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Multiple idiopathic external root resorption.

An unusual case of multiple idiopathic root resorption involving all of the maxillary and mandibular incisor, canine, and premolar teeth is presented. A review of the literature reveals that this case is unusual in that, although other cases of multiple idiopathic root resorption have been described, the site of the resorption has been at the cervical margin in most reports, not at the apices as in this case. In other reports in which the resorption did affect the apices, the resorption usually affected only one, two, or three teeth. The pattern of resorption in this case, affecting only teeth with deciduous precursors, appears to be unique.

Adolescent

Cellular roles in physiological root resorption of deciduous teeth in the cat.

This study has attempted to assess the importance of mesenchymal cells, fibroblasts, cementoblasts, and mononuclear phagocytes (i.e., macrophages) in physiological root resorption of feline deciduous teeth. Deciduous incisors of three- to six-month-old kittens undergoing root resorption were investigated by means of electron microscopy. In an early phase of root resorption, the resorption organ consisted of many fibroblasts and relatively few macrophages and odontoclasts, the last with a wide, clear zone and narrow, immature, ruffled border. In the active phase of root resorption, the resorption organ contained many odontoclasts with a well-developed ruffled border and a reduced clear zone, cementoblasts, fibroblasts, macrophages, neutrophils, and many blood vessels. Cementoblasts were present usually on the resorbing dentin surface adjacent to odontoclasts and, in many cases, these cells communicated with each other via gap junctions. Cementoblasts frequently extended broad cell processes with secretion granules and with phagosomes containing collagen fibrils into the dentinal tubules exposed to resorption lacunae. Some macrophages exhibiting a clear zone-like structure also appeared on resorbing dentin surfaces. In the resting phase of root resorption, the dentin surface was covered mostly with cementoblasts resembling bone lining cells. There was an occasional macrophage, but no odontoclasts were observed during this phase. During removal of the periodontal ligament concomitant with root resorption, many fibroblasts phagocytosed mature collagen fibrils, as well as amorphous fluffy material. These results suggest that these mesenchymal cells, as well as odontoclasts, are essential for the cellular removal of dental hard and soft tissues during shedding of feline deciduous teeth.

Animals

Dynamics of dentoalveolar ankylosis and associated root resorption.

The present experimental studies in monkeys were undertaken to study the initiation and progression of dentoalveolar ankylosis of replanted teeth and associated root resorption. Maxillary and mandibular lateral incisors were extracted and replanted after an extraoral period of 15 min or 1 h. Teeth with an extraoral period of 1 h were endodontically treated. Half the number of monkeys were given antibiotics at the time of replantation. The observation periods varied from 2 days to 40 weeks. Irrespective of the length of the extraoral period, initial root resorption and minor areas of ankylosis were found 1 week after replantation. The initial ankylosis was not preceded by root resorption. In teeth replanted after an extraoral period of 15 min the ankylotic area did not increase with increasing time after replantation. Instead the periodontal membrane was re-established, separating the root surface from the alveolar bone. In teeth replanted after an extraoral period of 1 h, the initial ankylotic area increased with increasing time after replantation. Eight weeks and more after replantation, most of the periodontal membrane was replaced by bone covered by osteoblasts and occasional osteoblasts that were in continuity with the endosteal cells outlining the marrow spaces of the alveolar bone. The cementum and dentin were then gradually resorbed with increasing time after replantation. Antibiotics given at the time of replantation reduced the initial inflammation in the periodontal membrane and the inflammatory root resorption after all observation periods and it also seemed to some extent to prevent bacteria from entering the necrotic pulp tissue. Based on the present results it is suggested that root resorption associated with dentoalveolar ankylosis is initiated by endosteal osteoblasts and is thus a hormonally regulated process. This is in contrast to inflammatory root resorption, which seems to be triggered by inflammatory cells.

Animals

[Histological study on root resorption of upper permanent incisor].

In the permanent tooth, physiological root resorption does not occur, but inflammatory resorption occurs due to the orthodontic force, ectopic eruption of neighboring tooth and others. In this study, the morphological and histological investigation of the root resorption of the upper permanent incisors caused by the ectopic eruption of the canine was carried out. The left central incisor and lateral incisor from a 12-year-old female were examined. The roots were resorbed almost completely, and in part the resorption extended into the enamel. The results were as follows: 1. In the resorbed dentine, two types of resorption lacuna were observed. One was in direct contact with resorption tissue and the other was repaired with cementum-like tissue. 2. In the resorption lacuna, no odontoclast was recognized. 3. The pulp tissue was normal and the internal resorption was not seen. 4. On the wall of the root canal connected with root resorption, a large amount of hard tissue was formed, and on the external surface of the root, secondary cementum was formed on the primary cementum. 5. Under the scanning electron microscope, the clear dentine tubules in the resorption lacuna, the shallow, unclear resorption lacuna with deposition of the hard tissue and the various steps between them were observed.

Child

[Apical root resorption of maxillary central incisors following orthodontic treatment].

