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Clinical view of pink discoloration of periodontal infection root resorption in central incisor. Granulation tissue has spread coronally and undermined the enamel, resulting in the ‘pink tooth’.
Source publication
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 i...
Context in source publication
Context 1
... periodontal infection resorption will include the alveolar bone adjacent to the resorption lacuna in the tooth. If the resorptive process reaches a supragingival area of the crown, the vascularized granulation tissue of the resorption lacuna may be visible through the enamel showing a pink discoloration at the crown (Fig.6). ...
Citations
... These factors include chemical or mechanical injury to the protective tissues, pressure on the tooth, and dental infection. 4 The type of RR can be identified according to the stimulating factor, and removal of that factor is key to selecting an appropriate treatment plan for RR. For example, the factor may be pressure from an impacted tooth or tumor or chemical irrigation from bleaching procedures using 30% hydrogen peroxide or other irrigation agents. ...
... For example, the factor may be pressure from an impacted tooth or tumor or chemical irrigation from bleaching procedures using 30% hydrogen peroxide or other irrigation agents. 4 In addition, intrapulpal infection may lead to RR. Although it has received less attention, orthodontic treatment is also a common cause of RR. 5 Most tooth resorption during orthodontic treatment is clinically insignificant, but when severe, root resorption poses a threat to the teeth. ...
Background/Aim
Root resorption occurs for various reasons and can also be seen as a treatment complication in orthodontics. This study aimed to assess the reliability and quality of YouTube™ videos on root resorption and to assess whether the videos referred to orthodontic treatment and other stimulation factors.
Materials and Methods
YouTube was searched using the keyword ‘root resorption’, which is the most searched term on Google Trends. The first 200 videos identified using the default filter ‘sort by relevance’ were used. Information such as the source, type, duration, and number of likes were recorded. Videos were analyzed using a 23‐point content scale related to root resorption and divided into groups (poor, moderate, and excellent) based on the Global Quality Score.
Results
A total of 95 videos were included in the study. Most were uploaded by dentists or dental clinics ( n = 64, 67.4%). The mean number of days since upload was 1536 ± 1254, and the mean duration was 5 ± 4 min. The videos had a mean of 80 ± 515 likes and 7043 ± 35,382 views, and a mean viewing rate of 1131.71 ± 8736.83. The most discussed topic was radiographic signs of root resorption. While the highest content score for the videos was 21, the average score was only 4. The mean GQS was 2 ± 1. Grouping videos by GQS showed that 55 (57.9%) were poor, 38 (40%) were moderate, and 2 (2.1%) were excellent. There was a significant relationship between videos that mentioned orthodontics ( n = 62; 65.3%) and higher GQS ( p = .036), and a significant difference was between GQS groups for total content levels ( p < .001).
Conclusions
YouTube videos related to root resorption lack sufficient information and clarity, and their quality needs to be improved. Oral health professionals should strive to produce higher‐quality videos.
... External cervical resorption is a progressive, dynamic process that affects periodontal and dental hard tissues [1]. External cervical resorption is caused by the activity of clastic cells and includes both resorptive and reparative phases [2,3]. Given its invasive and aggressive nature, external cervical resorption can lead to the destruction of root dentin in various directions [4,5]. ...
... Given its invasive and aggressive nature, external cervical resorption can lead to the destruction of root dentin in various directions [4,5]. The loss of dentine structures in the teeth with external cervical resorption reduces their fracture resistance to destructive forces such as occlusal trauma or traumatic forces, leading to the loss of the affected tooth [2,6,7]. ...
(1) Background: External cervical resorption causes dental hard tissue destruction that may reduce the fracture resistance of affected teeth. By using a compressive strength test, this study aimed to evaluate the fracture resistance of teeth with simulated external cervical resorption cavities that have different three-dimensional classifications. (2) Methods: In total, 170 teeth with simulated external cervical resorptions were divided into 16 experimental groups (n = 10) and 1 control group (n = 10) based on the three-dimensional classification: 1Ap, 1Bp, 1Cp, 1Dp, 2Ap, 2Bp, 2Cp, 2Dp, 3Ap, 3Bp, 3Cp, 3Dp, 4Ap, 4Bp, 4Cp, 4Dp and a control group. Defects were restored with mineral trioxide aggregate. The fracture resistances of the samples were statistically analyzed using two-way repeated ANOVA and the Bonferroni correction for multiple comparisons at a significance level of p < 0.05. (3) Results: The lowest resistance to fracture was observed in samples with vertical height level “4” and circumferential spread of “D” (p < 0.001). In the groups with circumferential spreads “B”, “C” and “D”, there were significant differences between the samples with vertical height levels “1”, “2”, “3” and “4” regarding fracture resistance (p < 0.001). (4) Conclusions: The circumferential spread and vertical height of the external cervical resorption influenced the fracture resistance of the affected teeth.
