Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ENDO > Seminar 9A: Resorption prof > Flashcards

Seminar 9A: Resorption prof Flashcards

1
Q

What is dental resorption?

A

Physiological or pathological process
Loss of dentine and or cementum by hard tissue resorbing cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does the clinical presentation of physiological and progressive resorption differ ?

A

Both often asymptomatic BUT progressive can become symptomatic in advanced stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the major risk of late diagnosis of resorption ?

A

Tooth loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is dentine protected from resorption ?

A

Non mineralised structure : pre dentine and odontoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is cementum protected from resorption ?

A

Non mineralised layer: pre cementum
Cells: cementoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Other than cells and non mineralised layer what else protects dentine and cementum from resorption ?

A
  1. Anti invasion factor from pre dentine and pre cementum, cartilage and blood vessel walls
  2. Intact PDL
  3. Hyaline layer of hopewell smith
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does intact PDL prevent resorption ?

A

Prevents multinucleated dentinoclast cells from attaching to dental hard tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the hyaline layer of hopewell smith?

A

Highly mineralised intermediate cementum layer
It MAY originate from the HERS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What type of resorption does the HLHS protect against ?

A

External root resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does the HLHS cover ?

A

Dentinal tubules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does the HLHS prevent happening ?

A

Root canal irritants from escaping and reaching the PDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What type of cells perform resorption?

A

Multinucleated giant cells or CLASTIC cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the first cellular process of the clast cells during resorption ?

A

Attachment of the clastic cell membrane to the hard tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In the cytoplasm of clast cells what zone must be attached to the hard tissue?

A

Clear zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of border is formed between the hard tissue and clast cell?

A

Ruffled border
Increased surface area for cocktail of enzymes to be released from and create a low pH environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What cells resorb bone?

A

Osteoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What cells resorb dentine and cementum?

A

Dentinoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the differences between osteoclasts and dentinoclasts?

A

Dentinoclast: smaller, fewer nuclei and minimal clear zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What two factors must occur prior to resorption to taking place?

A
  1. Damage to the non mineralised components
  2. Disruption to the odontoblasts , fibroblasts and cementoblasts which would usually offer protection

This allows colonisation of the clast cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What activates clast cells following injury ?

A

Acute inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

By what process allows for progressive resorption?

A

Chronic inflammation either pulp or PDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can resorption be classified ?

A

Site
Aetiology
Pathogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the types of pulpal resorption by site aetiology and pathogenesis

A

Internal
-transient
-progressive (sustained by bacteria or products OR sustained by cytotoxic materials during pulp therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the types of non pulpal resorption by site aetiology and pathogenesis?

A

External
-transient
-progressive external without persistent inflammation (replacement resorption)
-progressive external with persistent inflammation of PDL
-progressive associated with systemic diseases
-progressive idiopathic resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the subcategories for progressive external resorption caused be persistent localised inflammation of PDL?

A

Root canal infection
Pressure
Foreign material
Subgingival plaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Internal resorption occurs due to damage to what ?

A

Pre dentine and odontoblast layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is internal resorption sustained by ?

A

Pulpal inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What can cause internal resorption?

A

Trauma
Restorative procedures / materials
Orthodontics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How common is internal resorption?

A

Very rare (0.1-1.6%) of permanent teeth affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What symptoms does transient internal resorption present with?

A

Unlikely to be symptomatic because the pulpal inflammation is not sustained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

In progressive internal resorption what is the initial stimulus to cause pulpal inflammation?

A

Bacteria and or products or materials that leak thru dentinal tubules or cracks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

In the early stages of progressive IR what happens to the coronal pulp?

A

Becomes inflamed and then necrotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What provides the ongoing blood supply for the progressive IR?

A

The resorptive tissue and the pulp tissue apical to this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

When does progressive IR cease?

A

Once the pulp has necrotised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What will affect the rate of progressive internal resorption?

A

The strength of the inflammatory stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

In some cases of progressive IR calcified tissue can found inside the inflamed resorptive defect - what is this called?

A

Internal replacement resorption or
Metaplastic resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the clinical signs of IR?

A

If pulp chamber affected can lead to a pink spot on the crown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Why does the crown appear pink in IR?

A

The vascularised resorptive tissue is undermining the coronal enamel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

In cases of IR would you expect pulp tests to be positive or negative ?

A

Positive as vital pulp is required to sustain the resorption

40
Q

In some cases of IR why would the pulp
Test be negative ?

