetic replacement
- usually unrestorable
- pulp perforated
- sub-crestal
- limited prognosis
- internal repair
- orthograde endodontics
For what types of root resorption is orthograde endodontics an appropriate treatment?
- external inflammatory
- internal inflammatory
For what types of root resorption is surgical endodontics an appropriate treatment?
- external cervical
For what types of root resorption is no endodontics appropriate treatment?
- external replacement
- external surface