... Root resorption of the permanent teeth is generally reported to be caused by endogenous factors, such as pulpal infection and exogenous factors, such as tooth eruption, ankylosis, orthodontic force, periodontal tissue infection, and tumour pressure [7][8][9][10]. In a previous longitudinal study that followed the long-term prognosis of retained deciduous teeth, no correlation or specific pattern was found among age, presence or absence of caries, presence or absence of hypodontia, sex, or root resorption [11]. ...
Background
There are currently no studies that quantitatively compare the relationship of root resorption to the patient’s systemic history or craniofacial and intraoral morphology, especially in relation to possible host factors. Thus, this study aimed to clarify the factors associated with root resorption in retained mandibular second deciduous molars with the congenital absence of second premolars and predict the prognosis of retained mandibular second deciduous molars.
Methods
A cohort of 5547 patients who visited the orthodontic clinic at Tokyo Medical and Dental University Dental Hospital between 2013 and 2022 was screened. Lateral cephalometric radiographs, panoramic radiographs, upper and lower dental models, and orthodontic treatment questionnaires were used as reference materials to apply the inclusion and exclusion criteria. Ultimately, 111 patients were included in the analyses. The patients were divided into two groups based on the root resorption levels of the retained mandibular second deciduous molars. Those with less root resorption were classified under the good condition (GC) group, whereas those with more root resorption were classified under the poor condition (PC) group. Demographic, clinical, and cephalometric parameters were compared between the groups. A multivariate logistic regression model was used to predict the probability of root resorption.
Results
The prevalence of congenitally missing mandibular second premolars with persistent mandibular second deciduous molars was 2.0%. In a total of 111 patients, eighty-three teeth (53.2%) were classified into the GC group, whereas 73 teeth (46.8%) were classified into the PC group. The Frankfort-mandibular plane angle (FMA) [odds ratio (OR): 0.87], Frankfort-mandibular incisor angle (FMIA) (OR: 0.93), overbite (OR: 1.38), adjacent interdental space (OR: 1.46), distance from occlusal plane (OR: 0.80), and caries treatment (OR: 7.05) were significantly associated with the root resorption of the retained mandibular second deciduous molars.
Conclusions
Our findings suggest that skeletal morphology, oral morphological patterns, and history contribute to root resorption in retained mandibular second deciduous teeth with congenital absence of subsequent permanent teeth.
... Tooth avulsion is a complex and serious form of injury that occurs when a tooth is completely knocked out of its socket [1]. An avulsed tooth usually does not recover its function due to severe damage to the tooth and surrounding tissues [2,3]. The best prognosis for tooth replantation can be achieved when the extra-alveolar time does not exceed 5 min [4]. ...
Background/Aim: Tooth avulsion and delayed replantation may cause inflammatory responses and root resorption of the tooth. The aim of this study is to investigate the effect of a doxycycline-loaded nitric oxide-releasing nanomatrix (DN) gel on the delayed replantation of avulsed rat teeth, with a focus on assessing the gel’s potential to promote regeneration and inhibit complications associated with the replantation process. Materials and Methods: Twenty-four right maxillary first molars from male Sprague-Dawley rats were atraumatically extracted using sterile extraction forceps. The molars were dried for 1 h at room temperature (approximately 23 °C) and divided into four groups according to the root conditioning methods after extra-alveolar 60-min drying: Group 1, no root conditioning treatment prior to replantation; Group 2, soaking in 2% NaF solution for 5 min before replantation; Group 3, 5-min soaking in NO gel and injection of the gel into the alveolar socket; Group 4, 5-min soaking in DN gel and injection of the gel into the alveolar socket before replantation. The animals were euthanized four weeks after the operation and the specimens were evaluated histologically. Results: The use of NO gel alone showed better anti-inflammatory and periodontal effects than the control group, but it did not show a significant effect compared to the group using NaF. When using NO gel loaded with doxycycline, it showed a significant anti-inflammatory effect compared to the control group and showed a similar inhibitory effect to the group using NaF. Conclusions: Within the limits of this study, in delayed replantation situations, the control of inflammatory resorption and replacement resorption is an important factor for achieving a better prognosis of replanted teeth. Root surface treatment with DN gel decreased root resorption after delayed replantation.
