Root Resorption

Root Resorption

Process
1. Resorption by Giant cells (mononuclear phagocytes)
2. Resorption of tooth prevented by Pre-dentine & Pre-cementum layer (not fully mineralised)
3. Resorption occurs when fully mineralised dentine or cementum is present against soft tissue
  1. Damage to pre-dentine/pre-cementum layer
  2. Death of Odonto/Cementoblasts -> layer becomes fully mineralised)
4. Consistent stimulation required for continued resorption
  1. Otherwise resorption stops after 2-3wks & surface repaired with cementum-like material (not fully mineralised)
    1. = Transient root resorption
      1. No clinical significance
      2. Normal wear & tear
      3. Not detectable
Inflammatory resorption
1. Giant cell stimuli = Inflammation
  1. Systemic disorder
  2. Pressure
  3. Infection
2. External resorption
  1. Cervical
    1. Aggressive form
    2. Less common
    3. 1) Minor trauma -> damage below attached junctional epithelium
      1. 2) Pre-cementum lost
        3a) Junctional epithelim grows down & protects root from giant cell colonisation
        3b) Giant cells colonise root
        4a) Transient root resorption
        4b) Stimulus -> progressive resorption
        Pulp space infection
        Non-vital pulp
        Raise flap, clean defect & repair (GIC/composite)
        RCT
        Plaque build up -> external infection
        Vital pulp
        Pre-dentine prevents pulpal invasion
        Treatment
        Improve OH
        Raise flap, clean defect & repair (GIC/composite)
        Bleaching agents
    4. Diagnosis
      1. Localised gingival swelling/bleeding
      2. Pulpitis/PAP signs
      3. Pink spot on tooth
      4. Radiograph
  2. Non-cervical
    1. Stimulus
      1. Pressure
        Orthodontic treatment
        Ectopic/unerupted tooth
        U3s causing resorption of U2s
      2. Infection
        Apical periodontitis (chronic)
        Canal contents stimulate giant cells
        Treatment = RCT
        Dress with CaOH for 1wk before obturation
        Initial insult often = Trauma
      3. Systemic disorders
        Hyperparathyroidism
        Paget's disease
        Tumours
  3. Bone & root resorption
    1. Radiographically
      1. Radiolucency moves in relation with different radiograph views
      2. Tramlines of pulp chamber visible over radiolucency
3. Internal resorption
  1. Radiographically
    1. Radiolucency does not move with different radiograph views
    2. No tramlines visible
  2. Stimulus
    1. Infected pulp
      1. Toxins damage pre-dentine layer
      2. 1) Death of odontoblasts -> no further dentine deposition
        Trauma -> pressure from bleeding/clot formation
        2) Giant cells colonise & transient root resorption occurs
        3a) Resorption arrests if pulp recovers (no further inflammation) or Pulp dies
        3b) Chronic pulp inflammation -> Progressive resorption
  3. Diagnosis
    1. Pulpitis signs?
    2. Trauma history
    3. Pink spot on tooth
    4. Radiographic
  4. Treatment = RCT
    1. CaOH for 1wk before obturation
Replacement resorption = Ankylosis
1. = complete fixation of joint by bony union (no PDL, root fused to bone)
2. Diagnosis
  1. High metallic percussion note
  2. Rock-solid tooth
  3. Radiographically
    1. loss of PDL
    2. Root merges with bone (moth eaten)
3. Cause = Trauma -> damaged PDL
  1. Luxation
  2. Avulsion
4. Treatment = none
  1. Tooth crown may fracture or decoronate

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	Created by sanna pathy almost 5 years ago