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International Endodontic Journal Oct 2022Root resorption is the loss of dental hard tissue because of odontoclastic action. In permanent teeth, it is undesirable and pathological in nature. Root resorption may... (Review)
Review
Root resorption is the loss of dental hard tissue because of odontoclastic action. In permanent teeth, it is undesirable and pathological in nature. Root resorption may occur on the inner aspect of the root canal (internal root resorption) or on the outer aspect of the root (external root resorption). Regardless of its location, root resorption is irreversible, and may result in discomfort for the patient, requires management and/or, in some cases, results in the premature loss of the affected tooth. Root resorption is often challenging to accurately diagnose and manage. The aim of this narrative review is to present the relevant literature on the aetiology, pathogenesis, diagnosis and management, as well as discuss the future directions of diagnosis and management of root resorption.
Topics: Humans; Root Resorption; Root Canal Therapy; Dentition, Permanent
PubMed: 35229320
DOI: 10.1111/iej.13715 -
Science Progress 2022Tooth root resorption is multifactorial, leading to progressive destruction and eventual loss of tooth root dentin and cement. There are internal and external types of... (Review)
Review
Tooth root resorption is multifactorial, leading to progressive destruction and eventual loss of tooth root dentin and cement. There are internal and external types of root resorption, each having its variety. The etiology and pathogenesis of tooth root resorption are poorly understood, and the most significant etiological factors are trauma, pulpal infection, tooth bleaching, and orthodontic treatment. Tooth root resorption is primarily asymptomatic; thus, it is revealed accidentally by radiographic examination. Progressive clinical manifestations are pain, tooth discoloration, tooth mobility, and other conditions. Awareness of the causes and risk factors allowing tooth root resorption, and regular radiographic examination, in case of necessity, make it possible to reveal resorption at an early stage and to prevent its further development. Thus, the aim of this study is to present etiopathogenesis, a clinical course, and diagnostic peculiarities of internal and external types of tooth root resorption, enabling practicing dentists to timely diagnose root resorption and take appropriate measures to avoid further complications. Within the limitation of this review, even though the etiopathogenesis of tooth root resorption is yet not fully understood, it is suggested that the etiological factors fall into two groups (endogenic and exogenic) to enhance further understanding of the possible causes and mechanisms of root resorption and allow practitioners to monitor high-risk patients and make timely diagnoses. Moreover, radiographic examination and CBCT are indispensable for the diagnosis of root resorption.
Topics: Humans; Root Resorption; Tooth Discoloration; Tooth Root
PubMed: 35759366
DOI: 10.1177/00368504221109217 -
International Endodontic Journal Oct 2022Managing tooth discolouration involves a range of different protocols for clinicians and patients in order to achieve an aesthetic result. There is an increasing public... (Review)
Review
Managing tooth discolouration involves a range of different protocols for clinicians and patients in order to achieve an aesthetic result. There is an increasing public awareness in the appearance of their teeth and management of tooth discolouration may be inter-disciplinary and involve both vital and nonvital teeth. Vital teeth can be easily treated with low concentration hydrogen peroxide products safely and effectively using an external approach and trays. For endodontically treated teeth, the walking bleach technique with hydrogen releasing peroxide products is popular. However, there is an association with external cervical root resorption with higher concentrations of hydrogen peroxide of 30%-35%. There are also regulatory considerations for the use of hydrogen peroxide in certain jurisdictions internationally. Prosthodontic treatments are more invasive and involve loss of tooth structure as well as a life cycle of further treatment in the future. This narrative review is based on searches on PubMed and the Cochrane library. Bleaching endodontically treated teeth can be considered a safe and effective protocol in the management of discoloured teeth. However, the association between bleaching and resorption remains unclear although there is likely to be a relation to prior trauma. It is prudent to avoid thermocatalytic approaches and to use a base/sealer to cover the root filling. An awareness expectations of patients and multidisciplinary treatment considerations is important in achieving the aesthetic result for the patient. It is likely that there will be an increasing demand for aesthetic whitening treatments. Bleaching of teeth has also become increasingly regulated although there are international differences in the use and concentration of bleaching agents.
