RESORPTION OF TEETH

ROSHAN TOM THOMAS

THIRD YEAR
CONTENTS…
Resorption of teeth: It is a chronic progressive damage
or loss of tooth structure due to the action of cells called
odontoclast.

– It can be physiological as in case of resorption of deciduous teeth

or pathological which occurs in permanent teeth.
– Pathological resorption may be external or internal.
 EXTERNAL RESORPTION
-It may be initiated in the periodontium and affect initially
the external surface of tooth.
-Most common type of resorption.
 Etiology
External Resorption:
– ¤ Periapical inflammation
– ¤ Reimplantation of teeth
– ¤ Tumor & Cyst
– ¤ Excessive occlusal forces
– ¤ Impaction of teeth ¤ Idiopathic
1.Resorption associated with
periapical infection
– Eg; Periapical granuloma – causes subsequent resorption of root apex
– Resorption of calcified dental tissues occurs in the same fashion as that of
bone.
– Osteoclasts are an outstanding feature in the areas of active resorption.
– A periapical granuloma arising as a result of pulpal infection or trauma
causes resorption of the root apex if the inflammation persist for a sufficient
period of time.
– On radiograph it may appear as a slight raggedness or blunting of the root
apex
– Bone resorption occurs most commonly in highly vascular areas than
relatively less vascular areas.
– In a tooth that has had root canal treated and filled…but around
which periapical inflammation persist, resorption of root occurs
and ultimately leave only the root canal filling projecting out of the
shortened root.
– The radiograph of this case presents an unusual appearance and
overfilling of root canal.
2.Reimplanted Teeth
– The reimplantation or transplantation of teeth results in severe
resorption of the root.
– The tooth root is resorbed and replaced by bone producing an
Ankylosis.
– If the tooth root does not become completely resorbed the
ankylosis may result in functional tooth.
– Many reimplanted teeth shows complete resorption of the root
and are exfoliated.
3.Tumors & Cysts
– Both Benign & Malignant tumor may cause root resorption.
– Benign lesions are more likely to produce displacement of tooth than actual
destruction of the tooth.
– Cysts causes resorption in a manner similar to resorption caused by Benign
tumors.
– Eg: An apical periodontal cyst arising as a result of pulpal infection may exert
pressure on the apex of the involved/adjacent tooth, the intervening connective
tissue may inturn stimulates osteoclasts formation, thus resorption begins.
4. Excessive Mechanical or
Occlusal Forces

– Patients who have undergone orthodontic treatment frequently exhibit

multiple areas of root resorption.

– The resorption is irrespective of the manner of treatment i.e. the type

of appliance o the duration and degree of force exerted.

– Bone undergoes resorption far more readily than cementum when force
is exerted upon the tooth by orthodontic appliances.
5.Impacted Teeth
– Teeth that are completely Impacted or Embedded in bone
occasionally will undergo resorption of the crown or of crown &
root .
– The radiographic picture presented by these teeth is an unusual
one.
– Impacted teeth also may cause resorption of the roots of adjacent
teeth without itself getting resorbed.
 6.Idiopathic Resorption
– The term “idiopathic root resorption” has been applied to the resorption that
occurs without any obvious cause.
– The etiology is unknown
– The resorption may be related to one or more systemic disoders.
– May be due to endocrine/genetic disturbances.
– Teeth most commonly involved are maxillary bicuspids , mandibular incisors
and molars.
 Invasive cervical resorption
– External resorption may begin in cervical area and extend from a small opening
to involve a large area of dentin between the cementum and the pulp.
– This resorption can extend apically in to the pulp or coronally under the enamel
and may simulate the pink tooth in internal resorption.
– Cervical pattern of resorption is often more rapid, hence termed invasive
cervical resorption.
– In Some instances several tooth may get involved and called multiple idiopathic
root resorption.
– It may result from a variety of inflammatory, traumatic or bacterial stimuli
affecting the clastic cells within the PDL.
 Clinical features
– The affected tooth is usually asymptomatic.
– The most frequent sites include: upper incisors, upper and lower bicuspids.
– When the root is completely resorbed, the tooth may become mobile.
– If root resorption is followed by ankylosis then the tooth is immobile in
infraocclusion and there will be high percussion sound.
 Histopatholgy
– Numerous multinucleated dentinoclast seen at the areas of structure loss.
– Areas of resorption often repaired through deposition of osteodentin.
– Deposition of inflammed granulation tissue, replacement by woven bone also
seen.
 Radiographic features
– “Moth eaten” loss of tooth structure.
– Radiolucency is less well defined and demonstrates variation in density.
Management
– Identification and elimination of accelerating factor.
– Remove bacterial stimulation from dentinal tubules using calcium hydroxide.
– Cervical resorption can be treated by means of surgical approach , removal of
all soft tissue from the defect,and restoration of lost tooth structure.
 INTERNAL RESORPTION