... Root resorption is a dental complication that causes loss of cementum and dentine and is linked to either pathological or physiological activity of the tooth resorbing cells [10] . Two primary categories can be used to categorize the etiology of root resorption: stimulation by infection or pressure and mechanical or chemical injury [11]. Resorption of roots occur when cementoblasts from the tooth's outer layer are removed, the root surface is exposed. ...
Background: Mandibular third molars are the most frequently encountered impacted teeth in dental surgery cases. Impactions could be caused by differences in crown size, later development of roots, reduced skeletal growth and lack of space. If untreated, an impacted tooth can lead to a number of problems, including external root resorption, which is frequently observed in mandibular second molars. The current study was designed to investigate the prevalence of root resorption of mandibular second molar caused by impacted mandibular third molar. METHODS: A cross-sectional, observational study using panoramic radiographs obtained from December 2019 to February 2022 from of patients who visited the Dental Clinic of the University of Benghazi. All radiographs were assessed about presence, location and severity of external root resorption of second molar. Positions of the impacted third molars were classified using two classification systems Pell, Gregory's and Winter classification. Data were tabulated and analyzed using Chi Square test; P value was set at 0.05. RESULTS: Panoramic radiographs of 434 patients were examined that consisted of 244 (56.2%) female and 190 (43.7%) male. The prevalence of external root resorption of second molar was 213(49%). The severity of resorption was categorized as slight (70.4%), moderate (17.8%), and severe (11.7%), most of them was located at cervical third. External root resorption was proportionally higher in the impacted teeth with class B (50.2%) and mesio-angular positions (62.9%). CONCLUSIONS: Prevalence of external root resorption of mandibular second molars caused by Impacted third molars was high in this study especially in males. Mandibular third molars with a greater potential to cause the adjacent second molar's external root resorption were those in class B position according to Pell and Gregory classification and in mesioangular position regarding Winter classification. Keywords: Panoramic, Radiograph, Root resorption, second molar, third molar, Impacted.
... Thus, it is extremely important to conduct radiographic monitoring of orthodontic patients to diagnose and control EARR. According to Fuss et al. [18], radiographically, the loss of root structure is located in the apical third of the root, and no signs of radiolucency can be observed in the bone or root. Several imaging exams, such as panoramic radiography, periapical radiography (PR), face profile teleradiography, and cone beam computed tomography (CBCT), have been used to diagnose EARR [19][20][21][22]. ...
Objectives: This clinical study aimed to evaluate and compare the diagnostic accuracy of intraoral periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting external apical root resorption (EARR) in orthodontic patients during the retention phase. Methods: The research involved 41 Caucasian patients who had undergone comprehensive orthodontic treatment, with a total of 328 teeth analyzed. The Kappa values for inter- and intra-examiner agreement were high for both PR and CBCT, indicating a robust level of agreement among examiners. The study used a four-point scale for classifying EARR. Results: This study showed comparable accuracy, sensitivity, and specificity between PR and CBCT when using the most stringent criterion of “Definitely present”. The data suggested that CBCT outperformed PR when using a less stringent criterion (“Definitely present” or “Probably present”), particularly for maxillary incisors. However, overall diagnostic performance, as measured by the area under the ROC curve, showed only a slight advantage for CBCT over PR. Areas under the ROC curve range between 0.85 and 0.90 for PR and between 0.89 and 0.92 for CBCT. According to DeLong’s test, there is no evidence to conclude that the area under the ROC curve is different for PR and CBCT. Conclusions: Both PR and CBCT are accurate diagnostic tools for identifying EARR, with PR being deemed more suitable for routine clinical use due to its cost-effectiveness and lower radiation exposure. The findings emphasize the importance of considering the risk-benefit ratio when deciding on imaging modalities for monitoring EARR in orthodontic patients.
... The mineralized tissues of permanent teeth are generally not resorbed, but the etiology of root resorption occurs with the injury of non-mineralized tissues covering the outer surface of the root (precementum) or the inner surface of the root canal (predentin) (13,14). The continuation of the resorption depends highly on common stimulation factors of osteoclastic cells, such as infection or pressure (15). The etiology and pathogenesis of tooth root resorption have not been fully elucidated yet, but the most prominent etiological factors are known to be trauma, pulp infection, tooth whitening, and orthodontic treatment. ...
