Endodontics
Course Review
Enoch Ng, DDS 2014
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External Inflammatory Resorption
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Pathologic loss of cementum, dentin, and bone causing defect in root and adjacent bone tissues
Caused from infection, characterized by radiolucent areas along the root
May or may not invade dental pulp space!
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Subtypes
Cervical
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Invasive cervical
Heathersaiy Classification
Class I – small invasive resorptive lesion near cervical area,
shallow penetration into the dentin
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100% success rate
Class II – well defined invasive resorptive lesion penetrated
close to coronal pulp, little/no extension into radicular dentin
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100% success rate, may require NSRCT
Class III – deeper invasion of dentin by resorbing tissues, coronal
dentin and extending to coronal 1/3 of root
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Initial retention 92%, long term retention 77%
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95% treated with NSRCT
Class IV – large invasive resorptive process extended beyond
coronal 1/3 of root
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Long term success 12%
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Unable to totally remove resorptive lesion in most cases
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Extracanal invasive
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Subepithelial external inflammatory (from sulcular infections)
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Predisposing factors
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Trauma
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Intracoronal bleaching
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Periodontal therapy
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Bruxisum, intracoronal restorations,
development defect, systemic disease
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Idiopathic
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Contributing factors
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Mechanical damage to cementum
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Stimulation from bacteria
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Diagnosis
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Begins from pinpoint opening in cementum
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Occurs just below epithelial attachment
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Invades dentin – leaves cementum and pulp
intact
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Pulp usually vital
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Root canal system radiographically intact
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Radiographically may resemble caries
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“pink” tooth
Treatment
Ca(OH)
2
MTA
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Depends on extent and location
Supraosseous
NSRCT with Ca(OH)
2
interappointment medication
Flap and restore
Extrude and restore
Intraosseous
NSRCT with Ca(OH)
2
interappointment medication
Flap and repair/restore
Extraction/replantation