Topics: Humans; Tooth Discoloration; Tooth Bleaching; Tooth, Nonvital; Hydrogen Peroxide; Bleaching Agents; Hydrogen
PubMed: 35188275
DOI: 10.1111/iej.13711 -
Dental Traumatology : Official... Aug 2022Tooth resorption is either a physiological or a pathological process resulting in loss of dentin and/or cementum. It may also be associated with bone loss. Currently... (Review)
Review
Tooth resorption is either a physiological or a pathological process resulting in loss of dentin and/or cementum. It may also be associated with bone loss. Currently there is no universal classification for the different types of tooth resorption. This lack of a universal classification leads to both confusion amongst practitioners and poor understanding of the resorptive processes occurring in teeth which can result in incorrect/inappropriate diagnoses and mis-management. When developing a classification of diseases and/or conditions that occur within the body, several criteria should be followed to ensure a useful classification. The classification should not only include pathological conditions but also physiological conditions. Since tooth resorption can be either pathological or physiological, a classification of tooth resorption should include both of these categories. Any classification of diseases should be possible to use clinically, meaningful, useful, clear and universal. It should enable easy storage, retrieval and analysis of health information for evidenced-based decision-making. It should also be possible to share and compare data and information between different institutions, settings and countries. A classification of tooth resorption should be developed by combining anatomical, physiological and pathological approaches. For some types of resorption, the aetiological approach should also be incorporated. A classification of tooth resorption that uses simple, relevant and appropriate terminology based on the nature and location of the resorptive process occurring in teeth is proposed. There are two broad categories of internal and external tooth resorption which are sub-divided into three types of internal tooth resorption (surface, inflammatory, replacement) and eight types of external tooth resorption (surface, inflammatory, replacement, invasive, pressure, orthodontic, physiological, idiopathic). The clinician's understanding, diagnosis and management of tooth resorption can be facilitated by using this simple classification which should ideally be used universally by the entire dental profession to ensure clarity and to avoid confusion.
Topics: Dental Cementum; Humans; Molar; Root Resorption; Tooth Resorption
PubMed: 35605161
DOI: 10.1111/edt.12762 -
The Kaohsiung Journal of Medical... Apr 2018Orthodontic tooth movement relies on coordinated tissue resorption and formation in the surrounding bone and periodontal ligament. Tooth loading causes local hypoxia and... (Review)
Review
Orthodontic tooth movement relies on coordinated tissue resorption and formation in the surrounding bone and periodontal ligament. Tooth loading causes local hypoxia and fluid flow, initiating an aseptic inflammatory cascade culminating in osteoclast resorption in areas of compression and osteoblast deposition in areas of tension. Compression and tension are associated with particular signaling factors, establishing local gradients to regulate remodeling of the bone and periodontal ligament for tooth displacement. Key regulators of inflammation and tissue turnover include secreted factors like RANK ligand and osteoprotegerin, transcription factors such as RUNX2 and hypoxia-inducible factor, cytokines, prostaglandins, tissue necrosis factors, and proteases, among others. Inflammation occurred during tooth movement needs to be well controlled, as dysregulated inflammation leads to tissue destruction manifested in orthodontic-induced root resorption and periodontal disease. Understanding the biology has profound clinical implications especially in the area of accelerating orthodontic tooth movement. Surgical, pharmacological, and physical interventions are being tested to move teeth faster to reduce treatment times and time-dependent adverse outcomes. Future developments in acceleratory technology and custom appliances will allow orthodontic tooth movement to occur more efficiently and safely.
