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 www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. Root resorption. Part 1 - Brezniak and Wasserstein -AJO-DO 1993 Jan Andreasen defines three external root resorption types: Surface Resorption 2. Inflammatory Resorption 3. Replacement Resorption 1. www.indiandentalacademy.com
    3. 3. 1) Surface resorption -Self-limiting process, involving small outlining areas followed by spontaneous repair. -Stimulation is minimal and for a short period. -This defect is usually undetected radiographically and is repaired by a cementum-like tissue. -Commonly seen after orthodontic treatment is surface resorption. www.indiandentalacademy.com
    4. 4. 2)Inflammatory resorption  Where initial root resorption has reached dentinal tubules of an infected necrotic pulpal tissue or an infected leukocyte zone.  Transient inflamatory resorption-common after Rx  Progressive inflammatory resorption. When stimulation is for a long period . www.indiandentalacademy.com
    5. 5. 3) Replacement resorption, Bone replaces the resorbed tooth material that leads to ankylosis -rarely seen after orthodontic treatment. www.indiandentalacademy.com
    6. 6. PROFITT- Three external root resorption types:  1) Moderate Generalized-long Rx duration  2) Severe Generalized – -evidence of resorption before Rx -thyroid harmone -etiology???  3) Severe Localized-may be caused due to ortho Rx-cortical plates www.indiandentalacademy.com
    7. 7. IMPORTANT CONSIDERATIONS  Cementum is more resistant to resorption compared with bone. However, resorption of the cementum and dentin may also occur.  Breach in the formative cell layer covering the tissue, or when the precementum is mechanically damaged  Denuded root areas attract hard tissue resorbing cells . www.indiandentalacademy.com
    8. 8. IMPORTANT CONSIDERATIONS  The cementoclast- demineralization of the calcified tissue and degradation of the organic matrix after demineralization  Resorbing activity-characterized by synthesizing prostaglandin E with concomitant increase in cAMP. This process is regulated by hormones (parathyroid, and calcitonin). www.indiandentalacademy.com
    9. 9. IMPORTANT CONSIDERATIONS  Relates surface resistance to the innermost cellular layer of the periodontal ligament. This layer supplies the protective mechanism to the root, as well as the potential for a repair.  The cementoblasts, fibroblasts, osteoblasts, endothelial, and perivascular cells are included in this layer www.indiandentalacademy.com
    10. 10. IMPORTANT CONSIDERATIONS  occurs even in teeth where deposition of mineralized material was prevented.  May be resorbed directly or indirectly. Indirect resorption is seen as undermining resorption— from howship lacunae of the dentin.  Resorbed lacunae -mainly on the pressure side.  After it can take between 10 and 35 days for resorbed lacunae to appear on application of force. www.indiandentalacademy.com
    11. 11. IMPORTANT CONSIDERATIONS   According to Schwartz when pressure decreases below the optimal force (20 to 26 g/cm2) root resorption ceases. Reitan and Rygh are in agreement that cementoid fills those resorbed lacunae. Repair of resorbed lacunae is seen after 35 to 70 days of force application. www.indiandentalacademy.com
    12. 12. Root resorption during orthodontic therapy(Edward F. Harris- Seminars in orthodontics:2000)  Albert ketcham- 1st to notice  Orthodontically induced resorption occurs adjacent to the hyalinized zone and occurs during and after the elimination of the hyaline tissues.  Removal of hyalinized tissue leaves raw surface exposed to the dentinoclasts. www.indiandentalacademy.com
    13. 13. Prevalence Rudolph noted the resorption typically attacks the root tip and travels coronally leading to the “shed roof” effect.  Incisors-move the most / single-root spindly cone shape. Single rooted.  Acellular/ cellular cementum:more at the apex where there is cellular cementum.  Teeth with thick cementum – less. www.indiandentalacademy.com
    14. 14. Measurement Method  EARR-defined operationally as the degree a root has shortened from its original length by clastic activity.  Methods used to quantify resorption-visually assesed –calipers -light /electron microscopy -capture image with scanner or import image from digital x ray machine and make measurement on a software.  IOPAs using long cone technique. www.indiandentalacademy.com
    15. 15. www.indiandentalacademy.com
    16. 16.  Dermaut and De Munck.  CrownA x RootB/RootA x CrownB = RootB/RootA A and B are two examinations, such as pre treatment and post treatment.  Similar ratios – Linge n Linge, Nanda and Costapoulos. www.indiandentalacademy.com
    17. 17.  Cells involved- odontoclast- multinucleated cell formed by monocyte precursors-local tissue contribution??? www.indiandentalacademy.com
    18. 18. Root resorption after treatment Part 2 - Brezniak and Wasserstein -AJO-DO 1993 Feb (138-146): FACTORS AFFECTING RESORPTION  1. 2. 3.  Biologic factors Metabolic signals that generate changes in the relationship between osteoblastic and osteoclastic activity include Hormones Body type Metabolic rate. Genetics no definite genetic conclusion.( Heritability estimate of 70% - Edwards article- Clinical significancesearch for biochemical markers ). www.indiandentalacademy.com
    19. 19. FACTORS AFFECTING RESORPTION  Systemic factors. endocrine problems including hypothyroidism, hypopituitarism, hyperpituitarism -hormonal imbalance does not cause but influences the phenomenon.  secondary hyperparathyroidism is not primarily responsible for increased root resorption-recent study.  Study - parathyroid hormone plays a major role in bone metabolism. www.indiandentalacademy.com
    20. 20. FACTORS AFFECTING RESORPTION    Calcium ions are reputed to play an important role in mediating the effects of external stimuli (force, hormones) on their target cells. Nutrition.Becks demonstrated root resorption in animals deprived of dietary calcium and vitamin D. It was later suggested -not a major factor -Controversial results. Chronologic age. All tissues involved in the root resorption process show changes with age. www.indiandentalacademy.com
    21. 21. FACTORS AFFECTING RESORPTION  The periodontal membrane becomes less vascular, aplastic, and narrow, the bone more dense, avascular, and aplastic, and the cementum wider. (woods et al and bishara carried out independent studies to find out the relation bw age and root resorption and found none-Edwards Article).  Gender. No correlation between gender and root resorption www.indiandentalacademy.com
    22. 22. FACTORS AFFECTING RESORPTION  Ortho treatment - Study reports that the incidence of root resorption increased from 4% before orthodontic treatment to 77% after treatment.  Habits. Nail-biting, tongue thrust associated with open bite, and increased tongue pressure (finger sucking-Edwards article). Tooth structure. Deviating root form is more susceptible to postorthodontic root resorption.  www.indiandentalacademy.com
    23. 23. FACTORS AFFECTING RESORPTION   Convergent apical root canal is considered to be an indicative of high root resorption potential.85 The degree Root resorption in teeth with blunt- or pipetteshaped roots was significantly higher than in teeth with normal root form - most susceptible root form to root resorption. www.indiandentalacademy.com
    24. 24. (Levander and malmgren –assessment of ot form-add picture www.indiandentalacademy.com
    25. 25. FACTORS AFFECTING RESORPTION   Previously traumatized teeth. Traumatized teeth can exhibit external root resorption without orthodontic treatment. Orthodontically moved traumatized teeth with previous root resorption are more sensitive to further loss of root material.The average root loss for www.indiandentalacademy.com
    26. 26. FACTORS AFFECTING RESORPTION  Trauma patients after orthodontic therapy was 1.07 mm compared with 0.64 mm for untraumatized teeth.  Endodontically treated teeth. A higher frequency and severity of root resorption of endodontically treated teeth during orthodontic treatment was reported – ???? endodontically treated teeth are more resistant to root resorption because of an increased dentin hardness and density. www.indiandentalacademy.com
    27. 27. FACTORS AFFECTING RESORPTION  More dense the alveolar bone, the more root resorption occurred during orthodontic treatment.  Number of which increases according to the number of marrow spaces. controversial result.  Maxillary teeth are more sensitive than mandibular teeth -maxillary incisors probably due to the distance. www.indiandentalacademy.com
    28. 28. FACTORS AFFECTING RESORPTION   Root structure and relationship to bone and periodontal membrane tend to transfer the forces mainly to the apex . The most frequently affected teeth, according to severity, are the maxillary laterals, maxillary centrals, mandibular incisors, distal root of mandibular first molars, mandibular second premolars, and maxillary second premolars. www.indiandentalacademy.com
    29. 29. Mechanical factors  Appliances. 1)Fixed versus removable:fixed appliances is more detrimental to the roots .  Ketcham claimed that normal function is disturbed by the splinting effect of orthodontic fixed appliances over a long period that can cause root resorption.  Stuteville, on the other hand, suggested that the jiggling forces caused by removable appliances are more harmful to the roots. www.indiandentalacademy.com
