History of Endodontics aae/abe



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Resorption


Internal

  • Inflammatory

  • Replacement

External

  • Surface (transient)

  • Inflammatory

  • Apical (AIRR due to AP/PARL)

  • Pressure – “sterile” – ortho (Mattison, Reitan), tumors

  • Replacement



Classification of Resorption


Trope 2002 – Root Resorption Classificaitons:

Progressive Inflammatory:

  1. Non Infection related – PRESSURE – “sterile” inflammation, ortho & tumors, repair occurs after pressure removed

  2. Infection related - PULPAL

    1. Apical external inflammatory - pulp necrosis/AP

    2. Lateral external inflammatory – trauma

      1. Treat w/ CaOH2 long term (assess healing every 3 months)

  3. Infection related – SULCULAR

    1. External cervical aka Subepithelial Inflammatory

    2. Not related to pulpal environment

Fuss – classified root resorption according to stimulation factors:

  1. Pulpal infection – Lateral/Apical

  2. Periodontal infection - Sulcular

  3. Orthodontic pressure resorption (OIRR)

  4. Impacted tooth or tumor pressure resorption

  5. Ankylotic resorption – no bateria required (Suda)

Causes of Resorption – Theories



TropeTwo requirements for root resorption:

  1. Loss or damage of the protective layer (pre-cementum or pre-dentin)

  2. Inflammation must occur to the unprotected root surface


*Osteoclasts will not adhere to/resorb unmineralized matrix (pre-dentin or pre-cementum layers) – lack of RGD amino acid sequence for osteoclast binding
Trope - Cementum also inhibits the movement of toxins (TEBs) from root canal to periodontal tissues and visa versa thereby inhibiting inflammatory response except where missing (lateral/accessory canals, apical foramen) or lost (scaling)
Suda – confirmed correlation of bacteria and inflammatory resorption, however determined that ankylosis/replacement resorption can occur w/out bacterial infection present. Germ free study

Discuss Internal Root Resorption


Wedenberg/Lindskog:

  1. Internal resorption is transient or progressive depending on bacterial contamination/inflammation to prolong activity of clastic cells

  2. Dentin contains a resorption inhibitor, pre-dentin

  3. Internal resorption cannot develop unless normal pulp is replaced by a periodontal-like connective tissue.

  4. Multi-nucleated giant cells/macrophages = clastic cells present


Tronstad Tooth must be vital for Internal resorption to occur
Heithersay – Two types of Internal Resorption: Inflammatory and Replacement
Patel (Review)Damage to odontoblastic and pre-dentin layers resulting in exposure of mineralized dentin layer to odontoclasts. Pulp tissue: Apical to resorption is vital, Coronal to the lesion is necrotic. 2 Types: Inflammatory and Replacement (resorption + deposition of bone/cementum-like tissues); May be symptomatic; Differentiate between IRR and ECR with CBCT

Treatment of Internal Root Resorption



Caliskan/Turkun 1997-



  1. Etiologic factors: #1: Trauma, #2: Caries

  2. Most Common Location: Middle 1/3rd of canal, Maxillary Anteriors

  3. RCT w/ 1 week CaOH2 and GP obturation (warm condensation) is the treatment of choice for non-perforating internal resorptive defects.

  4. If perforated, CaOH2 (remineralization) should be attempted, but surgery may be necessary.

  5. Non Perforating Internal Resorption: 90% success

  6. Perforating Internal Resorption: 25% success


Stamos – Use Ultrasonics to debride and Warm gutta percha obturation technique


Discuss External Inflammatory Root Resorption





  1. Tronstad 1988– Progressive External Inflamm Resorption: Damage (Trauma, root planing) to external root surface denudes areas of precementum/cementoblastschemotactic for hard tissue resorbing cells (osteoclasts/odontoclasts), Pulpal infection sustains clastic cells




  1. Trope 2002 – Review Root Resorption – Pulp space infection – bacteria/TEBs pass through dentinal tubules and stimulate an inflammatory response in the PDL – Multinucleated giant cells bind/resorb the denuded root surface and continues until the stimulus is removed



GartnerBuccal object rule to differentiate external from internal resorption

PatelCBCT to differentiate external cervical from internal resorption

Discuss Replacement Resorption and Dentoalveolar Ankylosis


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