External root resorption

External root resorption

External resorption is the loss of tooth structure from the external
surface of the tooth by the action of osteoclast.

Classifications
1. External surface resorption
2. External cervical resorption
3. External replacement resorption
4. External inflammatory resorption
External surface resorption

• Is a self-limiting resorption that is transient.

• Small, superficial resorption cavities in the cementum and the
outermost layers of the dentin without an inflammatory reaction in the
PDL.

Caused
• traumatic injuries or orthodontic treatment

Treatment
• Primarily periodontal injury – endodontic intervention not indicated.
• If trauma/pressure eliminated – almost 100% repair
External cervical resorption

Cause
dental trauma, orthodontic treatment, intracoronal bleaching and idiopathic
origin
Heithersay et al – studied 259 teeth with invasive cervical resorption –
23% : related to orthodontic treatment
15% : acute trauma

Clinical Findings
Expanding lesion- show as a “pink spot” next to cervical margin

Radiographic Findings
Cervical bowl-shaped lesion is the start of invasive progression of resorption in
coronal & apical direction.

TREATMENT
When invasive nature finally encroaches pulp - need endodontic treatment
Essentially, treatment involves complete removal of the resorptive tissue and
restoring with a tooth-coloured restoration or Mineral Trioxide Aggregate (MTA).
xternal replacement (Ankylotic) resorption
This is the process of replacement of root surface with
bone otherwise known as ankylosis.

Causes
มักเกิดในฟันทีร่ ับอุบต
ั เิ หตุ เช่น Avulsion, Intrusion ทำให ้เซลล ์ที่
ซ่อมแซมเป็ นกำรสร ้ำงกระดูกแทนกำรสร ้ำงเคลือบรำกฟัน

Clinical Findings
ฟันจะมีลก
ั ษณะติดกับเบ ้ำ ไม่มก
ี ำรโยกเล็กน้อยเหมือนปกติ เคำะจะมี
ลักษณะ metallic sound

Radiographic Findings
จะมีกำรขำดหำยของ lamina dura และ PDS โดยไม่พบเงำโปร่งร ังสี
บริเวณรำกฟันกับกระดูก
Treatment
• Decoronation คือกำรตัดตัวฟันทีเกิ ่ ด ankylosis ออกแล ้วเหลือ
่
ส่วนรำกเอำไว ้ ซึงรำกฟั ่ งไว
นทีทิ ้ ้จะช่วยร ักษำควำมหนำและควำมสูง
ของกระดูกเบ ้ำฟัน
External inflammatory resorption
Causes
• Necrotic pulp
• Bacteria primarily located in pulp & dentinal tubules
trigger osteoclastic activity resulting in both tooth and
bone resorption
• Resorption can affect all parts of root
• Diagnosed 2-4 weeks after injury.
• Resorption rapidly progress – total root resorption within
few months.
• Most common after avulsion and luxation injuries
Clinical Findings
• Increased mobility
• Dull percussion tone (Tender to percussion and palpation)
• Sometimes tooth extruded
• Negative EPT and thermal testing
Radiographic Findings
• Radiolucency on the external root surface and adjacent
bone.
• Extensive root resorption if lesion is long standing in origin
Treatment
• Non-surgical root canal treatment is indicated - to remove