Root Resorption

Reham Hassan Associate professor of Endodontics

Non-Surgical Treatment:

Root canal therapy can be performed but certain difficulties might face the operator:

● 1 . Hemorrhage: Controlled by total pulp extirpation and NaOCl 5.25% with the help of a haemostatic agent and vasoconstrictor .

● 2 . Remnants of pulp tissue in inaccessible areas needs ultrasonic activation of irrigants inside the root canal and use of ICM as Ca(OH) 2 .

● 3 . Filling technique: Due to the irregular shape of the root canal so thermoplasticized injectable warm GP .

● 1- Teeth with small to moderate perforations with infrabony defects can be treated by long term Recalcification with Ca(OH) 2.

Technique of application:

After control of bleeding and canal debridement with ultrasonics, the canal apical to the defect is obturated .

Ca(OH)2 is mixed with few drops of saline, distilled water or anesthetic solution to form a thick paste .

It is then applied into the pulp chamber and root canal by endodontic pluggers to fill the canal and the defect

completely .

Post operative radiograph is essential at this step. The patient is recalled in 6 weeks for another film and

dressing change. The procedure should be checked at 3 months intervals with radiographic and clinical

examination .

Repair might be observed from 6 months up to 20 months postoperatively .

Repair is by deposition of cementum like or osteoid like tissue at site of the defect.

*High alkaline pH can initiate matrix formation by formative cells

stimulation.

*A high pH neutralizes the acidic products of the resorptive cells

creating an unfavorable environment for them.

* In addition the presence of Ca ions can activate ATPase, which

may enhance dental tissue mineralization.

* Also, it has an antibacterial effect due to its high pH, destroying

microorganisms.

Theories have been postulated to explain its

biological activity and mode of action of Ca(OH) 2:

● 2- MTA repair of perforation, as it is a biocompatible material with setting in moisture environment and high Ph value and good sealing ability .

● In difficult cases when non-surgical approach can’t seal

the defect or control bleeding.

● Altered anatomy of root apex by resorptive defect.

● Perforation near or at the epithelial attachment.

● Unsuccessful calcification .

Surface Resorption

● Monitor radiographically.

● Endodontic treatment only if signs of infection.

Pressure

● Remove cause e.g. unerupted cuspid, neoplasm.

Orthodontic

● Should stabilize on completion of orthodontic treatment

Treatment External inflammatory root resorption

● Endodontic treatment and intracanal medication with either Ledermix paste followed by long term Ca(OH)2. Root fill when resorption controlled.

● Prevention: following replantation of mature tooth pulp extirpation and Ledermix paste dressing as soon as possible.

1. Protect the DT by placing a layer of cement over the GP to prevent leaching of bleaching materials through the DT.

2. Eliminate the use of heat of thermocatalytic procedure.

3. Avoid etching Dentin as it opens DT and lead a direct path to the gingival tissue.

4. Beware of the caustic nature of superoxol .

● Class 1, 2 - Topical application of 90% trichloracetic acid, curettage, and glass ionomer restoration.

● Class 3 - Topical application of 90% trichloracetic acid to resorptive tissue, curettage, elective pulpectomy and canal preparation to gain access to deeper and encircling infiltrating channels. Ledermix paste intracanal dressing, followed by root filling and final glass ionomer cement restoration .

Adjunctive orthodontic extrusion if necessary .

-Alternative therapy: periodontal flap reflection, curettage, trichloracetic acid application to defect, endodontic therapy and restoration.

● Class 4 - monitor or extract and implant.

-Endodontic treatment to resorptive defect .

-Induce calcification by use calcium hydroxide alone or

following careful topical application of 90% trichloraceti

acid. ProRoot MTA may also be used.

-Guided tissue Regeneration GTR allow better results than conventional surgical techniques as it allows regeneration of PL cells to populate the surface of the tooth preventing healing with epithelial cells.

● Ledermix. Antibiotic/corticosteriod paste.

● Calcitonin . Hormone that inhibit osteoclastic bone resorption .

● Osteoprotegrin and Bisphosphonates.

● Mature tooth in normal occlusion; leave and monitor for ultimate implant replacement. In infra-occlusion; in selective cases surgical reposition and treat root surface with emdogain.

● Immature tooth in infraocclusion; in selected cases surgically reposition and treat root surface with emdogain; or decoronate and submerge. Implant therapy, if necessary, when alveolar growth completed.