Objective: Antiepileptic drugs used in the treatment of epilepsy patients have a negative effect on bone tissue, but as far as we know, tooth root resorption has not been investigated in these patients. The aim of this study was to evaluate the prevalence of external and internal root resorption and its distribution according to resorption sites in epilepsy patients using antiepileptic drugs. Material and Methods: Panoramic radiographs obtained before dental treatment were evaluated. While the case group consisted of only those with epilepsy, the control group included healthy subjects. The presence/absence of external and internal resorption of all teeth (except the third molars), region of resorption (cervical, middle, and apical region of the root), age, and sex were recorded in an excel file. Independent sample t-test or Mann-Whitney U test according to normality of distribution and a chi-square test to compare categorical variables were used. Results: The resorption in 93 (21.9%) of 424 patients (236 healthy subjects and 188 epileptic patients), the groups did not significantly differ by the presence of external and internal resorption (p = 0.089 and 0.746). It was more common in those over 30 years and males (p = 0.018 and 0.013). Conclusion: We concluded that the presence of resorption in epilepsy patients was not different from healthy subjects. However, in patients with epilepsy, resorption was mostly seen in the lower molars and middle 1/3 regions. Clinicians should consider our results when treating these patients.
... Therefore, the stable CXXC5-overexpression cell lines were developed by lentivirus transduction. Impaired cementum formation is often associated with periodontal disease, chronic periapical inflammation, and conditions that compress the periodontal ligament, such as orthodontic pressure, tumor pressure, trauma, and impacted tooth [27]. Among them, periodontitis and AP are representative of inflammatory cementum resorption, which have higher prevalence than pressure-related ones and therefore become the focus of our research. ...
Background
Cementoblasts on the tooth-root surface are responsible for cementum formation (cementogenesis) and sensitive to Porphyromonas gingivalis stimulation. We have previously proved transcription factor CXXC-type zinc finger protein 5 (CXXC5) participates in cementogenesis. Here, we aimed to elucidate the mechanism in which CXXC5 regulates P. gingivalis- inhibited cementogenesis from the perspective of mitochondrial biogenesis.
Methods
In vivo, periapical lesions were induced in mouse mandibular first molars by pulp exposure, and P. gingivalis was applied into the root canals. In vitro, a cementoblast cell line (OCCM-30) was induced cementogenesis and submitted for RNA sequencing. These cells were co-cultured with P. gingivalis and examined for osteogenic ability and mitochondrial biogenesis. Cells with stable CXXC5 overexpression were constructed by lentivirus transduction, and PGC-1α (central inducer of mitochondrial biogenesis) was down-regulated by siRNA transfection.
Results
Periapical lesions were enlarged, and PGC-1α expression was reduced by P. gingivalis treatment. Upon apical inflammation, Cxxc5 expression decreased with Il-6 upregulation. RNA sequencing showed enhanced expression of osteogenic markers, Cxxc5 , and mitochondrial biogenesis markers during cementogenesis. P. gingivalis suppressed osteogenic capacities, mitochondrial biogenesis markers, mitochondrial (mt)DNA copy number, and cellular ATP content of cementoblasts, whereas CXXC5 overexpression rescued these effects. PGC-1α knockdown dramatically impaired cementoblast differentiation, confirming the role of mitochondrial biogenesis on cementogenesis.
Conclusions
CXXC5 is a P. gingivalis -sensitive transcription factor that positively regulates cementogenesis by influencing PGC-1α-dependent mitochondrial biogenesis.
... The impacted mandibular third molar (IMTM) might cause pericoronitis, caries, odontogenic cysts, tumours, damage to adjacent teeth, anterior teeth crowding, periodontal problems with adjacent second molars, or external root resorption (ERR) (2,3). The occurrence of ERR goes through two stages: chemical or mechanical injury and stimulation from infection or pressure on protective tissues on the external root surface (4). The ERR of the mandibular second premolar is caused by the second molar's contact with the mandibular third molar (MTM), indicating that pressure applied by the MTM might cause the ERR of the mandibular second molar (MSM). ...
Background:
The relationship between the impacted mandibular third molar (IMTM) and the external root resorption (ERR) of the mandibular second molar (MSM) was analysed with cone-beam computed tomography (CBCT). The risk factors affecting the ERR of the MSM were examined to provide a reference.
Material and methods:
A total of 327 patients (total: 578 teeth) admitted to the Affiliated Hospital of Yanbian University for IMTM extraction from January 2017 to December 2019 was chosen and divided according to gender and age. The correlation between the IMTM and ERR of MSM was analysed, including inclination angle, impaction direction and depth. The relationship of mandibular ascending ramus classification with ERR of MSM was also analysed. In addition, the correlation between the MTM impaction type and the severity of ERR was analysed.
