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ENDO > Seminar 9: Resorption > Flashcards

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
Q

What is the pathophysiology behind IR?

A

Damage to predentine and odontoblast layer

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26
Q

How may IR present clinically ?

A

Pink spot if takes place in pulp chamber

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27
Q

How does IR appear radiographically ?

A

Well circumscribed symmetrical oval lesion
Continuous with root canal
Chamber CANNOT be seen through lesion

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28
Q

With parallax how does IR appear?

A

Central

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29
Q

What maybe seen on a X-ray with IR apical to resorption lesion?

A

Radiopaque calcified mass

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30
Q

Would you expect to get positive or negative pulp test response in IR?

A

Can be vital
Maybe negative or coronal pulp necrotic

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31
Q

When do patients typically get symptoms during resorption ?

A

Once the pulp becomes necrotic and infected

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32
Q

Which teeth are more commonly affected by IR?

A

Teeth following auto transplant

33
Q

When would you typically see apical internal resorption ?

A

In teeth that have periapical lesions and associated with inflammatory external resorption

34
Q

What concentration of NaOCL would you use in IR cases?

A

5%
Need to start RCT ASAP to avoid perforations

35
Q

What is the pathophysiology behind progressive internal resorption?

A
  1. Bacterial invasion causing inflammation
  2. Bacteria invade pulp causing necrosis
  3. Blood supply is provided by vital pulp tissue apical to resorption
36
Q

When does progressive internal resorption cease?

A

Once pulp becomes necrotic

37
Q

In progressive internal replacement what tissue can be found inside the chamber ?

A

Dentine / bone like
Calcified material

38
Q

In what instances are you more likely to see external resorption ?

A

Severe trauma / injury

39
Q

In transient external resorption how May this appear radiographically?

A

Small indentations

40
Q

Which cells/layer have been damaged in External transient resorption?

A

Precementum
Cementoblasts

41
Q

How can precementum or cementoblasts become damaged

A

trauma
Orthodontic surgery
Orthognathic surgery
Periodontal surgery
Bruxism
Excess heat use in obturation / RCT

42
Q

What is the clinical presentation of transient ER?

A

Self limiting
Asymp

43
Q

How does transient ER appear radiographically ?

A

Delineations lined by intact PDL

44
Q

What is the treatment required for transient ER?

A

Nil

45
Q

What is progressive external resorption without persistent inflammation also known as?

A

Replacement resoprtion

46
Q

In which cases would you more commonly see ER without inflam/RR?

A

Usually luxation injury e.g avulsion
When damage to more than 20% of cementum occurred

47
Q

In RR or ER without inflammation what happens to the sites where resorption taking place?

A

Osteoclasts resorb bone and denuded root surface
Osteoblasts deposit bone and dentine in areas of resorption

48
Q

How does RR present clinically?

A

High pitched sound when tapped
often asymptomatic
No physiological tooth movement

49
Q

In a child how may RR present clinically as the child ages?

A

Infraocclusion

50
Q

How does RR appear radiographically?

A

No PDL space ad mottling effect between bone and cementum

51
Q

How do you manage RR following avulsion?

A

When teeth are avulsed RCT them within 7-14 days

52
Q

Progressive inflammatory ER can be sustained by what?

A

Root canal infection
Pressure
SG plaque
Foreign body

53
Q

What is the aetiology begin progressive ER sustained by inflammation?

A
  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
Q

How does inflammatory Progressive ER present caused by root canal infection present clinically?

A

CAP
Negative pulp
May have mobility

55
Q

how does inflammatory Progressive ER caused by root canal infection present radiographically?

A

Irregular outline
Moves in same direction as parallax
Root canal outline remains intact

56
Q

How does inflammatory Progressive ER present caused by pressure present clinically?

A

Shortened roots
Normal PDL space
Mobile tooth
Vital pulp

57
Q

How do you manage inflammatory Progressive ER present caused root canal infection?

A

RCT and may require long term CaOH dressing

58
Q

how do you manage inflammatory Progressive ER present caused by pressure?

A

Removal of pressure source

59
Q

How does inflammatory Progressive ER present caused by foreign body and SG plaque develop?

A

removal of cementum following root planing allows dentinoclasts to adhere to root surface

60
Q

How does inflammatory Progressive ER present caused by foreign body/SG plaque present clinically?

A

Asymp initially but may develop into pulpitis
Non carious cavity may be probed subgingivally
MAY see pink spot if enamel undermined

61
Q

How do you manage inflammatory Progressive ER present caused foreign body/SG plaque?

A

Surgical exposure
Remove resorptive lesion
restore with defect with GIC
MAY req RCT

62
Q

Periradicualr EIRR caused by trauma is caused by what?

A

intra canal bacteria and their products

63
Q

Why are younger teeth at greater risk of Periradicualr EIRR?

A

Wider tubules and thinner dentinal walls so easier for bacterial products to diffuse through

64
Q

Name three systemic diseases associated with progressive RR

A

Herpes Zoster
Hypoparathyroidism
Radiotherapy

65
Q

How does Herpes Zoster cause progressive RR

A

Internal resorption
Damage to nerve endings in pulp can lead to pulpitis

66
Q

How does hypoparathyroidism cause progressive EIRR?

A

External
Hypomineralised dentine at greater risk of resorption

67
Q

What is invasive/external cervical resorption? (ICR)

A

Form of external resorption
ONLY HAPPENS CERVICALLY

68
Q

How does external cervical resorption develop?

A

damage to PDL + sub epithelial cementum

69
Q

Which teeth are most commonly effected by external /invasive cervical resorption?

A

Mainly seen in max incisors
Mainly due to highest risk of trauma and damage from parafunctional habits

70
Q

Is it true that in ICR there can be both destructive and reparative phases happening simultaneously?

A

TRUE

71
Q

What are the predisposing factors for ICR?

A

+++intra-coronal bleaching esp at higher concentrations
++Trauma
+ Ortho
Can also be idiopathic

72
Q

How does ICR present clinically?

A

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
Q

How does ECR present radiographically?

A

Bone loss around lesion
Pulp seen through resorption defect
Usually a mottled appearance

74
Q

With parallax views how do internal resorption lesions change?

A

They do not change as X-ray tube head moves

75
Q

With parallax views how do external resorption lesion change?

A

They change as tube head moves

76
Q

How do you manage ICR?

A

expose resorption
can use trichloroacetic acid 90% to aid removal of lesion
+/- RCT or monitor pulp status

77
Q

How can ICR lesions be classified?

A

Patel system
Heithersay 1999 system
Both based upon the level of lesion
Circumferential involvement
Proximity to root canal

78
Q

List factors causing persistent pupal inflammation

A

Bacteria and their products leaking into pulp via cracks
Bacteria and their products in pulp proper
Cytotoxic materials

79
Q

List factors causing persistent PDL inflammation

A

SG plaque
External pressure e.g. ortho/cyst
Root canal infection via foramina and denuded root surfaces

ENDO (22 decks)

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