Root Resorption Diagnosis, Classification and Treatment Choices Based on Stimulation Factors
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Root resorption ^ diagnosis, classification and treatment choices based on stimulation factors Root resorption is a dental complication that can lead to tooth extraction. There are many classi¢ca- tions and terms for di¡erent types of root resorption. For example, `apical replacement resorption' has been used for apical root resorption following ortho- dontic treatment (1). The same pathological process has been included under the category of `in£amma- tory root resorption' (2). In the classical classi¢cation of root resorption following traumatic injuries (3), replacement and in£ammatory resorption are related to completely di¡erent etiologies and treatment pro- tocols. As this phenomenon creates confusion, it is essential to develop a new clinical-related classi- ¢cation which will improve communication among clinicians, teachers, and researchers. This new classi- ¢cation should be simple to learn and teach, and should include the most common types of root resorp- tion. The etiology of root resorption requires two phases: injury and stimulation (2, 4). Injury is related to non- mineralized tissues covering the external surface of the root, the precementum, or internal surface of the root canal, the predentin. The injury is similar to sev- eral types of root resorption and may be mechanical following dental trauma, surgical procedures, and excessive pressure of an impacted tooth or tumor. It may also occur, following chemical irritation, during bleaching procedures using hydrogen peroxide 30% or other irritating agents (5). Denuded mineralized tissue is colonized by multinucleated cells, which initi- ate the resorption process. However, without further stimulation of the resorption cells, the process will Dental Traumatology 2003; 19: 175±182 Copyright # Blackwell Munksgaard 2003 Printed in Denmark. All rights reserved DENTAL TRAUMATOLOGY ISSN 1600±4469 175 Fuss Z,Tsesis I, Lin S. Root resorption ^ diagnosis, classi¢cation and treatment choices based on stimulation factors. Dent Traumatol 2003; 19:175^182. # Blackwell Munksgaard, 2003. Abstract ^ Etiology of different types of root resorption requires two phases: mechanical or chemical injury to the protective tissues and stimulation by infection or pressure. Injury can be similar in various types of root resorption. The selection of proper treatment is related to the stimulation factors. Intrapulpal infection is the stimulation factor in internal root resorption and external periradicular inflammatory root resorption. Adequate root canal treatment controls intrapulpal bacteria and arrests the resorption process. In cervical root resorption, infection originates from the periodontal sulcus and stimulates the pathological process. As adequate infection control in the sulcus is unlikely, removal of granulation tissue from the resorption lacuna and sealing are necessary for repair. Removal of the stimulation factor, i.e. pressure, is the treatment of choice in root resorption related to pressure during orthodontic treatment, or an impacted tooth or tumor. In ankylotic root resorption, there is no known stimulation factor; thus, no predictable treatment can be suggested. Therefore, various types of root resorptions can be classified according to the stimulation factors: pulpal infection resorption, periodontal infection resorption, orthodontic pressure resorption, impacted tooth or tumor pressure resorption, and ankylotic resorption. Zvi Fuss, Igor Tsesis, Shaul Lin Department of Endodontology, Tel Aviv University, Tel Aviv, Israel Key words: root resorption; calcium hydroxide; Activpoint 1 ; chlorhexidine; ankylosis Dr Zvi Fuss, Department of Endodontology,Tel Aviv University, Tel Aviv, Israel Fax: 972 3 6495145 e-mail: fuss@netvision.net.il Accepted 8 January, 2003
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All different types of root resorbtions
Transcript of Root Resorption Diagnosis, Classification and Treatment Choices Based on Stimulation Factors
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