BDS4 Oral Surgery > Root Resorption > Flashcards

Root Resorption Flashcards

(44 cards)

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1
Q

What is root resoprtion defined as

A
  • non-bacterial destruction of dental hard and soft tissues due to interaction of clastic cells
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2
Q

What are key features of clastic cells

A
  • very motile
  • ruffled boarders - increase surface area for resorption
  • in contact with dentine
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3
Q

What promotes osteoclast formation

A

RANKL

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4
Q

What inhibits RANKL

A

OPG

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5
Q

What stimulates RANKL

A
  • PTH
  • bacterial lipopolysaccharides
  • trauma (phsyical or chemical)
  • chronic inflammation
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6
Q

What surfaces act to prevent resorption

A
  1. PDL
  2. Cementum (particularly the non-mineralised layer)
  3. predentine (non collagenous component)
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7
Q

How may damage occur to cementum that can initiate root dentine resorption

A
  • trauma can damage rppt sirface
  • in about 20% of teeth, there is an area of exposed dentine
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8
Q

How does predentine provide protection

A

protects internal dentine from internal resorption
it has a different collagen makeup

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9
Q

What can root resorption be split into

A
  • internal
  • external
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10
Q

What can internal root resorption be classified into

A

inflammatory
replacement

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11
Q

What can external root resorption be classified into

A
  • inflammatory
  • replacement
  • cervical
  • surface
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12
Q

What do we look at in the extr aoral examination

A
  • smile line
  • external cervical resoprion tends to happen to upper incisors
  • want to know if its an aesthetic issue
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13
Q

What should we assess in the tooth in question

A
  • coronal integrity
  • colour
  • periodontal pocketing with PCP12 probe
  • sinus
  • swelling
  • apical tenderness
  • TTP
  • mobility
  • occlusal contact in ICP
  • integrity of adj teeth
  • sensitivtiy test
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14
Q

What is the implication of a high smile line

A

post surgical recession or scarring is an aesthetic risk

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15
Q

What is the implication of the coronal integrity

A

can the tooth be restored after tx

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16
Q

Why do we look at the colour of the tooth

A

do we see a pink sport

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17
Q

What is the implication of periodontal pocketing

A
  • is there a periodontal communication with the resorption
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18
Q

What is the implication of sinus

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A
  • has the internal resorption perforated the root canal
19
Q

What is the implication of swellign and apical tenderness

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A
  • associated with periradicular disease
20
Q

What is the implication of mobility

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A
  • is there no physiological mobility
  • is there high pitched percussion
21
Q

What are the clinical findings of internal inflammatory resorption. Think of it in context of the following clinical findings
* coronal integrity
* periodontal pocketing
* colour
* sinus
* swelling
* apical tenderness
* TTP
* mobility
* sensitivity

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A
  • coronal integrity - can be unrestored
  • periodontal pocketing - nil unless lesion has perfed the root surface
  • colour - normal
  • sinus - nill unless periradicular disease
  • swelling - nil
  • apical tenderness- nil
  • TTP - nil
  • mobility- nil
  • sensitivity
22
Q

What are the radiographic findings of internal inflammatory resorption

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A
  • centred in canal
  • doesnt move with beam shift because it is internal
  • internal tram lines of the pulp are missing
23
Q

What is the pathogenesis of internal inflammatory resorption

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A
  • coronal pulp is necrotic
  • lesion includes inflammatory and vascular tissue - if perforated will communicate with PDL
  • apical pilp is vital
  • lesion will continue to progress until apical pulp goes vital
  • therefore if there is a PA radiolucency, this means the resorption has stopped and this reduced complications
24
Q