– Unusual form of resorption.

– It is a condition starting in the pulp, in which the pulp chamber or the root
canals or both, of the tooth expand by resorption of the surrounding dentin.
– 2TYPES:
Internal inflammatory resorption :
– Due to intense inflammatory reaction within pulp.
– Cervical portion of tooth is affected mostly.
Internal replacement/metaplastic resorption: portions of pulpal dentinal walls
are resorbed and replaced with bone or cementum like bone.
Etiology
– Inflammatory hyperplasia of the pulp
– Direct and indirect pulp capping
– Pulpotomy
– Enamel invagination
– Acute trauma to teeth
– Pulp polyp
Mechanism
Vascular Inflammation and
Precipitating factors changes production of
in pulp granulation tissue

Metaplasia of
connective tissue Odontoclast Resorption of
and macrophages appears internal wall of pulp
 Clinical features
– Appearance : pink hued area on the crown of the tooth, which represents
hyperplastic pulp tissue filling the resorbed area and showing through the
remaining overlying tooth substance.
– location: it may affect any tooth in primary and secondary dentition, with
prevalence in permanent dentition, more common in central incisors, laterals,
premolar and canine and third molar according decreasing frequent.
– Age and sex distribution: occurs during fourth and fifth decades of life. More
common in males.
– Symptoms: asymptomatic.
Pink tooth of mummery
– Tooth manifests a reddish area called the “pink spot”
– This reddish area represents granulation tissue showing through the resorbed
area of crown.
Sign
– When lesion is present in the crown it may expand by showing a dark shadow
due to necrosis of pulpal tissue
– If resorption is in the root it may weaken the tooth and results in its fracture
 Radiographic features
Internal inflammatory resorption:
– Round or ovoid radiolucent area in the central portion of the tooth which is
associated with the pulp.
– Uniform well circumscribed symmetric radiolucent enlargement of the pulp
chamber or canal.
– Balloon like dilation of root canal.

Internal replacement resorption:

– Appears as an enlargement of canal, which is filled with a material which is less
radiodense than the surrounding dentin.
– Central zone of pulp replaced with bone.
– Partial obliteration of canal often seen.
 Histological features
In internal inflammatory resorption, the pulp tissue in the area of
destruction is vascular and exhibits increased cellularity and
collagenization.
– Presence of multinucleated dentinoclast.
– Resorption of inner surface of dentin.
– Presence of inflammatory infiltrate.
– Proliferation of pulpal tissue seen.
– It may show occasional osteoclasts or odontoclasts hence called
odontoclastoma.
– Pulp tissue exhibits chronic inflammatory reaction .
– Alternating periods of resorption and repair manifested as
irregular lacunae like areas in dentin that may partially or
completely filled with irregular dentin or osteodentin.
In replacement resorption the normal pulp replaced by woven bone
that fuses with the adjacent dentin.
Management

– Removal of soft tissues from the site of dental destruction.

– Extirpation of pulp with routine endodontic treatment or retrograde filling.
– If perforation occurs initial placement of calcium hydroxide paste may result in
remineralisation of the site of perforation and stop the resorptive process.
– Extraction often is necessary for radicular perforations that do not respond to
therapy.
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