Tooth Resorption

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By: mahaak (38 month(s) ago)

Excellent presentation Dr.

By: el_ammora (40 month(s) ago)

very nice

By: khalidclinic (42 month(s) ago)

Good Good Tooth Resorption presentation Dr.

By: drchaks (44 month(s) ago)

Respected Sir, This is Dr. Chakravarthy here. Am doing my master in endodontics from Manipal college of dental sciences INDIA. I went through your presentation on tooth resorption and found it to be par excellence. very informative and precise. If it is not much of a problem sir can you please mail me a copy of your presentation. Its for preparing a seminar on Internal resorption for our college clinical club.any further textual information also would be very helpful. Awaiting a quick and positive response. regards

By: sunrays_g (44 month(s) ago)

hello Dr.bander, sir ur ppt is very good and very nicely presented with all possible information sir i'm a doctor from india who would like to have this presentation in my collection so if u can mail it to me my mailing address is sunrays_gs@yahoo.com

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Presentation Transcript

Tooth Resorption : 

Presented by: Dr.Bander Al-Abdulwahhab BDS,AEGD,MD,SBARD Tooth Resorption

Contents : : 

Contents : 1.1. Definition. 1.2. Predisposing factors. 1.3. Features. 1.4. Mechanism. 1.5. Prognosis. 1.6. Identification and differentiation. 1.7. Management INTERNAL RESORPTION. 2. EXTERNAL RESORPTION. 2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2.5. Classification. 2.6 Identification and differentiation. 2.7 Management

Slide 3: 

Tooth resorption is a perplexing problem for all dental practitioners. The etiologic factors are vague, diagnoses are educated guesses, and often the chosen treatment does not prevent the rapid disappearance of the calcified dental tissues. Even diagnostic tool has limitations because resorption on the buccal or lingual surface of the tooth usually cannot be discerned until 20% to 40% of the tooth structure has been demineralized. Introduction:

Slide 4: 

INTERNAL RESORPTION: 1.1. Definition. 1.1. Internal resorption: is initiated within the pulp chamber or root canal of the tooth.

Slide 5: 

INTERNAL RESORPTION: 1.1. Definition. 1.2. Predisposing factors. 1.1. Internal resorption: is initiated within the pulp chamber or root canal of the tooth. 1.2. Predisposing factors: are Unknown, the process appears to be associated with pulpal inflammation e.g.( trauma, partial pulp removal, pulp capping with calcium hydroxide and a cracked tooth). and the presence of bacteria .

Slide 6: 

1.1. Definition. 1.2. Predisposing factors. 1.3. Features. Preceded by disappearance of the odontoblastic layer of cells, followed by an invasion of macrophage-like dentin-resorbing cells. Internal resorption is usually asymptomatic and is discovered on routine radiographic evaluation. The resorptive process may progress slowly, rapidly, or intermittently, with periods of activity and inactivity. INTERNAL RESORPTION:

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1.1. Definition. 1.2. Predisposing factors. 1.3. Features. 1.4. Mechanism. 1.5. Prognosis. The prognosis is excellent once the inflamed tissue has been removed. INTERNAL RESORPTION:

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1.1. Definition. 1.2. Predisposing factors. 1.3. Features. 1.4. Mechanism. 1.5. Prognosis. 1.6. Identification and differentiation. INTERNAL RESORPTION: Margins INTERNAL EXTERNAL Smooth and well defined Rough, and have a "moth-eaten" appearance. Symmetric Asymmetrical. Symmetrical. Canal anatomy Altered + size Unaltered Different horizontal beam angles Internal: The relationship of the canal to the defect will remain the same, regardless of the angle. External: the relationship of the defect to the canal will shift as the horizontal angle of the beam is altered. 1.6

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1.1. Definition. 1.2. Predisposing factors. 1.3. Features. 1.4. Mechanism. 1.5. Prognosis. 1.6. Identification and differentiation. 1.7. Management 1.7.1. Non perforated 1.7.2. Perforated INTERNAL RESORPTION: INTERNAL RESORPTION Non Perforated Perforated 1.7. 1). Pulp removal and canal preparation: 1. Coronal access modified or enlarged to allow greater penetration of the NaOCI. 2. Copious irrigation with (NaOCI). 3. Ultrasonic instrumentation coupled with high volume flushing. 4. Interim CaOH if difficult to remove at 1st visit. 1 2 3

