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Seminar 9: Resorption Flashcards

1
Q

What is resorption?

A

Physiological or pathological process
Loss of dentine and or cementum
By clastic cells

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2
Q

What protects dentine and cementum from resorption?

A

Non mineralised components: pre dentine/pre cementum/PDL
Cells: odontblasts and cementoblasts

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3
Q

What feature is specifically protects cementum from resorption ?

A

Hyaline layer of Hopewell-Smith

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4
Q

How does pre dentine / cementum and PDL protect against resorption?

A

They secrete anti invasion factors preventing attachment of clastic cells to hard tissue surface

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5
Q

How does hyaline layer of Hopewell- Smith protect against External Root Resorption?

A

Covers dentinal tubules
Protects them against noxious stimuli and irritants

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6
Q

What type of cells are clastic cells?

A

Multinucleated giant cells

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7
Q

What cells resorb bone?

A

Osteoclasts

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8
Q

What cells resorb dentine and cementum?

A

Dentinoclasts

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9
Q

According to Patel et al 2010 name the stages of resorption

A

Attachment
Clear zone formation
Podosome formation
Resorption

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10
Q

What happens in the attachment stage of resorption?

A

Patel et al 2010
Attachment of clast to hard tissue surface

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11
Q

What happens in the clear zone stage of resorption?

A

Reorganisation of myoskeleton of clastic cell allowing intimate contact of cell membrane to resorbing surface

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12
Q

What happens in the podosome formation stage of resorption?

A

Finger like projections creating a ruffled border to increase surface area to take place

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13
Q

What happens in the final stage of resorption?

A

A highly acidic environment is created leading to hard tissue breakdown

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14
Q

What are the requirements for resorption to take place?

A
  1. damage to predentine/cementum and PDL
  2. Protection from osteoblasts/cementoblasts/fibroblasts is inhibited
  3. Colonisation of denuded hard tissue surface by clastic cells
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15
Q

How can pre dentine become damaged?

A

Trauma
Restorative materials/procedure
Vital bleaching
Ortho
Perio disease

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16
Q

How can precementum become damaged?

A

Trauma
Ortho
Orthognathic surgery
Perio surgery
Bruxism
Heat during RCT obturation

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17
Q

Once an injury has occurred how are dentinoclasts and osteoclasts activated ?

A

Acute inflammation which initiates resorption

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18
Q

What are the causes of chronic inflammation which can fuel resorption?

A

Pulpal: bacteria in the pulp or their products leaking via cracks or restorative materials
Perio: sub gingival plaque, Ortho, root canal infection

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19
Q

Resorption can be sustained by?

A

Chronic inflammation from pulp or PDL

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20
Q

How can resorption be classified?

A

Site
Aetiology
Pathogenesis

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21
Q

What are the two types of resorption by site?

A

Internal
External

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22
Q

What are the types of internal resorption?

A

-Transient
-Progressive (sustained by bacteria or their products OR by cytotoxic materials in pulp therapy)
-Replacement

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23
Q

What are the types of external resorption ?

A

-transient
-progressive ER without persistent inflam
-progressive with persistent inflammation by bacteria / foreign material / SG plaque
-progressive ER idiopathic
-progressive ER systematic disease
-replacement resorption

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24
Q

What percentage of teeth suffer from internal resorption ?

