resorption

Question 1

Classification of Resorption

Answer 1

Tronstat -  classified root resorption
	Transient Inflammatory (surface)
	Progressive Inflammatory
		Internal
		External
			Cervical
			Replacement

Fuss – classified root resorption according to stimulation factors
Pulpal infection
Periodontal infection
Orthodontic pressure resorption
Impacted tooth or tumor pressure resorption
Ankylotic resorption – no bateria required (Suda)

Gartner – discussed buccal object rule to identify ext from internal resorption

Question 2

Causes of Resorption – Theories

Answer 2

Trope – two requirements for root resorption

1. loss or alteration of the protective layer (pre-cementum or pre-dentin)
2. inflammation must occur to the unprotected root surface

Osteoclasts will not adhere to or resorb unmineralized matrix

Cementum also inhibits the movement of toxins from root canal to periodontal tissues and visa versa thereby inhibiting inflammatory response except where missing (lateral/accessory canals, apical foramen) or lost (scalling)

Suda – confirmed correlation of bacteria and inflammatory resorption, however determined that ankylosis can occur w/out bacterial infection present. Germ free study

Question 3

Causes of Internal Resorption

Answer 3

Wedenberg –

1. Dentin contains a resorption inhibitor, macrophages do not grow on pre-dentin.
2. Internal resorption cannot develop unless normal pulp is replaced by a periodontal-like connective tissue.

Question 4

Treatment of Internal Resorption

Answer 4

Caliskan et al –

1. conventional RCT is the treatment of choice for non-perforating internal resorptive defects.
2. If perforated, CaOH2 (remineralization) should be attempted, but surgery may be necessary.
3. 90% success with non-perforating using 1 wk CaOH2 and warm condensation
4. 25% success with perforating resorption

Stamos – use ultrasonics to clean and warm gutta percha obturation technique

Question 5

Discuss External Resorption

Answer 5

1. Kuperman – Inflammatory tissue resembling perio connective tissue grew into the canal from the defect
2. Trope – dog tooth study, long term CaOH2 (12 wks) more effective than short term (1 wk)

Question 6

Discuss Invasive Cervical Resorption

Answer 6

1. Torabinejad – not well defined, only macrophages not other inflammatory cells. Treatment based on location of resorption (supraosseous, crestal or infraosseous)
2. Frank & Bakland – may be asymptomatic with normal pulp. Treatment may not involve RCT.
3. Heithersay – strong association exists between invasive cervical resorption and orthodontic treatment, trauma, and intracoronal bleaching, either alone or in combination. Recommends using TCA for treatment.

Question 7

Orthodontic treatment, resorption and endodontics

Answer 7

Mattison – No difference was seen in external root resorption between endodontically treated teeth and vital teeth when subjected to orthodontic forces.

Question 8

Stressed pulp syndrome – effect of restorative dentisty on the pulp

Answer 8

Abou-Rass - teeth with stressed pulps should be endo treated before restoring

Felton – full coverage restorations led to a higher incidence of pulp morbidity

Berganholtz – abutment teeth undergo necrosis more often (15%) than crowned non-abutments (3%)

Question 9

Would you leave a tooth open to drain?

Answer 9

August – Necrotic teeth left open to drain were filed and closed with minimal flare-ups.

Weine – When access is left open, a greater number of appointments were needed to complete treatment and more flare-ups occurred than when the tooth was kept sealed. “If you file, don’t close, if you close don’t file”

Bence – Avoid leaving teeth open to prevent flare-ups when reclosing.

Simon – described oral pulse granuloma due to legumes.