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BDS4 Periodontology > Root Resorption > Flashcards

Root Resorption Flashcards

(42 cards)

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1
Q

What is root resorption?

A

the non bacterial destruction of the dental hard and soft tissue due to the interaction of clastic cells

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2
Q

What are the 3 key features of an osteoclast?

A
  1. very motile
  2. ruffled border
  3. in contact with dentine
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3
Q

What is the function of RANKL?

A

promoting develop of bone

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4
Q

What is the function of OPG?

A
  • inhibiting RANKL
    • inhibits development
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5
Q

What 4 things stimulate RANKL?

A
  1. parathyroid hormone, B3 and interleukin
  2. bacterial lipopolysaccharides
  3. trauma (physical or chemical)
  4. chronic inflammation
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6
Q

What are the 3 different surfaces of a tooth that act to prevent resorption?

A
  1. periodontal ligament
  2. cementum (particularly non-mineralised)
  3. predentine (non collagenous component)
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7
Q

What are the two subsections of root resorption?

A
  • internal
  • external
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8
Q

What are the 2 different types of internal root resorption?

A
  • inflammatory
  • replacement
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9
Q

What are the 4 different types of external root resorption?

A
  • inflammatory
  • replacement
  • cervical
  • surface
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10
Q

What should extra oral examination of a tooth with suspected root resorption involve?

A
  • smile line
    • consideration for further treatment
      • endodontic microsurgery
      • post surgical scarring
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11
Q

What should clinical examination of a tooth with expected root resorption include?

A
  • coronal integrity
    • remaining tooth tissue
      • determine restorability
  • colour
    • pink spot
  • periodontal pocketing
    • PCP12 probe
      • vertical and horizontally
    • perio communication with resorption
  • sinus
    • relation to mucogingival junction
    • internal resorption perforated canal
  • swelling
    • associated with peri-radicular disease
  • apical tenderness
    • associated with peri-radicular disease
  • tenderness to percussion
    • PDL, not necessarily peri-radicular disease
  • mobility
    • no physiological movement
    • high pitched percussion
  • occlusal contact in ICP and guidance
    • tooth function
  • integrity of adjacent teeth
    • alternative replacement options
      • bridge
  • sensibility test
    • pulp response
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12
Q

What radiographic views are required for examining root resorption?

A
  • 2 angles of periapical
    • 30 degrees mesial/distal shift
  • CBCT
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13
Q

How does internal root resorption appear radiographically?

A

disruption to the structure of the canal system

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14
Q

How does external root resorption appear radiographically?

A

disruption to root structure with root canal system unaffected

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15
Q

What are the clinical findings for teeth with internal inflammatory root resorption?

A
  • coronal integrity
    • can be unrestored
  • periodontal pocketing
    • NIL
      • unless lesion perforated root surface
  • colour
    • normal
  • sinus
    • NIL
      • unless peri-radicular disease
  • swelling
    • NIL
  • apical tenderness
    • NIL
  • tenderness to percussion
    • NIL
  • mobility
    • physiological movement
  • sensibility test
    • positive response
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16
Q

What are the radiographic findings of internal inflammatory root resorption?

A
  • lesion centred in canal
  • does not move with beam shift
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17
Q

What is the pathogenesis of internal inflammatory root resorption?

Study These Flashcards
A
  • coronal pulp necrotic
  • lesion has inflammatory and vascular tissue
  • apical pulp is vital
  • lesion grows as apical pulp becomes necrotic
18
Q

What are the treatment options for internal inflammatory root resorption?

Study These Flashcards
A
  • orthograde endodontics
    • possible haemorrhage
    • active irrigation
    • intervisit medicament
    • thermal obturation
19
Q

What are the clinical findings of internal replacement root resorption?

Study These Flashcards
A
  • coronal integrity
    • can be unrestored
  • periodontal pocketing
    • NIL
  • colour
    • normal
  • sinus
    • NIL
  • swelling
    • NIL
  • apical tenderness
    • NIL
  • tenderness to percussion
    • NIL
  • mobility
    • physiological movement
  • sensibility test
    • positive response
20
Q

What are the radiographic findings of internal replacement root resorption?

Study These Flashcards
A
  • pulp expanded
  • trabecular like pattern
  • mineral deposits and ledge formation
21
Q

When should teeth with internal replacement root resorption be treated?