A

2% perm teeth

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25
What is the pathophysiology behind IR?
Damage to predentine and odontoblast layer
26
How may IR present clinically ?
Pink spot if takes place in pulp chamber
27
How does IR appear radiographically ?
Well circumscribed symmetrical oval lesion Continuous with root canal Chamber CANNOT be seen through lesion
28
With parallax how does IR appear?
Central
29
What maybe seen on a X-ray with IR apical to resorption lesion?
Radiopaque calcified mass
30
Would you expect to get positive or negative pulp test response in IR?
Can be vital Maybe negative or coronal pulp necrotic
31
When do patients typically get symptoms during resorption ?
Once the pulp becomes necrotic and infected
32
Which teeth are more commonly affected by IR?
Teeth following auto transplant
33
When would you typically see apical internal resorption ?
In teeth that have periapical lesions and associated with inflammatory external resorption
34
What concentration of NaOCL would you use in IR cases?
5% Need to start RCT ASAP to avoid perforations
35
What is the pathophysiology behind progressive internal resorption?
1. Bacterial invasion causing inflammation 2. Bacteria invade pulp causing necrosis 3. Blood supply is provided by vital pulp tissue apical to resorption
36
When does progressive internal resorption cease?
Once pulp becomes necrotic
37
In progressive internal replacement what tissue can be found inside the chamber ?
Dentine / bone like Calcified material
38
In what instances are you more likely to see external resorption ?
Severe trauma / injury
39
In transient external resorption how May this appear radiographically?
Small indentations
40
Which cells/layer have been damaged in External transient resorption?
Precementum Cementoblasts
41
How can precementum or cementoblasts become damaged
trauma Orthodontic surgery Orthognathic surgery Periodontal surgery Bruxism Excess heat use in obturation / RCT
42
What is the clinical presentation of transient ER?
Self limiting Asymp
43
How does transient ER appear radiographically ?
Delineations lined by intact PDL
44
What is the treatment required for transient ER?
Nil
45
What is progressive external resorption without persistent inflammation also known as?
Replacement resoprtion
46
In which cases would you more commonly see ER without inflam/RR?
Usually luxation injury e.g avulsion When damage to more than 20% of cementum occurred
47
In RR or ER without inflammation what happens to the sites where resorption taking place?
Osteoclasts resorb bone and denuded root surface Osteoblasts deposit bone and dentine in areas of resorption
48
How does RR present clinically?
High pitched sound when tapped often asymptomatic No physiological tooth movement
49
In a child how may RR present clinically as the child ages?
Infraocclusion
50
How does RR appear radiographically?
No PDL space ad mottling effect between bone and cementum
51
How do you manage RR following avulsion?
When teeth are avulsed RCT them within 7-14 days
52
Progressive inflammatory ER can be sustained by what?
Root canal infection Pressure SG plaque Foreign body
53
What is the aetiology begin progressive ER sustained by inflammation?
1. Root canal infection causes inflammation within PDL 2. Apical CDJ is the and risk of resorption 3. Necrotic bacterial products diffuse through dentinal tubules fuelling resorption
54
How does inflammatory Progressive ER present caused by root canal infection present clinically?
CAP Negative pulp May have mobility
55
how does inflammatory Progressive ER caused by root canal infection present radiographically?
Irregular outline Moves in same direction as parallax Root canal outline remains intact
56
How does inflammatory Progressive ER present caused by pressure present clinically?
Shortened roots Normal PDL space Mobile tooth Vital pulp
57
How do you manage inflammatory Progressive ER present caused root canal infection?
RCT and may require long term CaOH dressing
58
how do you manage inflammatory Progressive ER present caused by pressure?
Removal of pressure source
59
How does inflammatory Progressive ER present caused by foreign body and SG plaque develop?
removal of cementum following root planing allows dentinoclasts to adhere to root surface
60
How does inflammatory Progressive ER present caused by foreign body/SG plaque present clinically?
Asymp initially but may develop into pulpitis Non carious cavity may be probed subgingivally MAY see pink spot if enamel undermined
61
How do you manage inflammatory Progressive ER present caused foreign body/SG plaque?
Surgical exposure Remove resorptive lesion restore with defect with GIC MAY req RCT
62
Periradicualr EIRR caused by trauma is caused by what?
intra canal bacteria and their products
63
Why are younger teeth at greater risk of Periradicualr EIRR?
Wider tubules and thinner dentinal walls so easier for bacterial products to diffuse through
64
Name three systemic diseases associated with progressive RR
Herpes Zoster Hypoparathyroidism Radiotherapy
65
How does Herpes Zoster cause progressive RR
Internal resorption Damage to nerve endings in pulp can lead to pulpitis
66
How does hypoparathyroidism cause progressive EIRR?
External Hypomineralised dentine at greater risk of resorption
67
What is invasive/external cervical resorption? (ICR)
Form of external resorption ONLY HAPPENS CERVICALLY
68
How does external cervical resorption develop?
damage to PDL + sub epithelial cementum
69
Which teeth are most commonly effected by external /invasive cervical resorption?
Mainly seen in max incisors Mainly due to highest risk of trauma and damage from parafunctional habits
70
Is it true that in ICR there can be both destructive and reparative phases happening simultaneously?
TRUE
71
What are the predisposing factors for ICR?
+++intra-coronal bleaching esp at higher concentrations ++Trauma + Ortho Can also be idiopathic
72
How does ICR present clinically?
Initially asymptomatic and responds to pulp tests May see pink spot Tooth ma also appear grey in later stages representing pulp necrosis May detect SG non carious cavity with vascular tissue present
73
How does ECR present radiographically?
Bone loss around lesion Pulp seen through resorption defect Usually a mottled appearance
74
With parallax views how do internal resorption lesions change?
They do not change as X-ray tube head moves
75
With parallax views how do external resorption lesion change?
They change as tube head moves
76
How do you manage ICR?
expose resorption can use trichloroacetic acid 90% to aid removal of lesion +/- RCT or monitor pulp status
77
How can ICR lesions be classified?
Patel system Heithersay 1999 system Both based upon the level of lesion Circumferential involvement Proximity to root canal
78
List factors causing persistent pupal inflammation
Bacteria and their products leaking into pulp via cracks Bacteria and their products in pulp proper Cytotoxic materials
79
List factors causing persistent PDL inflammation
SG plaque External pressure e.g. ortho/cyst Root canal infection via foramina and denuded root surfaces

ENDO (22 decks)

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