Root Resorption

Dr. Marium Zaman

BDS FCPS
Professor and Head of the
Dept. of Operative Dentistry and Endodontics
 Root resorption
► It is defined as a condition which is
associated with either a physiologic or a
pathologic process that results in loss of
cementum or dentine of tooth root.

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 Classification
► I. External
► II. Internal
► III. Idiopathic

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 Stimuli for resorption
► Enzymes
► Oxygen tension
► Hormones
► Locally produced chemical mediators
► Electric currents

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 Protection against resorption
► The root is resistant to resorption both on its
internal as well as external surface, and generally
would not be resorbed in response to these
stimuli.
► Externally, it is protected by pre-dentine and
odontoblasts.
► Internally, it is protected by C.T. of PDL, the
outermost layer (cementoblasts, cementoid) and
the innermost intermediate layer of cementum.

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 Types of resorption
► Physiologic : shedding
► Pathologic : local, systemic
► 1. excessive orthodontic forces
► 2. impactions
► 3. tumors or cysts
► 4 .trauma
► 5. inflammation

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 Surface resorption
► During a luxation injury mechanical damage
to the cementum occurs and a local
inflammatory response and localized area of
root resorption occurs.
► Healing of PDL occurs along with root
surface repair within 14 days if no further
inflammatory stimulus is present.

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 Surface resorption contd.
► The resorptive lacunae
are asymptomatic.
► In most cases cannot
be visualized on
radiographs.

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 Dentoalveolar ankylosis and
replacement resorption
► Ifthe trauma to root surface is extensive
(e.g.,intrusive luxation) involving more than
20% of the root surface, an abnormal
attachment can occur after healing.
► As the root surface becomes devoid of cells,
cells that are precursors of bone move
across the socket wall to repopulate the
damaged root.

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 Replacement resorption contd.
► Therefore, bone comes in direct contact
with the damaged root surface without
intermediate PDL.This phenomenon is called
DENTOALVEOLAR ANKYLOSIS.
► The osteoclasts in contact with the root
resorb dentins as if were bone which is then
replaced by bone. This progressive
replacement is of root with bone is termed
REPLACEMENT RESORPTION.
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 Replacement resorption

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 Replacement Resorption

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 Replacement Resorption

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 Replacement resorption contd.
► Histologically,
the condition is characterized
by absence of PDL and cemental layer
between root dentine and bone.
► Radiographically, the distinction between
the root and surrounding bone is lost and a
moth eaten appearance results.

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 Replacement resorption contd.
► Clinically,
lack of mobility of the tooth and a
metallic sound to percussion is
characteristic, as is infraocclusion in the
developing occlusion.
► Ultimately the tooth is lost because of loss
of root support.

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 Inflammatory root resorption
► After apical periodontitis or trauma, portions
of the cemental covering of the root are
damaged and protective quality is lost.
► If the pulp is infected, the bacterial toxins
may pass into the dentinal tubules and
excite an inflammatory response in the PDL.
The result will be resorption of the root and
bone.

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 Inflammatory Root Resorption

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 Inflammatory root resorption
► Multinucleate giant cells continue to resorb
the denuded root surface until the stimulus
(pulp canal bacteria) is removed.
► Radiographically, it is observed as
progressively forming radiolucent areas of
the root and adjacent bone.

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 Cervical root resorption
► Cervical root resorption is a progressive root
resorption of inflammatory origin usually
occuring immediately below the epithelial
attachment of the tooth.
► The cause is unprotected or altered root
surface attracting resorbing cells and an
inflammatory response maintained by
infection.

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 Cervical resorption

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 Cervical root resorption contd.
► It can occur long after orthodontic
treatment, orthognathic surgery, periodontal
treatment, nonvital bleaching, or trauma.
► THE PULP PLAYS NO ROLE IN IN CERVICAL
ROOT RESORPTION AND IS USUALLY
NORMAL IN THESE CASES.

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 Cervical root resorption contd.
► The pathogenesis is not fully understood.
► It is postulated that source of stimulation is
the bacteria in the tooth sulcus.
► Clinically, it is asymptomatic.
► It is often detected during routine
radiographs.
► Pulp is not involved usually and vitality tests
are normal.

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 Cervical resorption contd.
► Ifdue to an extensive resorptive defect the
pulp becomes exposed, abnormal sensitivity
to thermal stimuli occurs.
► In long standing cases, granulation tissue
may be seen undermining enamel giving it a
pinkish appearance.
► This may be confused with internal
resorption.
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 Cervical resorption contd.
► Radiographic appearance varies.the resorptive site
may give a mottled appearance.
► It is usually possible to trace the outline of pulp
canal through the radiolucency of resorptive
defect.
► Histologically, it resembles that of chronic
inflammation with attempts at repair by
cementum-like and bone-like material.

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 Internal root resorption
► Rare in permanent teeth.
► It is characterized by an oval shaped
enlargement of the root canal space.
► External resorption, which is much more
common, is often misdiagnosed as internal
resorption.
► The internal aspect of the root is resorbed
by multinucleated giant cells adjacent to
granulation tissue in the pulp.
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 Internal resorption

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 Internal resorption

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 Internal resorption contd.
► Trauma may be an initiating factor in
internal resorption.
► It is usually asymptomatic.
► Pain occurs only if the crown is perforated.
► For internal resorption to occur atleast part
of the pulp should be vital.
► Pulp vitality test gives a positive response.

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 Internal resorption contd.
► Coronal portion of the pulp is often necrotic,
whereas, the apical pulp can remain vital.
► The pink colour is caused by granulation
tissue in the coronal dentine undermining
the crown enamel.
► Radiographically, there is a uniform
radiolucent enlargement of the pulp canal.

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 Internal resorption contd.
► Histologic picture shows granulation tissue
with multinucleated giant cells. An area of
necrotic pulp tissue is seen coronal to the
granulation tissue.

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 External versus internal
resorption
► External ► Internal
► Defect on the external ► Lesion appears close
aspect of the root moves
to the canal regardless
away from the canal as
the angulation changes. of the angle of
► Root canal outline appears radiograph exposure.
normal. ► Root canal outline
► Defects seen in root and appears distorted.
bone. ► The resorptive defect
is confined to root.

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 Contd.
► Involves an infected ► +ve response to
root canal space, -ve sensitivity occurs
response to pulp because occurs in vital
vitality (except pulps.
cervical). ► Pink spot is a possible
► Pink spot absent in sign.
apical and lateral,
present in cervical.

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 Idiopathic resorption
► In some cases of external resorption neither
a local cause nor systemic cause can be
found. The root apices may be rounded and
the teeth shorter than normal with several
teeth affected.
► Another variety occurs which is more
aggressive and affects the cervical aspect of
the root.

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 Idiopathic resorption

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 Idiopathic resorption

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