Results:
The incidence of ERR of MSM in male patients was higher than in females (27.9% vs.17.6%, p = 0.018). The occurrence and the site of ERR showed statistical differences in the inclination angle [(≤20°, 3.6%) vs. (21°-40°, 27.1%) vs. (41°-60°, 27.6%) vs. (61°-80°, 25.6%) vs. (>80°, 31.7%), p <0.001], impaction direction [(Vertical, 1.1%) vs. (Mesial, 32.7%) vs. (Horizontal, 25.3%), p <0.001] and depth of MTM [(Low position, 38.6%) vs. (Median position, 32.0%) vs. (High position, 13.7%), p <0.001]. Also, there was a significant difference in the mandibular ascending ramus type [(Class I, 17.4%) vs. (Class II, 32.3%) vs. (Class III, 44.9%), p <0.001]. In addition, the severity of ERR showed statistical differences in the mesial (40.9%, p<0.05), lower impaction (54.5%, p<0.05) depth of MTM and type III of mandibular ascending ramus (63.6%, p<0.05).
Conclusions:
The inclination angle, impaction direction, and depth of MTM were the influencing factors for the occurrence and site of ERR. Also, mandibular ascending ramus type was the impact fact. For MTM with mesioangular, lower impaction, and mandibular ascending ramus with type III, the ERR of the MSM was severer.
... Root resorption (RR) of permanent teeth is a pathologic process that can occur in response to infection or damage to the periodontal ligament (PDL), with a concomitant impact on the underlying unmineralized tissues (precementum) and lining cells (cementoblasts) (Andreasen & Hjorting-Hansen, 1966b;Fuss et al., 2003). ...
... Several classifications of root resorption have been proposed (Andreasen & Hjorting-Hansen, 1966b;Fuss et al., 2003;Galler et al., 2021;Patel & Ford, 2007). Most are based on etiological factors, and anatomic landmarks (Andreasen & Hjorting-Hansen, 1966b;Fuss et al., 2003;Galler et al., 2021;Patel & Ford, 2007). ...
... Several classifications of root resorption have been proposed (Andreasen & Hjorting-Hansen, 1966b;Fuss et al., 2003;Galler et al., 2021;Patel & Ford, 2007). Most are based on etiological factors, and anatomic landmarks (Andreasen & Hjorting-Hansen, 1966b;Fuss et al., 2003;Galler et al., 2021;Patel & Ford, 2007). The aetiology of RR can also be classified based on the presence or absence of infection, namely, infection-related resorption (resulting from microbial infection) (Abbott & Lin, 2022;Andreasen, 1985;Andreasen & Hjorting-Hansen, 1966a;Fuss et al., 2003;Jiang et al., 2002) or non-infection-related resorption (e.g., sterile resorption) (Årtun et al., 2009). ...
Background
The mechanism of action of root resorption in a permanent tooth can be classified as infection‐related (e.g., microbial infection) or non‐infection‐related (e.g., sterile damage). Infection induced root resorption occurs due to bacterial invasion. Non‐infection‐related root resorption stimulates the immune system through a different mechanism.
Objectives
The aim of this narrative review is to describe the pathophysiologic process of non‐infection‐related inflammatory processes involved in root resorption of permanent teeth.
Methods
A literature search on root resorption was conducted using Scopus (PubMed and Medline) and Google Scholar databases to highlight the pathophysiology of bone and root resorption in non‐infection‐related situations. The search included key words covering the relevant category. It included in vitro and in vivo studies, systematic reviews, case series, reviews, and textbooks in English. Conference proceedings, lectures and letters to the editor were excluded.
Results
Three types of root resorption are related to the non‐infection mechanism of action, which includes surface resorption due to either trauma or excessive orthodontic forces, external replacement resorption and external cervical resorption. The triggers are usually damage associated molecular patterns and hypoxia conditions. During this phase macrophages and clastic cells act to eliminate the damaged tissue and bone, eventually enabling root resorption and bone repair as part of wound healing.
Discussion
The resorption of the root occurs during the inflammatory phase of wound healing. In this phase, damaged tissues are recognized by macrophages and neutrophiles that secrete interlaukines such as TNF‐α, IL‐1, IL‐6, IL‐8. Together with the hypoxia condition that accelarates the secretion of growth factors, the repair of the damaged perioduntiom, including damaged bone, is initiated. If the precementum and cementoblast are injured, root resorption can occur.
Conclusions
Wound healing exhibits different patterns of action that involves immune stimulation in a bio‐physiological activity, that occurs in the proper sequence, with overlapping phases. Two pathologic conditions, DAMPs and hypoxia, can activate the immune cells including clastic cells, eliminating damaged tissue and bone. Under certain conditions, root resorption occurs as a side effect.