Topics: Biomechanical Phenomena; Bone Resorption; Core Binding Factor Alpha 1 Subunit; Cytokines; Gene Expression Regulation; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Mechanotransduction, Cellular; Osteoblasts; Osteoclasts; Osteogenesis; Osteoprotegerin; Periodontal Ligament; RANK Ligand; Tooth; Tooth Movement Techniques
PubMed: 29655409
DOI: 10.1016/j.kjms.2018.01.007 -
Dental Traumatology : Official... Aug 2022In 1966, Andreasen and Hjørting-Hansen were the first to describe a relationship between tooth resorption and dental trauma. However, Andreasen's original... (Review)
Review
In 1966, Andreasen and Hjørting-Hansen were the first to describe a relationship between tooth resorption and dental trauma. However, Andreasen's original classification did not include other resorptive processes which have since been identified. Numerous articles have been published suggesting new terminology and definitions for tooth resorption. A uniform language with universally accepted terminology is crucial to eliminate the multiplicity of terms and definitions which only cause confusion within the profession. An electronic literature search was carried out in the PubMed database using the following keywords for articles published in English: "root resorption," "inflammatory root resorption," "replacement resorption," "cervical resorption," "trauma," "ankylosis," "surface resorption," and "internal resorption." The search also included textbooks and glossaries that may not have surfaced in the online search. This was done to identify articles related to tooth resorption and its etiology in dentistry. The aim of this review was to present the history that has led to the variety of terms and definitions for resorption. This review emphasizes the need for a clearer, simpler, and more comprehensive nomenclature for the various types of tooth resorption which are presented in Part 2 of this series.
Topics: Humans; Root Resorption; Tooth Ankylosis; Tooth Resorption
PubMed: 35559593
DOI: 10.1111/edt.12757 -
International Journal of Oral Science Jun 2021Nowadays, orthodontic treatment has become increasingly popular. However, the biological mechanisms of orthodontic tooth movement (OTM) have not been fully elucidated.... (Review)
Review
Nowadays, orthodontic treatment has become increasingly popular. However, the biological mechanisms of orthodontic tooth movement (OTM) have not been fully elucidated. We were aiming to summarize the evidences regarding the mechanisms of OTM. Firstly, we introduced the research models as a basis for further discussion of mechanisms. Secondly, we proposed a new hypothesis regarding the primary roles of periodontal ligament cells (PDLCs) and osteocytes involved in OTM mechanisms and summarized the biomechanical and biological responses of the periodontium in OTM through four steps, basically in OTM temporal sequences, as follows: (1) Extracellular mechanobiology of periodontium: biological, mechanical, and material changes of acellular components in periodontium under orthodontic forces were introduced. (2) Cell strain: the sensing, transduction, and regulation of mechanical stimuli in PDLCs and osteocytes. (3) Cell activation and differentiation: the activation and differentiation mechanisms of osteoblast and osteoclast, the force-induced sterile inflammation, and the communication networks consisting of sensors and effectors. (4) Tissue remodeling: the remodeling of bone and periodontal ligament (PDL) in the compression side and tension side responding to mechanical stimuli and root resorption. Lastly, we talked about the clinical implications of the updated OTM mechanisms, regarding optimal orthodontic force (OOF), acceleration of OTM, and prevention of root resorption.
Topics: Humans; Osteoblasts; Osteoclasts; Periodontal Ligament; Periodontium; Root Resorption; Tooth Movement Techniques
PubMed: 34183652
DOI: 10.1038/s41368-021-00125-5 -
Journal of Dental Research Feb 2017External apical root resorption during orthodontic treatment implicates specific molecular pathways that orchestrate nonphysiologic cellular activation. To date, a... (Review)
Review
External apical root resorption during orthodontic treatment implicates specific molecular pathways that orchestrate nonphysiologic cellular activation. To date, a substantial number of in vitro and in vivo molecular, genomic, and proteomic studies have supplied data that provide new insights into root resorption. Recent mechanisms and developments reviewed here include the role of the cellular component-specifically, the balance of CD68, iNOS M1- and CD68, CD163 M2-like macrophages associated with root resorption and root surface repair processes linked to the expression of the M1-associated proinflammatory cytokine tumor necrosis factor, inducible nitric oxide synthase, the M1 activator interferon γ, the M2 activator interleukin 4, and M2-associated anti-inflammatory interleukin 10 and arginase I. Insights into the role of mesenchymal dental pulp cells in attenuating dentin resorption in homeostasis are also reviewed. Data on recently deciphered molecular pathways are reviewed at the level of (1) clastic cell adhesion in the external apical root resorption process and the specific role of α/β integrins, osteopontin, and related extracellular matrix proteins; (2) clastic cell fusion and activation by the RANKL/RANK/OPG and ATP-P2RX7-IL1 pathways; and (3) regulatory mechanisms of root resorption repair by cementum at the proteomic and transcriptomic levels.
