Root Resorption Flashcards
(49 cards)
What is root resorption?
Non-bacterial destruction of the dental hard and soft tissue due to the interaction of clastic cells
What are the key features of Osteo/dentinoclasts?
- Very motile
- Ruffled boarder- good at getting into lacunae
- In contact with dentine- large surface area
- Integrins
- Intracellular vesicles
What causes RANKL stimulation? (results in bone resorption)
- Parathyroid hormone, B3 and interleukin -1B
- Bacterial lipopolysaccharides
- Trauma (physical, chemical)
- Chronic inflammation
How are dentinoclasts influenced by OPG and RANKL?
- Up regulated by RANKL
- Down regulated by OPG
What are the surfaces that protect a tooth from resorption?
PDL
Cementum
Predentine- protects from internal resorption
-> if these are intact then dentino/osteoclast cannot come into contact with dentine
What are the types of root resorption?
Internal
-> inflammatory
-> replacement
External
-> surface
-> inflammatory
-> replacement
-> cervical
What are the aspects to assess on examination in cases with suspected root resorption and why? pt 1
Smile line - if there is a consideration for Endodontic Microsurgery
-> aesthetic risk from scarring/recession
Coronal integrity of remaining tooth and restoration quality
-> can tooth be restored predictably
Colour
-> Pink spots
Periodontal pocketing with a PCP12 probe both vertically and horizontally
-> Communication between periodontium and resorption (6PPC for tooth)
Sinus including location in relation to mucogingival junction
-> has internal resorption perforated the canal
What are the aspects to assess on examination in cases with suspected root resorption and why? pt 2
Swelling/Apical tenderness
-> Associated with periradicular disease
Tenderness to percussion
-> Checking PA tissue
Mobility
Occlusal contact in ICP and guidance
-> Is the tooth functional and prudent to retain
Integrity of adjacent teeth
-> alternative replacement options like bridge
Sensitivity test
-> check for pulp response
What radiographs are taken for root resorption?
PA
-> Parallax (30 degrees M/D beam shift)
-> helps determine whether buccal or lingual or int/external (if resorption moves- EXTERNAL)
CBCT
How does internal and external inflammatory resorption appear on radiographs?
Internal- balloons out from internal aspect of canal
-> Parallel lines of RCS have been lost
External- superimposition of resorption but can still see tramlines of the root canals
What are the clinical findings with internal inflammatory resorption? (Very little signs and symptoms)
Coronal integrity- may be unrestored
Perio pocketing- nil unless lesion has perforated root surface
Colour- normal
No sinus- unless PA disease
No Swelling, apical tenderness TTP
Normal mobility
Positive to sensibility tests (mostly)
How does internal inflammatory resorption appear radiographically?
Centred in canal, doesn’t move with beam shift
What is the pathogenesis of internal inflammatory resorption?
Coronal pulp is necrotic
Lesion includes inflammatory and vascular tissue - if perforated will communicate with PDL
Apical pulp is vital
Lesion will continue to progress until apical pulp goes completely necrotic
What does a periapical lesion in a tooth with suspected internal inflammatory resorption suggest?
PA radiolucency suggests loss of vitality of the tooth (resorption has topped)
What is the issue with treatment of internal inflammatory resorption?
Possible haemorrhage
How is internal inflammatory resorption treated?
Active irrigation- M activator
Intervisit medicament- Ca/Iodoform paste (esp if not happy with disinfection)
Thermal obturation
-> seal below CEJ with flowable and composite (if unrestored)
What colour is necrotic pulp?
Black
What are the clinical findings for Internal Replacement Resorption?
May be unrestored
NO:
Perio pocketing, colour change, sinus, swelling, apical tenderness, TTP, mobility
Positive to sensibility tests
How does internal replacement resorption appear on radiograph?
- Pulp is enlarged with radiopacities (pulp is being replaced by mineralised mixed hard tissue- dentine, cementum, bone, PDL)
- RCS has expanded
How is internal replacement resorption managed?
Chances of instrument fracture are high- very difficult to negotiate pulp chamber
-> Accept, monitor, plan for definitive restoration
What are the features of external surface resorption?
Patient presents with mobile teeth
PDL remains intact, No PA radiolucency
Pulp is vital
What are the causes of External surface resorption?
Ortho
Ectopic canines/teeth- resorb roots of adjacent teeth (resorption pattern follows shape of ectopic tooth)
Ameloblastoma (refer to OMFS)- suggest which teeth need extracted
Idiopathic/Incidental
Occurs in deciduous teeth as permanent successor erupts
What does a trabecular pattern developing in the area of resorption suggest?
Healing
What are the incidences of ESR in ortho patients?
Occurs in 90%
-> 15% have moderate
-> 2-5 % have sever
Teeth used for anchorage are worst affected
