Root resorption /certified fixed orthodontic courses by Indian dental academy


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Root resorption /certified fixed orthodontic courses by Indian dental academy

  1. 1. ROOT RESORPTION INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3.  Root resorption is a physiologic or pathologic process occuring as a result of changes seen in the tooth or surrounding periradicular tissues characterized by loss of tooth structure over the root surface.  External apical root resorption ( EARR ) of permanent teeth is uncommon but a frequent sequelae to orthodontic tooth movement.
  4. 4. CLASSIFICATION OF ROOT RESORPTION •ACCORDING TO TYPE Physiologic root resorption occurring on deciduous teeth during eruption of permanent teeth Pathologic root resorption occurring on permanent roots •ACCORDING TO LOCATION Internal root resorption External root resorption
  5. 5. •ACCORDING TO SEVERITY Surface resorption occurs commonly periapically as microdefects on the root surface and stops when the instigating agent is removed and there is repair of cementum. Inflammatory resorption Occurs when root resorption progresses into the dentinal tubules to reach the pulpal tissue. Replacement resorption Produces ankylosis of a tooth because bone replaces the resorbed bone substance.
  6. 6. CLASSIFICATION OF ORTHODONTICALLY INDUCED ROOT RESORPTION According Brezniak and Wasserstein (AJO-DO 1993) Cemental or surface resorption with remodeling  Dentinal resorption with repair (deep resorption)  Circumferential apical root resorption. 
  7. 7. Cemental or surface resorption with remodeling: In this process, only the outer cemental layers are resorbed, and they are later fully regenerated or remodeled. This process resembles trabecular bone remodeling. Dentinal resorption with repair (deep resorption) In this process, the cementum and the outer layers of the dentin are resorbed and usually repaired with cementum material. The final shape of the root after this resorption and formation process may or may not be identical to the original form. Circumferential apical root resorption. In this process, full resorption of the hard tissue components of the root apex occurs, and root shortening is evident. Different degrees of apical root shortening are, of course, possible.
  8. 8. ETIOLOGY Root resorption may occur as a result of : •Dental trauma / surgical procedures / Infections •Orthodontic treatment •Pressure from tumors / cysts •Irritation from chemicals ( Eg. H2O2 during bleaching)
  9. 9. ROOT RESORPTION DUE TO PULPAL INFECTION: Injury to the precementum or predentin, infected dentinal tubules may stimulate the inflammatory process with osteoclastic activity in the periradicular tissues or in pulpal tissues, consequently initiating external or internal root resorption. ROOT RESORPTION DUE TO PERIODONTAL INFECTION : Infrequently, external root resorption may occur after injury to the pre-cementum, apical to the epithelial attachment, followed by bacterial stimulation originating from the periodontal sulcus.
  10. 10. ROOT RESORPTION DUE TO IMPACTED TOOTH , TUMOR PRESSURE : Pressure root resorption can be observed during the eruption of the permanent dentition, especially of maxillary canines ( affecting lateral incisors ) and mandibular third molar ( affecting madiubular second molars ). Tumors and osteosclerosis impingning on the root of the tooth could also be an etiological factor for pressure resorption ANKYLOTIC ROOT RESORPTION In severe traumatic injuries ( intrusive luxation or avulsion with extended dry time ), injury to the root surface may be so large that the healing with cementum is not possible, and one may come into contact with the root surface without an intermediate attachment apparatus. This phenomena is termed dentoalveolar ankylosis.
  11. 11. ROOT RESORPTION DUE TO ORTHODONTIC PRESSURE The injury originating in the orthodontic root resorption is from the pressure applied to the roots during tooth movement. Continuous pressure stimulates the resorbing cells in the apical third of the roots, a possibility of significant shortening of the root. Teeth are asymptomatic and the pulp is usually vital unless the pressure of the operative procedure is high, which disturbs the apical blood supply.
  12. 12. GENETIC PREDISPOSITION TO EXTERNAL APICAL ROOT RESORPTION IN ORTHODONTIC PATIENTS J Dent Res 82(5): 356-360, 2003 The linkage results for D18S64, which lies close to the candidate gene TNFRSF11A, provide suggestive evidence that this locus, or a closely linked one, contributes to the genetic component of root resorption and the strength of this linkage, make TNFRSF11A a candidate gene for further study
  13. 13. BIOLOGY OF ROOT RESORPTION Orthodontic force Compression of PDL Removal of hyaline material Removal of superficial surface of cementum Root resorption Hyalinization & inflammation Activation of osteoclasts
  14. 14. THE REPAIR PROCESS Morphologically, the repair process of the resorbed lacunae is described as beginning from the periphery, the bottom, or all directions. It begins about two weeks after force removal, with the placement of acellular cementum succeeded by cellular cementum. This process is evident in 38% and 82% of human premolar lacunae after two and five weeks, respectively.
  15. 15. QUANTIFICATION OF ROOT RESORPTION : Broadly, two methods have been used to quantify resorption : ORDINAL SCALE DATA : Visually assessed grades of resorption assigned RATIO SCALE DATA: Measurements with calipers or some computer aided device
  16. 16. THE ORDINAL SCALE USED TO MEASURE ROOT RESORPTION BY LEVANDER E. & MALMGREN GRADE 2 GRADE I0 GRADE 3 GRADE 4 of of Evidence ooOne-fourth Scalloping Normal erosion and blunting Intact root the of atleast oLoss root periapically of apex morphology resorbed one-half the originallength oRoot length Apical outline probably and is smoothnot yet affected continuous oDistance between the root and lamina dura is uniform
  17. 17. CONTEMPORARY REVIEW OF ETIOLOGICAL FACTORS ASSOCIATED WITH ROOT RESORPTION Janson et al reported a higher resorption potential for class II div 2 cases in comparison with class I , class II div I and class III patients. Among all the extraction patterns, extraction of all the first premolars showed the greatest resorption potential. McNab et al has reported a higher incidence of resorption, as well as amount of root resorption in patients treated with the Begg appliance as compared to the Edgewise technique.
  18. 18. TYPE OF TOOTH MOVEMENT Intrusion and torque movements are found to be most commonly associated with the resorption process. TYPE OF FORCE Interrupted forces were shown according to studies to cause less severe apical blunting and smaller resorption- affected areas.
  19. 19. ROOT SHAPE AND LENGTH Among differently shaped root ends, the least resorption was observed in blunted root ends and the greatest was seen in pointed or tapered root ends. Longer roots are more prone than shorter ones to resorption, due to the greater displacement required to produce an equal amount of torque, versus shorter roots.
  20. 20. EFFECT OF DRUGS •Drugs such as corticosteroids and alcohol have been identified as predisposing factors. • An increased risk for root resorption among asthamatic patients was also recently reported by Mc Nab et al •The changes they observed were attributed to changes in the immune system of patients
  21. 21. MANAGEMENT  A review of literature supports a temporary halt in orthodontic treatment for a period of 4 – 6 months. The resorptive process ceases and the reparative process starts within this period. Drugs such as bisphosphonates, NSAIDs, various hormones and cytokines including prostaglandin E2 and L-thyroxine etc have been tried and tested to little clinical success.
  22. 22. CONCLUSION External apical root resorption is an iatrogenic consequence of orthodontic treatment. Keeping this in mind, we as orthodontists should take all known measures to reduce its occurrence
  23. 23.