Topics: Animals; Cytokines; Dental Cementum; Humans; Orthodontics, Corrective; Root Resorption; Signal Transduction
PubMed: 27811065
DOI: 10.1177/0022034516677539 -
Dental and Medical Problems 2022External apical root resorption (EARR) is a serious complication that should be avoided during orthodontic treatment; this pathology depends on multiple factors. Data... (Meta-Analysis)
Meta-Analysis Review
External apical root resorption (EARR) is a serious complication that should be avoided during orthodontic treatment; this pathology depends on multiple factors. Data from clinical studies should be assessed to determine the influence these factors have on the development of EARR. This systematic review aims to compare EARR produced by different factors (orthodontic systems, dental trauma, and dental vitality). The protocol was registered on the PROSPERO database. The search was performed on 5 databases. Accepted study designs included randomized controlled trials, nonrandomized clinical trials, and observational studies. Full-text articles from clinical studies of EARR associated with orthodontic treatment in English, Spanish, or Portuguese with no publication date restrictions were selected. Data from the studies, such as age, population, study groups, and outcome measures, were recorded. Multiple meta-analyses were performed with data from the included studies. Evidence suggests that EARR induced by orthodontic treatment is similar, regardless of the technique used. Evidence of the effect of previous dental trauma on EARR during orthodontic treatment is limited. There is less EARR associated with orthodontic treatment in endodontically treated teeth than in vital teeth. These conclusions should be considered with caution due to the low certainty of the evidence.
Topics: Humans; Orthodontic Appliances, Fixed; Root Resorption; Tooth, Nonvital; Clinical Trials as Topic
PubMed: 36206494
DOI: 10.17219/dmp/145369 -
Australian Dental Journal Mar 2016External inflammatory resorption is one of the potential consequences of trauma to the teeth. It occurs when there has been loss of cementum due to damage to the... (Review)
Review
External inflammatory resorption is one of the potential consequences of trauma to the teeth. It occurs when there has been loss of cementum due to damage to the external surface of the tooth root during trauma, plus the root canal system has become infected with bacteria. It is characterized by the radiographic appearance of loss of tooth substance with a radiolucency in the adjacent periodontal ligament and bone. The loss of cementum allows the intracanal bacteria and/or their endotoxins to reach the periodontal ligament more readily and this can lead to the development of the inflammatory resorptive process. External inflammatory resorption can ultimately lead to loss of the tooth if it is not managed in a timely manner. There are some injuries that are very likely to develop this type of resorption and a preventive approach can be adopted by commencing root canal treatment immediately as part of the emergency management of such cases. In cases where the resorptive process is already established, root canal treatment can arrest the resorption and encourage hard tissue repair. The use of a corticosteroid-antibiotic intracanal medicament has been shown to be particularly useful in the prevention and management of external inflammatory resorption. Calcium hydroxide should not be used as an immediate medicament because of its inherent toxicity and irritant properties but it is valuable as a subsequent medicament to encourage hard tissue repair where required. This review outlines the external inflammatory resorptive process and the management strategies that can be employed to prevent it from occurring, and to treat it if already present.
Topics: Calcium Hydroxide; Dental Cementum; Dental Pulp Cavity; Humans; Periodontal Ligament; Root Canal Irrigants; Root Canal Therapy; Root Resorption; Tooth Injuries; Tooth Root
PubMed: 26923450
DOI: 10.1111/adj.12400