What are the tx options for internal inflammatory resorption

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A
  • orthograde endodontics only
  • may see possible haemorrhage due to vascularity
  • active irrigation
  • intervisit medicamnet
  • thermal obturation
25
What are the clinical findings of internal vascular resorption. Think of it in context of the following clinical findings * coronal integrity * periodontal pocketing * colour * sinus * swelling * apical tenderness * TTP * mobility * sensitivity
* coronal integrity - can be unrestored * periodontal pocketing - nil * colour- nil * sinus- nil * swelling- nil * apical tenderness- nil * TTP- nil * mobility- normal * sensitivity- positive
26
What are the radiographic findings of internal replacement resorption
* large pulp * RC system looks expanded * radiopacities within internal aspect of pulp chamber - being replaced with mineralized material * high risk endo tx - high risk of instrument fracture etc * accept, monitor and plan for definitive tx
27
What are the clinical findings of external surface resorption. Think of it in context of the following clinical findings * coronal integrity * periodontal pocketing * colour * sinus * swelling * apical tenderness * TTP * mobility * sensitivity
* coronal integrity - can be unrestored * periodontal pocketing - nil * colour - nil * sinus - nil * swelling - nil * apical tenderness - nil * TTP - nil * mobility - increased physiological mobility * sensitivity - positive
28
What is the radiographic signs of external surface resorption
* PDLs intact * no PA radiolucency * shorter roots
29
What is the aetiology of external surface resorption
usually orthodontics * usually anchorage teeth are worst effected ectopic teeth pathological lesions idiopathic
30
What is the tx of external surface resorption
* pulp is healthy * endo tx will have no efefct * remove the source * splint if mobile
31
What are the clinical findings of external inflammatory resorption. Think of it in context of the following clinical findings * coronal integrity * periodontal pocketing * colour * sinus * swelling * apical tenderness * TTP * mobility * sensitivity
* coronal integrity - usually restored * periodontal pocketing - nil * colour - nil * sinus - possibly * swelling- possibly * apical tenderness- possibly * TTP- possibly * mobility - maybe increased depending on extent * sensitivity - negative, pulp is necrotic
32
What are the radiographic findings for external inflammatory resorption
usually a radiolucency with reduced root length
33
What is the aetiology of external infammatory resorption
* necrotic pulp - bacterial or dental trauma in origin * PA inflammatory lesion precipitates resorption process
34
What is the tx of external inflammatory resorption
* remove cause of inflammation * orthograde endo, surgical endo, XLA
35
What are the clinical findings of external replacement resorption. Think of it in context of the following clinical findings * coronal integrity * periodontal pocketing * colour * sinus * swelling * apical tenderness * TTP * mobility * sensitivity
* coronal integrity - can be unrestored but infra occluded * periodontal pocketing - nil, possibly erythematous * colour - nil * sinus - nil * swelling - nil * apical tenderness - nil * TTP - nil **but high pitched note** * mobility - **no physiological mobility** * sensitivity - positive
36
What are the radiographic findings of external replacement resorption
* root disppearing * resembles bone * PDL lost * trabecular pattern of bony infill * 20% of root effected = high pitch note
37
What is the aetiology of etxernal replacement resorption
* trauma - significant injuries to periodontium such that bone (osteolcasts) are then in contact with external root dentine to begin resorption
38
What is the tx for external replacement resorption
* decoronation * monitor - until px has stopped growing * restore to normal height? * **endodontic treatment will not stop the resorption**
39
When should we do decoronation
* if infraocclusion is >1mm in a growing px * remove crown to alveolar level and allow root to resorb * this preserves bone volume * adj teeth and periodontium develop normally * tooth replacement with denture or RBB
40
What are the clinical findings of external replacement resorption. Think of it in context of the following clinical findings * coronal integrity * periodontal pocketing * colour * sinus * swelling * apical tenderness * TTP * mobility * sensitivity
* coronal integrity - can be unrestored * periodontal pocketing - yes if extensive and profuse BOP * colour - pink spot * sinus - nil * swelling- nil * apical tenderness- nil * TTP- nil * mobility - normal or no mobility * sensitivity - positive
41
What are the radiographic findings
radiolucent lesions within tooth however tram lines intact
42
What is external cervical resorption classified by
apical coronal direction 1. crestal 2. coronal 1/3 3. middle 1/3 4. apical 1/3 circumferential 1. 1/4 2. 1/2 3. 3/4 4. more than 2/4
43
What are the risk factors for external cervical resorption
* orthodontics * trauma * historical non-vital whitening when heat was applied (source of trauma) * wind instruments * viral infection * systemic disturbance - thyroid
44
What are the tx options for external cervical resorption
* monitor - resorption will likely continue * extract + prosthetic replacement * internal repair and orthograde endo
BDS4 Oral Surgery
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