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1.1. Definition. 1.2. Predisposing factors. 1.3. Features. 1.4. Mechanism. 1.5. Prognosis. 1.6. Identification and differentiation. 1.7. Management 1.7.1. Non perforated 1.7.2. Perforated INTERNAL RESORPTION: INTERNAL RESORPTION 1.7. 1). Pulp removal and canal preparation: 1. Coronal access modified or enlarged to allow greater penetration of the NaOCI. 2. Copious irrigation with (NaOCI). 3. Ultrasonic instrumentation coupled with high volume flushing. 4. Interim CaOH if difficult to remove at 1st visit. Non Perforated Perforated 2). Canal Obturation: 1. Small or moderate defect: use vertical compaction with warm gutta-prcha, thermoplasticized gutta-prcha, or pressure syringe injection. 2. Large defect: use same techniques with more pressure required. 3. Near-perforation: use same techniques with avoid excessive pressure, use CaOH-based root canal sealer. (why)

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1.1. Definition. 1.2. Predisposing factors. 1.3. Features. 1.4. Mechanism. 1.5. Prognosis. 1.6. Identification and differentiation. 1.7. Management 1.7.1. Non perforated 1.7.2. Perforated INTERNAL RESORPTION: INTERNAL RESORPTION 1.7. Determined of perforation: Clinically: 1. Continue hemorrhage after all the Pulp has been removed. 2. Blood in paper points at side. 3. Sinus tract at point of perforation. Raadiographically: lateral radicular lesion at resorptive defect. Non Perforated Perforated

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1.1. Definition. 1.2. Predisposing factors. 1.3. Features. 1.4. Mechanism. 1.5. Prognosis. 1.6. Identification and differentiation. 1.7. Management 1.7.1. Non perforated 1.7.2. Perforated INTERNAL RESORPTION: INTERNAL RESORPTION 1.7. Nonsurgical Repair: in case of: 1-The defect is not extensive. 2- Defect is far apical to epithelial attachment. Technique: - Calcium hydroxide paste into the canal until a hard-tissue barrier is formed. then obturated with GP & sealer. or - MTA Non Perforated Perforated Management

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1.1. Definition. 1.2. Predisposing factors. 1.3. Features. 1.4. Mechanism. 1.5. Prognosis. 1.6. Identification and differentiation. 1.7. Management 1.7.1. Non perforated 1.7.2. Perforated INTERNAL RESORPTION: INTERNAL RESORPTION 1.7. Nonsurgical Repair. Surgical Repair: -Full mucoperiosteal flap. -Area is curetted, cleaned and restored with an alloy, composite resin, glass ionomer restoration or MTA. Non Perforated Perforated

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1.1. Definition. 1.2. Predisposing factors. 1.3. Features. 1.4. Mechanism. 1.5. Prognosis. 1.6. Identification and differentiation. 1.7. Management 1.7.1. Non perforated 1.7.2. Perforated INTERNAL RESORPTION: INTERNAL RESORPTION 1.7. Nonsurgical Repair. Surgical Repair. In case of the resorption is extensive or occurs on lingual or proximal surfaces: 3- Root and tooth resection (resorbtion at apical area or one root is affected). 4- Intentional replantation. (with minimal root damage occurs in an inaccessible area). 5- Extraction. Non Perforated Perforated

Slide 15: 

2.1. Definition. 2.2. Histopathology. 2. EXTERNAL RESORPTION: External resorption: is initiated in the periodontium and often results in significant loss of hard tooth structure. Histologically: scalloped border lined with osteoclasts.

Slide 16: 

2.1. Definition. 2.2. Histopathology. 2.3 Radiographically. 2. EXTERNAL RESORPTION: External resorption: is initiated in the periodontium and often results in significant loss of hard tooth structure. Histologically: scalloped border lined with osteoclasts. Radiographically: - Defect is rough. - Asymmetric. - Moth-eaten appearance. - Intact canal.

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2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2. EXTERNAL RESORPTION: Causes: 1.Trauma. 2. Periradicular inflammation. 3. Orthodontic movement. 4. Impacted teeth. 5. Nonvital bleaching.

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2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2.5. Classification. 2.5.1. Replacement resorption. 2.5.2. Inflammatory resorption. 2. EXTERNAL RESORPTION: 2.5.1. Replacement resorption (ankylosis): characterized by osseous ingrowth into the resorbed areas of the root . 2.5.2. Inflammatory resorption: - Components are both necrotic pulp and bacteria. Replacement and inflammatory resorption are common and serious complication subsequent to avulsion or luxation(10% extrusive, 50% intrusive) injuries.

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2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2.5. Classification. 2.5.1. Replacement resorption. 2.5.2. Inflammatory resorption. 2. EXTERNAL RESORPTION: 2.5.1. Replacement resorption (ankylosis): Treatment: NO. treatment. In most cases, regardless of treatment rendered, progressive replacement root resorption result in tooth loss. 2.5.2. Inflammatory resorption: Treatment: immediate root canal treatment.

