Pathological root resorptions

Pathological root resorptions

I- Definition:

According to the American Association of Endodontists (1994): “Resorption is a condition associated with a physiological or pathological process causing loss of dentin, cementum, or bone tissue.”

Currently, all authors tend to consider rhizalyses as physiological and resorptions as pathological.

II- Classification

1-Internal root resorptions

Internal resorptions resulting in the resorption of the canal walls from the pulp.

This phenomenon can start on any pulp, cameral or canal wall, and result in an intradental cavity. We find:

Replacement resorptions

This internal process resorbs the dentin which is replaced by a hard tissue, such as osteodentin, different from dentin but close to bone and cementum

Inflammatory resorptions

It results in resorption of dentin without replacement mineralization. Characterized by granulation tissue rich in giant inflammatory cells which will resorb the canal walls

2-External root resorptions

Surface resorptions

They are discrete, superficial and limited root resorptions, affecting the ligament and the cementum. They are reversible and can repair spontaneously by cementum apposition.

Inflammatory resorptions

This type of resorption presents as an excavation in the cementum and dentin,

Replacement resorptions

Cementum and ligament destruction is replaced by newly formed bone tissue

Ankylosis;

it consists of a fusion of the dental root with the alveolar bone by disappearance of the ligament space

III- etiologies;

General

Hyperparathyroidism
Paget’s disease
Hypophosphatemia and hypocalcemia
Chronic renal failure

Local

1-Internal root resorptions; they can be due to

-traumas:
– orthodontic treatments
– pulp infection;
– the chemical agents used:
– for teeth whitening;
– milling of teeth;
– the use of exothermic setting material;

2-External root resorptions; they can be due to

-accidental trauma:
-occlusal trauma
– orthodontic treatments
-in endodontics; certain methods of compacting hot gutta create a rise in temperature which can lead to resorptions
– intraligamentary anesthesia
– an impacted tooth that erupts on a tooth already on the arch

IV- Pathophysiology

In the presence of irritation, there is the appearance of tissue inflammation characterized by the presence of chemical mediators (leukotriene, interleukin, etc.), these will stimulate the (osteoclasts, osteoclasts or odontoclasts) and a resorption of hard tissues may appear;

If the irritation is short-lived, healing may occur by the formation of hard tissue of the same structure as the destroyed hard tissue or of a similar structure

If irritation continues, osteoclastic activity also continues and can lead to irreversible resorptions.

V- Diagnosis

1-Internal root resorptions

A- Clinical examination

Positive vitality test
Tooth mobility
Pinkish coloration of the crown ( Pink Spot ) if the granuloma is coronal
Spontaneous pain if there is perforation of the root

B-Radiological examination

The discovery of root resorption is often fortuitous; it can be coronal or radicular (1/3 cervical, middle or apical)

inflammatory internal resorption ; these lesions develop inside the pulp chamber characterized by round or oval radiolucent images with clear boundaries centered on the canal and well separated from the periodontal ligament by a dentin plug
Internal replacement resorption: characterized by an asymmetrical pulp cavity with irregular edges; the resorption cavity is filled with radiopaque tissue less dense than dentin and similar to bone tissue
2-External root resorptions

external surface resorption; it is asymptomatic, characterized by a positive vitality test and mini-cavities invisible on the X-ray
External replacement resorption:
- asymptomatic tooth
- Normal percussion
- on the X-ray; replacement of root loss with bone tissue
Ankylosis;
- tooth is underbitten
- Metallic sound on percussion
- Mobility gradually decreases
- Disappearance of the desmodontal space
inflammatory external resorption;
- At an early stage the tooth is asymptomatic,
- In the event of progression, spontaneous pulp pain associated with mobility is sometimes observed.
- The radiograph reveals a radiolucent image of the cementum and dentin with irregular edges and the root canal remains straight.

VI- Treatment

1-Treatment of internal root resorption:

Lesion without root perforation
- Pulp removal and root canal debridement
- Placement of calcium hydroxide at the canal level
- Root canal filling
Lesion with canal perforation

If the perforation is above the bone crest, surgical intervention + filling of the cavity with a CVI or composite + endodontic treatment
If the perforation is below the crest:
- either filling the perforation with CaOH2 or MTA or BIODENTINE followed by a watertight root canal filling
- Either surgical intervention is filling of the cavity + endodontic treatment

2-Treatment of external root resorption:

Surface resorption
- Spontaneous healing
Replacement resorption and ankylosis
- Non-existent treatment
Inflammatory resorption
If the lesion is apical; root canal debridement + CaOH2 disinfection for 1 to 6 months, the use of MTA or biodentine is possible. Endodontic surgery is possible
If the lesion is lateral or cervical: the treatment is purely surgical by creating a flap + curettage of the lesion + filling of the cavity with CVI or BIODENTINE

VII- conclusion

It is important to remember that resorptions are progressive, often insidious, pathologies. It is therefore essential to identify and treat them quickly.

Some lesions are idiopathic, others are combined which makes the diagnosis more difficult and reduces the chances of survival of the tooth on the arch I- Definition: