Resorption of tooth roots is one of the most mysterious dental phenomena. It occurs in people, regardless of gender, age and condition of the oral cavity. This is a dental complication that can cause the patient to lose teeth. It is found in dental surgery quite often.
Types of pathology
The following types of tooth root resorption are distinguished: physiological at the roots of temporary teeth and pathological resorption.
Depending on where resorption occurs, it is divided into internal and external.
Due to the appearance, the external is conditionally classified into replacement, superficial and inflammatory.
Cervical is also added to the types of external resorption.
Complications of internal resorption by perforation are possible.
Concomitant factors of the appearance of pathology are trauma (chronic or acute) - a constant mechanical effect, inflammation of the periodontal and pulpal complex, tumors, cysts, unknown etiology.
The onset of physiological root resorption of primary teeth is noted during the change of temporary teeth permanent. It is based on the selective activity of osteoclasts using the Kappa-B nuclear factor activator receptor. However, the studies provide a vague explanation of the process of pulp resorption.
It was found that pathological resorption of the roots of deciduous teeth is uneven, uniform, and also in the area of furcation.
With uniform resorption at the same time, all dental roots are absorbed , the furcation zone is affected slightly.
Uneven occurs on the root closest to the follicle of the permanent tooth. Often, the root of the tooth hurts.
The third type of resorption originates in the furcation zone, and then passes to the roots of temporary teeth. After bone resorption, the role of osteoclasts passes to the cells of odontoblasts and pulps.
Internal root resorption is an asymptomatic phenomenon that is almost always randomly determined.
A common cause is trauma and inflammation of the pulp. Damage to the dentinal tubules and predentin by inflammatory mediators (interleukins 1B) stimulate the RANKL system, which selectively activates osteoclasts in pulp and / or periodontal tissues.
Since normal pulp is transformed into granulomatous tissue due to internal resorption, it is transmitted through the dental tissue. There is a "pink spot". Subsequent pulp necrosis changes pink to gray.
If resorption progresses, the patient complains of pain, periodontal lesions lead to increasing dental mobility.
Internal root resorption and perforation
It differs in leakage (like VRK) without the presence of perforation, however, it comes to periodontal ligament and cement. On this basis, therapy and prognosis of pathology is complicated. It is determined by the size of the violation.
Superficial root resorption
This type of tooth root resorption is a physiological process, because it responds to damage during orthodontic treatment or during trauma - necrosis and cementoblast ischemia occur. It acts in the field of cement, rarely goes beyond it. Typically, defects are small, rarely established, especially from the oral and vestibular sides. There are no functional disorders.
After the trigger is eliminated, new structures are built right away, so treatment is not necessary.
Inflammatory external resorption
What else can the situation mean when the root of the tooth hurts? The most aggressive and fastest type of external root resorption. Its appearance is due to bacterial infection of the root canals, trauma (especially complete tooth dislocation), extensive dentinal tubules and pulp necrosis due to incomplete root formation. This process is accompanied by widespread destruction of root tissues, impaired function and loss of CES.
Ankylosis, or replacement resorption
This type of external resorption of tooth roots, however, in terms of severity of tissue destruction is not inferior to inflammatory. It appears with injuries, especially with a full or hammered tooth dislocation. Usually represents the outcome of inflammatory resorption, even with its therapy. Substitutional resorption is a chronic process, appears in the area of damage to the periodontal ligament on the external root surface, never stops on its own, and in almost all cases ends with tooth loss.
A strong pathological effect damages the periodontal ligament, resulting in the inevitable formation of bones in this place. The tooth becomes immobile.
When substitution resorption is stopped, they speak of a transient type. If it comes to tooth loss, then resorption is called progressive.
Cervical resorption
Whatever the name of this type of resorption - invasive, cervical external or cervical peripheral, it is an idiopathic type of external. Trauma, scaling, bruxism and orthodontics cause her development. In the course of some studies, scientists presented cases of the effect of intracanal bleaching on the appearance of external resorption. It turned out that hydrogen peroxide (30%) is able to penetrate the surface of the cement through the tubules, destroy both it and periodontium.
It does not always appear in the neck zone, which is determined by the depth of the pathological pocket. The resorption of the infection in the gingival sulcus is supported, gradually enveloping the pulp chamber. Her damage does not occur. Cervical resorption proceeds without symptoms until pulpar and periodontal infections join. If the defect is deep, sensitivity to temperature appears, the walls of the cavity become hard, bleed weakly during sounding and creak. Dental treatment in dentistry will be discussed below. First, find out how the pathology is diagnosed.
Diagnosis of root resorption
The difficulty in diagnosing root internal resorption is the lack of patient complaints about health. This can go on for years. Therefore, we must pay tribute to x-ray diagnostics.
X-ray examination also helps in determining the external resorption. Typically, defects have uneven edges, can penetrate the depth of dentin, are detected on any root surface. But there are situations when the focus of enlightenment has clear boundaries, as with internal resorption. In this case, you need to make several projections of the x-ray and make sure that the contour of the root canal is superimposed on the pathology contours. Even better is CBCT.
It is more difficult to distinguish inflammatory resorption from substitution. With radiological replacement, the foci of the periodontal gap and enlightenment are difficult to detect, since a bone is formed. Due to the chronic nature of the process, ankylosis proceeds more easily.
The diagnosis of invasive cervical resorption is made based on x-ray diagnostics and the clinic.
Root resorption treatment
If we talk about the treatment of root resorption, it is difficult to make a universal plan. The choice of method is determined by the type of resorption, its size, pulp involvement, as well as providing adequate access.
With internal root resorption, root canal treatment is performed. They are sealed with composite sealants, MTA and gutta-percha. This requires a highly qualified dentist and good knowledge of the anatomy of the root canals.
When internal resorption with perforation from the side of the oral cavity, treatment should be carried out after creating competent surgical access by cutting and further exfoliating the flap. At the same time, high quality antiseptic treatment is performed.
With the right approach to the treatment of inflammatory external resorption in dental surgery, it is necessary to eliminate the cause, scrupulously drug and mechanical treatment of the root canals and fillings in the future (there may be an option to establish a temporary filling up to three weeks) if the tooth is functionally significant.
With replacement resorption, root canal treatment is performed by removing pulp with necrosis. Enamel matrix proteins were used for some time, but their positive effect was not proven. Replacement resorption in most cases leads to tooth loss. The patient should be warned about this.
Dentistry in dentistry should be comprehensive and timely.
Idiopathic cervical resorption is presumably associated with trauma by bacteria, bleaching, systemic pathology, periodontal ligament irritation, and urolithiasis. The results of using MTV at the same time as the composite “sandwich technology” and the JRC have proved to be excellent.
Reviews of apex root resection
This pathology is quite common. Reviews confirm this. To blame, as a rule, injuries and inflammatory processes of the pulp. During treatment, it is important to establish a possible cause, and then eliminate it.
There are many opinions regarding the temporary filling of calcium with hydroxide. Some experts successfully use calcium, laying it in channels for six months or more. But there are studies that prove the progression and development of resorption, which did not appear before. In addition, temporary filling with calcium (more than three months) reduces the elasticity of dentin, there is a risk of the appearance of fractions.