    30. 30. Mechanical factors  2)Begg versus edgewise: It is often stated that the light wire Begg technique causes less root resorption than edgewise, although maxillary incisor root resorption during the Begg third stage has been documented.  3) Magnets: It is suggested that the increase in force as space closes with time (attraction) can stimulate a more physiologic tissue response, and thus decrease the potential for root resorption. www.indiandentalacademy.com
    31. 31. Mechanical factors  4)Intermaxillary elastics: Linge and Linge found significantly more root resorption on the side where elastics were used  5) Extraction versus nonextraction: McFadden and Vonder found no difference  6) Other appliances:Rapid maxillary expansion, with cervical traction, has been reported to cause severe root resorption of the first maxillary molars. www.indiandentalacademy.com
    32. 32. Mechanical factors  Orthodontic movement type.. Intrusion is probably the most detrimental to the roots involved. Bodily movement should be less than that of tipping.  Orthodontic force-higher stress causes more root resorption The extent of tooth movement: Root resorption is directly related to the distance moved by the roots. www.indiandentalacademy.com
    33. 33. Combined biologic and mechanical factors  Treatment duration. Most studies report that the severity of root resorption is directly related to treatment duration.  Relapse. Teeth are prone to additional root loss during relapse as a result of light muscles forces  Occlusal force -Heavy mastication, occlusal trauma. www.indiandentalacademy.com
    34. 34. Other considerations  Loss of crestal bone and tooth stability.  3 mm of root resorption is approximately equivalent to 1 mm of crestal bone loss. www.indiandentalacademy.com
    35. 35. Clinical considerations related to root resorption  1. Informed that apical root shortening (root resorption) may be a consequence of orthodontic treatment.  2. Periapical radiographs:  (a.) Periapical radiographs -important orthodontic records as any pretreatment record, and are particularly useful to compare pretreatment and post treatment. www.indiandentalacademy.com
    36. 36. Clinical considerations related to root resorption (b.) Impossible to predict the onset of root resorption, periodic control radiographs are indicated. Once every year after appliance placement (6 months-Edwards article). (c.) Post treatment radiographs essential assess the bone/root integrity after treatment. www.indiandentalacademy.com
    37. 37. Clinical considerations related to root resorption  3. Orthodontic treatment timing. Early as possible since there is less root resorption in developing roots and young patients show better muscular adaptation to occlusal changes.  4.Resorption is detected during treatment – goals must be reassessed. www.indiandentalacademy.com
    38. 38. Clinical considerations related to root resorption  A decision should be made – 1) Terminate the treatment 2) Arrive at a treatment compromise. 3) When necessary, applied forces should be stopped and/or a bite plane used to disocclude the teeth.  6. Habits such as nail biting or tongue thrust should be stopped. www.indiandentalacademy.com
    39. 39. Clinical considerations related to root resorption  7. All types of tooth movement can cause root resorption. It seems that intrusion is the most detrimental.  8. Occlusal traumatism and jiggling are detrimental -finish treatment with a correct occlusion.  9. It is essential to recognize anatomic and physiologic limitations. Surgical intervention may be required.. – www.indiandentalacademy.com
    40. 40. Clinical considerations related to root resorption  10. Teeth with resorbed roots - abutments to bridges only when their root length exceeds the clinical crown length  11. Orthopedic effect in the early treatment phase has less destructive potential on the roots compared with the dentoalveolar effect at a later treatment phase  12. Root resorption - weighed against appliance efficiency and individual treatment objectives. www.indiandentalacademy.com
    41. 41. Clinical considerations related to root resorption    13. Treatment time - short as possible 14. Traumatized teeth - treated cautiously. 15. Medical examination and familial tendency records - especially in cases of severe resorption. www.indiandentalacademy.com
    42. 42. Clinical considerations related to root resorption  16. Root resorption continues after appliance removal or during retention, sequential root canal therapy -calcium hydroxide. G-p filling -only after root resorption ceases  17. Full-mouth radiographs when receiving a transfer case. www.indiandentalacademy.com
    43. 43. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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