A

If the coronal pulp is necrotic then this may give a false negative as apically there maybe vital tissue OR
if the internal resorption has ceased as the pulp is truly/fully necrotic

41
Q

In what scenario would patients develop symptoms in IR?

A

If the necrotic pulp becomes infected

42
Q

How does IR present radiographically ?

A

Well circumscribed
Symmetrical
Oval
Pulp chamber cannot be seen through the lesion

43
Q

In a mesio-distal parallax view how does IR appear?

A

Remains the same

44
Q

In what circumstances can you have PARLs in IR?

A

total pulp necrosis
Root wall perforation

45
Q

In which circumstance can it be difficult to determine internal or external resorption ?

A

When an IR lesion has increased in size so much that it has breached the root wall

46
Q

How soon after identifying IR should root canal be commenced and why?

A

As soon as detected
To prevent root perforation and lesion progression

47
Q

What concentration of NaOCl should be used in IR cases?

A

5% to help dissolve the inflamed tissue

48
Q

What else could you consider using to enhance the effect of NaOCl in IR cases?

A

Ultrasonics

49
Q

What should be checked for in cases of internal resorption once the canal is located?

A

A perforation using a curved file attatched to an apex locator. Want to ensure hypo is not extruded through any perforation

50
Q

What inter-visit medicament should be used in PIR cases and why?

A

CaOH
-prevents recolonisation by bacteria
-facilitates removal of any residual inflamed tissue in the resorptive lesion

51
Q

If there is an extensive lesion in PIR how would this change the use of CaOH?

A

Long term dressing should be left to induce hard tissue genesis

52
Q

In what PIR circumstances would you delay obturation?

A

When there is a large lesion you may want to wait until bone healing has occurred to avoid extrusion of root canal filling material

53
Q

What obturation methods may you consider using in PIR cases ?

A

-Thermoplasticed GP
-Combination of vertical and lateral compaction to fill void
-surgical approach to explore the defect

54
Q

When are you most commonly expected to see external resorption?

A
  1. Severe dental trauma
  2. apical periodontitis
  3. ortho treatment
55
Q

Which part of the root is most commonly affected by external resorption?

A

Apical ++
Lateral and cervical less common

56
Q

In transient ER to what tissues/cells has there been injury to?

A

precementum
cementoblasts

57
Q

What is another name of transient ER?

A

external surface resorption

58
Q

In which traumatic injury cases are you more likely you to see transient ER?

A

Less traumatic trauma injuries as there was damage followed by repair

59
Q

How does transient ER appear clinically?

A

usually asymp

60
Q

How does transient ER appear radiographically?

A

Usually cannot see the small resorptive defects and they are lined by intact PDL

61
Q

What treatment is required for transient ER?

A

None

62
Q

What is the other name of progressive external resorption without persistent inflammation of periodontal tissue?

A

Replacement resorption

63
Q

In what clinical circumstances would you most commonly see RR/PER?

A

Luxation injuries
Following re-implantation of avulsed teeth when there is been damage to at least 20% of the cementum and extensive damage to PDL

64
Q

What two factors that would usually be secreted allows the osteoclasts to populate the denuded root surface in RR/PER?

A

Anti-invasion factor
Collagenase

65
Q

Which two tissues can osteoclasts not differentiate between?

A

Bone and Cementum

66
Q

In RR/PER what type of tissue is laid down following the osteoclastic activity?

A

Bone is laid down by osteoblasts-akin to bone remodelling

67
Q

What is the difference between ankylosis and RR?

A

in ankylosis there has been no loss of cementum/dentine - fusion just happens

68
Q

What is the clinical presentation of RR/PER?

A

asymp

69
Q

What is a clinical sign of RR/PER and ankylosis?

A

-high pitched sound when the tooth is tapped
-no physiologic tooth movement

70
Q

If a tooth is infraoccluded what may this be a sign of?

A

Ankylosis
RR/PER

71
Q

How does RR/PER appear radiographically?

A

Mottling between bone and cementum
NO PDL space

72
Q

How do you manage RR/PER?

A

Management is manly in the form of prevention-ensuring avulsed teeth are stored in an appropriate medium to preserve the vitality of the PDL

73
Q

What is the pathogenesis behind PER with inflammation of PDL sustained by root canal infection ?

A

-Root canal infection is the most common cause of PER
-Seen in 87.3% of teeth with periradicular periodontitis likely because the cementum at the apical CEJ root thin/non existent to offer an protection against resorption
-The concentration of resorbing factors can overcome the resistance to resorption especially when the inflammation is confined to a small root area

74
Q

In cases of dental trauma how does PER with inflammation of the PDL sustained by root canal infection arise?

