Natalie So ‘19

PBL 3.1

Root Resorption Theme-based

Osteoclast: Ruffled border, multi-nuclei

Does not resorb a healthy tooth ->
 Inflammation -> resorb the bone but not the tooth
o Signals in the tooth to prevent osteoclast from resorbing the tooth
 Cellular cementum
 Predentine layer (cells inside the pulp)
 Root surface debridement
o If scraped away cementum, dentine still will not be resorbed
o Junctional epithelium will attach on that area and protect the hard tissue
Root resorption:
 Can occur within or outside root canal
 Situation that can cause resorption:
o Avulsion
 Longest: 1 hour dry time (a lot would have died)
 Replantation
 Wound healing by primary intention (clean wound, close together; takes about a week or ten
days)
 At the site where periodontal ligament
o (Hemostasis -> acute inflammation (vascular response) -> osteoclast
activated)
 Secondary intention
 Resorption can be transient or long-term (when inflammation sustain)
 Easily infected
 Bacteria inside and metabolite travelled outside through dentinal tubes
 Sustain inflammation/resorption
 Internal resorption
o Always inflammatory
o Bacteria can jump from dentinal tubule to tubule
 Travel into the
o Necrotic pulp don’t have internal resorption because there is no blood supply
 External resorption
o Inflammatory resorption
 To differentiate whether it is internal/ external resorption
o Use parallex technique
o External resorption
 Even it is buccal/ lingual positioned resorption -> can still see the faint outline of root canal
o Internal resorption -> bulge of radiolucency inside canal
 Cervical resorption
o Named by position
o With unknown etiology
o Predisposed by developmental
o At the CEJ
o Cementum and enamel do not join together
 More likely to have cervical resorption
o Resorption usually in incisors (more common in lower)
o Idiopathic, excessive (affects several teeth)
o No treatment available, cannot be restored
o Even after surgical approach (open up the flap) -> it will still reoccur
 Replacement resorption
o Replaced by bone or osteocyte tissue at the woven bone structure
 Natalie So ‘19

 Ankylosis
o When there is direct union of the tooth and and the epithelium

 Natural space maintainer
 T(x)
o Internal:
o External: Start off with steroid treatment -> slow down resorptive process; then use antibiotics to
control inflammation
 Calcium hydroxide put inside for too long will encourage ankylosis
 Steroid: Ledermix (mixture of steroid and antibiotics but steroid is the main active ingredient)
-> slow down inflammation
 Dress inside the canal (1 week) then dress with calcium hydroxide

1. Idiopathic external cervical resorption

2. External replacement resorption
3. Internal resorption
4. External inflammatory resorption

Splinting
 If tooth too mobile -> bacteria will go down and affect healing
 Relatively easy in avulsion cases -> because involve the healing for soft tissue and only need to stay in place
for one week
o Some mobility is needed -> to encourage the function of PDL
o Held too rigid in place -> for too long -> cause ankylosis
 Held by wire or composite -> join to the neighbor tooth (which is a bit mobile)
 Horizontal root fracture
o Splint rigidly for 6 weeks

T2 Notes:
 Stimulating factors: Prostaglandins
 Not necessarily all avulsion will lead to necrotic pulp (Young, open apex -> high success of vitality ->
revascularize)
 Condyle -> endrochonal ossification
o Need to know type of ossification: for reconstruction surgery, bone donation
o Same ossification/ origin -> slower resorption rate
 Mylohyoid line [Important]
o Separate sublingual and submandibular space
o Age relation: bone resorption due to no more tensile strength from periodontal ligament; denture on
edentulous ridge -> increase rate of resorption; shorter mandibile (ridge)
 Mylohyoid ridge in elderly patient, no longer a line but a sharp edged ridge on the inside of
mandible because of the muscle attachment and use -> pulled by muscles and become
prominent over time
 Mental eminence, genial tubercle also similar
o Mylohyoid muscles Anterior fibers: Median raphe
o Posterior fibers: hyoid bone (Impression Key Skill)
 Disuse atrophy
o No exercise -> muscles will gone
 Retromolar pad
o More against resorption, where RPD should rest on
 Anterior retromolar pad hard, Posterior soft
 So RPD should rest onto the anterior part
 Due to muscles attachment, tension -> bone deposition

3 consequences of replantation
 Surface resorption
 Natalie So ‘19

 External inflammatory resorption

 Replacement resorption

Tetanous booster?
Antibiotics apply ???? Dose? (Heinok)
Prevention: Mouth guards
Flexible splinting for prevention of ankylosis

Cysts and granuloma and abscess

Cannot be distringuished in radiograph
Large -> cyst;
Abscess should have fluctuant

Relating to PBL Case:

 Shouldn’t be due to lost of cementum -> cementum hard; should be lost of PDL
 Long standing and untreated -> periapical cyst/ abscess -> may recur or spread to fascial space -> cellulitis ->
Cavernous sinus likely -> life threatening
 Surface external resorption: small amount of underlying dentine
 Mesial -> replacement resorption; Distal-> inflammatory
 Compression: resorption of bone; Tensile strength: deposition

Journal:
 Fig 7: should be from buccal/ lingual, depends on the projection of xray
 Predentine should be less