Study These Flashcards
A
  • very difficult to treat
    • consider leaving if asymptomatic
22
Q

How does external surface root resorption appear clinically?

Study These Flashcards
A
  • coronal integrity
    • can be unrestored
  • periodontal pocketing
    • NIL
  • colour
    • normal
  • sinus
    • NIL
  • swelling
    • NIL
  • apical tenderness
    • NIL
  • tenderness to percussion
    • NIL
  • mobility
    • increased physiological movement
  • sensibility test
    • positive response
23
Q

How does external surface root resorption appear radiographically?

Study These Flashcards
A
  • reduced root length
    • normal pulp
    • PDL in tact
  • trabecular pattern within root structure
24
Q

What is the aetiology of external surface root resorption?

Study These Flashcards
A
  • orthodontics
    • 90% of teeth have some ESRR
    • 15% have moderate
    • 2-5% have severe
    • usually anchorage teeth most affected
  • ectopic teeth
    • pressure from erupting tooth
  • pathological lesions
    • pressure from pathological lesion
  • idiopathic
24
How is external surface root resorption managed?
- not progressive historic - no active management - cannot RCT due to bone deposition - pulp is healthy - endodontic treatment has no effect - source removed to stop resorption - splint teeth if mobile
25
How does external inflammatory root resorption present clinically?
- coronal integrity - usually restored - periodontal pocketing - NIL - colour - normal - sinus - possibly - swelling - possibly - apical tenderness - possibly - tenderness to percussion - possible - mobility - may be increasing - depends on extent - sensibility test - negative response - pulp is necrotic
26
How does external inflammatory root resorption present radiographically?
- peri-apical radiolucency - apex of root resorbed
27
What is the aetiology of external inflammatory root resorption?
- necrotic pulp - bacteria or trauma origin - periapical inflammatory lesion - precipitate resorption process
28
How is external inflammatory root resorption treated?
- remove cause of inflammation - orthograde endodontics - obturation challenging - apical construction - surgical endidintics - extraction
29
How does external replacement root resorption appear clinically?
- coronal integrity - can be unrestored - infra occluded - periodontal pocketing - NIL - possible erythematous - colour - normal - sinus - possibly - swelling - possibly - apical tenderness - possibly - tenderness to percussion - NIL - high pitched note - mobility - no physiological mobility - sensibility test - positive response
30
How does external replacement root resorption present?
- pulp appears normal - no periapical radiolucency - no obvious PDL
31
How is external replacement root resorption managed?
- endodontic treatment has no impact - must remove GP before any surgery - decoranation - if infra occlusion more than 1mm - in growing patient - remove crown to alveolar level - allows root to resorb - preserves bone volume - adjacent teeth and periodontium - develop normally - replacement with denture or RRB - monitor - work out if patient has stopped growing - incisal composite
32
What is the aetiology of external replacement root resorption?
- trauma - significant injuries to the periodontist - bone in contact with external root dentine - lateral luxation - avulsion
33
How does external cervical root resorption present clinically?
- coronal integrity - can be unrestored - incisal edge discrepancy - periodontal pocketing - yes if extensive - profuse bleeding on probing - not always present - colour - pink spot - not always present - sinus - NIL - swelling - NIL - apical tenderness - NIL - tenderness to percussion - NIL - mobility - normal or no physiological mobility - sensibility test - positive response
34
How does external cervical root resorption present radiographically?
- root canal not affected - irregular shaped defect - apple core appearance
35
What protects the pulp from obliteration in external cervical root resorption?
pre-dentine
36
What are the ways in which external cervical root resorption can be classified?
- apiece-coronal direction - circumferential
37
What are the risks of external cervical root resorption?
- orthodontics - trauma - avulsion - luxation - historical non-vital whitening - wind instruments - viral infection - systemic disturbance - thyroid
38
What are the treatment options for external cervical root resorption?
- monitor - resorption will likely continue - decoration - maintains hard and soft tissue - good for aesthetics - options for restoration - extraction - prosthetic replacement - usually unrestorable - pulp perforated - sub-crestal - limited prognosis - internal repair - orthograde endodontics
39
For what types of root resorption is orthograde endodontics an appropriate treatment?
- external inflammatory - internal inflammatory
40
For what types of root resorption is surgical endodontics an appropriate treatment?
- external cervical
41
For what types of root resorption is no endodontics appropriate treatment?
- external replacement - external surface

BDS4 Periodontology (3 decks)

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