A

-damage of PDL leading to resorption of cementum and expose underlying dentine
-if the pulp becomes necrotic and infected then microbial products can diffuse through the dentinal tubules to the periradicular tissues fuelling the inflammation

75
Q

How would you manage cases of dental trauma leading to PER with inflammation of the PDL sustained by root canal infection?

A

Long term dressing with CaOH

76
Q

What are the clinical signs and simps of PER with inflammation of the PDL sustained by root canal infection?

A

-symps of CAP
-in extensive cases mobility
-pulp tests -ve

77
Q

What are the radiographic signs and clinical
symps of PER with inflammation of the PDL sustained by root canal infection?

A

Resorptive lesions present at any level of the root
-in cases of no luxation injuries then maybe a PARL with shortening of the root
-resorptive lesions are ill-defined, asymmetrical
-the outline of the root canal is unchanged and the lesions change with parralax

78
Q

How would you manage PER with inflammation of the PDL sustained by root canal infection?

A

-Prevention: by carrying out timely RCT where there have been extensive luxation injuries
-L0ng term CaOH dressing as intervisit

79
Q

What challenges are posed when obturating PER with inflammation of the PDL sustained by root canal infection?

A

Ensuring GP is not extruded

80
Q

How does PER with inflammation of the PDL sustained by pressure arise?

A

-impacted teeth
-ortho
-occlusal trauma
-cysts/tumours

81
Q

How is PER with inflammation of the PDL sustained by pressure mediated?

A

On a molecular basis

82
Q

What is the management for PER with inflammation of the PDL sustained by pressure?

A

Removal of the source of pressure

83
Q

How does PER with inflammation of the PDL sustained by pressure present clinically?

A

-Asymp
-vital pulp
-increased mobility /shortened roota

84
Q

How does PER with inflammation of the PDL sustained by pressure present radiographically?

A

Intact PDL surrounding the resorptive defect

85
Q

What procedures would you see PER with inflammation of the PDL sustained by foreign material arise?

A

Seen following
-connective tissue grafting
-bone grafting
-tissue regen

86
Q

Why do you see PER with inflammation of the PDL sustained by foreign material following certain procedures?

A

Often root planing is carried out prior to grafting/regen and this damages the cementum so dentintinoclasts can attach to the cementum

87
Q

In which two PER with inflammation of PDL categories present the same way clinically and radiographically?

A

Foreign material and SG plaque

88
Q

What is another name for PER with inflammation of the PDL sustained by sub gingival plaque?

A

cervical resorption

89
Q

How is PER with inflammation of the PDL sustained by sub gingival plaque initiated?

A

Damage to the cervical attachment apparatus (cementum/PDL) below epithelial attachment by:
orthodox
scaling
orthographic/DA surgery
internal bleaching

90
Q

In cases of PER with inflammation of the PDL sustained by sub gingival plaque is the pulp usually invaded?

A

NO!
Due to protection offered by predentine
-The lesion spreads cervically but not into the pulp

91
Q

In cases of PER with inflammation of the PDL sustained by sub gingival plaque when is the pulp invaded?

A

If the predestine layer has been damaged or mineralised

92
Q

How does PER with inflammation of the PDL sustained by sub gingival plaque present clinically?

A

-Asymp initially then pulpitis in advanced stages
-may see a pink spot when the enamel is undermined
-non carious cavity can be detected subgingivally but supracrestal
-pulp is usually vital

93
Q

How does PER with inflammation of the PDL sustained by sub gingival plaque present radiographically?

A

-Well circumscribed/mottled lesions present at any position cervically
-Outline of pulp intact
-Where lesion involves proximal surfaces there maybe angular bone loss

94
Q

How do you manage PER with inflammation of the PDL sustained by sub gingival plaque?

A

-Surgical exposure and curettage of lesion to remove all the inflammation tissue
-Any undermined enamel/dentine should be spared to help retain the GIC restoration

95
Q

What soln can be placed following surgical exposure and removal of the resorptive tissue in PER with inflammation of the PDL sustained by sub gingival plaque?

A

90% trichloroacetic acid

96
Q

In cases of pulpal exposure following surgical removal in PER with inflammation if the PDL sustained by sub gingival plaque what should happen next?

A

immediate root canal treatment shaping and obturation and then restore the defect
-if not done immediately access rates are reduced significantly

97
Q

Why would you complete the RCT first then place the GIC in PER with inflammation if the PDL sustained by sub gingival plaque?

A

The restoration may become dislodged

ENDO (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions