Root Resorption

Root Resorption

External root resorption  ( Caused by attachment damage, Periodontal defect.)


1. Surface root resorption (SRR)  - Transient, self limiting, reversible.
· Mechanical damage to cementum and disruption of PDLàdiscontinuous lamina dura.
· Clinically asymptomatic. Pulp is generally vital, repair usually occurs within 14 days.
· No tx indicated.
 
2. Inflammatory resorption  -
Surface inflammatory resorption (IRR) -  Necrotic pulp with bacteria in tubules is the stimulus for continued resorption of dentin after cementum resorbed due to attachment damage. Generally occurs in the apical and lateral aspects of the root.
· Radiographically looks like moth eaten resorption defects of cementum and dentin.
· Clinically asymptomatic, but PULP is NECROTIC.
· Treatment involves removing pulp and placing and replacing calcium hydroxide medicament to remove bacteria and toxins in dentinal tubules and stop process. This treatment is only sometimes effective in stopping the process.
 
· Cervical inflammatory resorption (CRR) – ( Results from sulcular infection caused by trauma (ortho, aggressive scaling), non-vital bleaching or unknown. )
· Radiographically appears as bony defect and radiolucency around cervical area of tooth; may be confused with cervical caries or burnout. If it is located on the buccal or lingual CEJ region, appears as a hazy radiolucency overlapping the well defined pulp chamber (how you can differentiate from internal root resorption).
· Clinically the tooth may look pink and have a crestal bony defect. PULP is generally VITAL or has been RCT treated (not necrotic).
· Treatment involves flapping to expose lesion, surgical removal of granulation tissue and placing glass ionomer restoration.
 
3. Replacement resorption (ankylosis) (RRR) - Caused by damage to and disruption of PDL, often after reimplantation of teeth or in some primary teeth. Cementum replaced with bone, then dentin replaced with bone.
· Radiographically loss of lamina dura and fusing of bone and tooth is evident. Often leads to infraocclusion. Located on lateral and apical aspects of root and generally continues until whole root replaced with bone and crown decoronates.
· Clinically, percussion of the tooth produces a high-pitched metallic sound, and the tooth may be in infraocclusion.
· No treatment is indicated or has been shown to stop progression or eventual loss of the tooth.
· Sometimes this is a goal of reimplanting a tooth to allow for a nice implant site later. To encourage ankylosis, before implating the tooth scrub off all the PDL cells or place the tooth in acid to ensure their death.
· *Most people use RRR and ankylosis interchangeably, but RRR refers to the resorptive process and ankylosis refers to the end result.

Internal root resorption – ( Caused by pulp , Root canal defect. )
- Pulpal inflammation caused by caries, attrition, cracks, trauma, deep preparations or trauma stimulates odontoclastic cells to resorb dentin inside the tooth. Relatively rare, especially in permanent teeth. Process continues as long as there are vital cells in the pulp.
- Radiographically appears as enlargement of pulp canals or chamber with altered irregular anatomy.
- Clinically, is usually asymptomatic, and picked up on routine radiographs. Tooth tests vital. If the resorption is in the coronal part of the tooth, it may look pink.
- Treatment: prompt endodontic therapy (2 visit) is highly successful in stopping the process, and the tooth has a good prognosis is the resportion is caught early and the defect is small.