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2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2.5. Classification. 2.5.1. Replacement resorption. 2.5.2. Inflammatory resorption. 2.5.3.Periradicular inflammation. 2. EXTERNAL RESORPTION: 2.5.3. Periradicular Inflammation: Causes: chronic pulpal inflammation or the direct contamination of the priradicular tissues through poorly filled root cana1s. Treatment: RCT.

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2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2.5. Classification. 2.5.1. Replacement resorption. 2.5.2. Inflammatory resorption. 2.5.3.Periradicular inflammation. 2.5.4. Excessive forces of orthodontic movement. 2. EXTERNAL RESORPTION: Excessive forces of orthodontic movement: Resorption occurs in nearly all patients undergoing orthodontic tooth movement. Most root resorption is minimal and ceases after the appliances are removed. Few cases can be severe resu1ting in shortened root length. Treatment: Once root resorption is recognized, eliminate the excessive forces. Few cases continue, resulting very short root.

Slide 22: 

2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2.5. Classification. 2.5.1. Replacement resorption. 2.5.2. Inflammatory resorption. 2.5.3.Periradicular inflammation. 2.5.4. Excessive forces of orthodontic movement. 2.5.5. Conditions associated with impacted teeth. 2. EXTERNAL RESORPTION: Conditions associated with impacted teeth: Caused by an adjacent impacted tooth. Treatment: 1-Type I: Involves periodontium only or minor tooth surface. Treatment: Removing impaction + observation.

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2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2.5. Classification. 2.5.1. Replacement resorption. 2.5.2. Inflammatory resorption. 2.5.3.Periradicular inflammation. 2.5.4. Excessive forces of orthodontic movement. 2.5.5. Conditions associated with impacted teeth. 2. EXTERNAL RESORPTION: Conditions associated with impacted teeth: Caused by an adjacent impacted tooth. Treatment: 1-Type I: 2-Type II: Involves periodontium and dentin. Treatment: Removing impaction + observation. If affects cervical portion: Removing impaction +appropriate restorative, periodontal or orthodontic treatment.

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2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2.5. Classification. 2.5.1. Replacement resorption. 2.5.2. Inflammatory resorption. 2.5.3.Periradicular inflammation. 2.5.4. Excessive forces of orthodontic movement. 2.5.5. Conditions associated with impacted teeth. 2. EXTERNAL RESORPTION: Conditions associated with impacted teeth: Caused by an adjacent impacted tooth. Treatment: 1-Type I: 2-Type II: 3-Type III: Involves periodontium, dentin and pulp. Treatment: RCT, If it is fail, root resection or implant.

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2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2.5. Classification. 2.5.1. Replacement resorption. 2.5.2. Inflammatory resorption. 2.5.3.Periradicular inflammation. 2.5.4. Excessive forces of orthodontic movement. 2.5.5. Conditions associated with impacted teeth. 2. EXTERNAL RESORPTION: Conditions associated with impacted teeth: Caused by an adjacent impacted tooth. Treatment: 1-Type I: 2-Type II: 3-Type III: 4-Type IV: Involves periodontium, dentin, pulp and adjacent structures. (rare). Treatment: both teeth must be extracted.

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2.1. Definition. 2.2. Histopathology. 2.3. Radiographically. 2.4. Causes. 2.5. Classification. 2.5.1. Replacement resorption. 2.5.2. Inflammatory resorption. 2.5.3.Periradicular inflammation. 2.5.4. Excessive forces of orthodontic movement. 2.5.5. Conditions associated with impacted teeth. 2.5.6. Bleaching of nonvital teeth. 2. EXTERNAL RESORPTION: 2.5.6. Bleaching of nonvital teeth: Cause: external cervical resorption. theory of cervical resorption: 1-Seeps through patent dentinal tubules and initiates inflammatory resorptive, increase with thermocatalytic bleaching. 2-Damage through periodontium, caused by the bleaching agent at the time of treatment. Treatment: root extrusion or extraction.

Tooth Resorption : 

Tooth Resorption INTERNAL RESORPTION Non Perforated RCT Perforated Non surgical Repair Small, apically ( CaOH+ RCT),MTA Surgical Repair Extensive (RCT+ restoration) Root resection Resorption in one root Intentional replantation Minimal, in inaccessible area. Extraction EXTERNAL RESORPTION Replacement resorption No treatment Inflammatory resorption Immediate RCT. Periradicular inflammation RCT Excessive forces of orthodontic movement Eliminate excessive forces. Conditions associated with impacted teeth Periodontium(extraction), Periodontium +dentin (extraction), Periodontium +dentin affects cervical portion (extraction + appropriate restorative), Periodontium +dentin and pulp (RCT or root resection), Periodontium+ dentin+ pulp+ adjacent structures (extraction). Bleaching of nonvital teeth Root extrusion or extraction

Slide 28: 

Thank you