This research shows the relationship between orthodontic treatment and apical root resorption. The latest edgewise appliance with a pre-adjusted bracket (Alexander method) was used in the present experimentation. Examination by roentgen cephalometry and intraoral radiography was performed before and after the maxillary central incisors had been moved orthodontically. The conclusion is that there was no significant difference among the grade 0, 1, 2 and 3 of apical root resorption in the change of long axis inclination of the maxillary central incisors. But there was a significant difference among the grade 0, 1, 2 and 3 of root resorption in the distance of the apical root movement. The most apical root resorption was observed when the apical root was moved lingually.

Humans

Microscopical aspects of root resorption of human deciduous teeth.

In order to obtain detailed information on the tissue changes which occur during physiological root resorption, 52 human deciduous teeth at various stages of resorption were studied under light microscopy. The early stage of root resorption was defined as resorption of not more than one third of the root length; the late stage was defined as resorption of more than one third. A close topographical interrelationship was found among che sites of pressure of the permanent tooth, the extent of root resorption and the types of tissue changes. Linear resorption (which reflects suspension or marked slowing down of resorption) and redeposition of hard tissue were more pronounced at the early stage of resorption, while lacunar resorption was more pronounced at the late stage. There were pronounced haemorrhagic and inflammatory infiltrates within the pulp at the late stage of resorption and the subodontoblastic cells disappeared as the infiltrates took over the tooth. False denticles were found frequently, especially at the early stage of resorption. Unexpectedly, acellular cementum was found to be deposited against secondary dentine at the cuspidal tip of the pulp chamber of seven teeth, independently of any sign of resorption nearby. These data indicate that: 1) the pressure exerted by a permanent tooth is the most important factor in the differentiation of odontoclasts. 2) the extent of lacunar (i.e., active) resorption correlates directly with the resorption rate, which is higher at the late stage of root resorption. 3) inflammation is a consequence, rather than a cause, of resorption; it may lead to the loss of subodontoblastic cells and a consequent decrease in the ability of the pulp cells to replace damaged odontoblasts. 4) the pulp of the deciduous tooth might be cementogenic in some way, given that about 13% of the samples were found to be so.

Adolescent

Progression of root resorption following replantation of human teeth after extended extraoral storage.

Avulsed human permanent teeth subjected to a minimum of 1 h dry extraoral storage before replantation were followed radiographically for an average of 4.8 years. The depth of root resorption cavities was assessed using a radiographic index, and the rate of root resorption was defined as the index change over time. The frequency of inflammatory and replacement resorption was determined at each observation time. Replacement resorption increased in frequency with time in all patients. In teeth endodontically treated within 3 weeks of replantation, minimal inflammatory resorption was found regardless of the age of the patients. In teeth where endodontic treatment was performed more than 3 weeks after replantation, the frequency of inflammatory resorption was significantly higher in young patients but not in older patients, up to more than 3 years after replantation. The rate of root resorption was found to be related to age. In patients 8-16 years old at the time of avulsion the rate of root resorption was significantly higher compared with patients 17-39 years old. Age had a higher impact on the rate of root resorption compared with the delay in endodontic treatment after replantation. It was concluded that a tooth replanted with a necrotic periodontal membrane will become ankylosed and resorbed within 3-7 years in young patients, whereas a tooth replanted under similar conditions in older patients may remain in function for a considerably longer time.

Adolescent

[A study of root resorption of deciduous teeth in dogs. Influence of successional tooth germ and occlusal force].

The role of successional tooth germ and occlusal force in root resorption of mandibular second deciduous molars was studied in 24 beagle dogs by means of radiographic and histologic evaluations. 70 days after birth their mandibular right third permanent premolar germs were surgically removed, and in 10 of the dogs the maxillary right and left second deciduous molars were extracted to decrease the occlusal force on the mandibular second deciduous molars. 1) When successional tooth germs were present, whether the occlusal force was normal or decreased, the alveolar bone and deciduous tooth adjacent to the tooth germ were resorbed, accompanied by eruption of the permanent tooth. After the resorption of the deciduous tooth reached half of the root, many odontoclasts were observed in the dental pulp of the deciduous tooth. The root resorption was hastened by internal resorption. 2) When successional tooth germs were removed, whether the occlusal force was normal or decreased, the root resorption was delayed. The resorption from the root surface progressed very slowly, but shortly after this resorption reached the pulp, internal resorption occurred and the deciduous tooth was resorbed in short time. 3) When the occlusal force was decreased, in the deciduous teeth in which successional tooth germs were present, the tooth resorption tended to delay to a later time. However in the deciduous teeth from which the successional tooth germs were removed, the processes of tooth resorption was very different in individuals, the difference between tooth resorption in normal occlusal force and in decreased occlusal force was not clear. 4) In all groups, shallow resorption on the deciduous root surface was observed before the successional tooth started to erupt, and this resorption was apart from the tooth germ. By repeating resorptive periods and resting periods, this resorption progressed according to the increase in age, and in the resting period, resorption was repaired by new deposits of cementum.

Animals

[Apical root resorption during orthodontic treatment].

Pre- and posttreatment radiographs of 2050 orthodontically treated patients were examined and apical root resorptions of more than 2 mm were identified. 30 patients (211 teeth) were affected. Treatment characteristics and objectives of this group (with severe apical root resorption) were compared to a treated group of 30 patients (with no resorption) to determine clinical risk factors. Extrusion, but especially jiggling and a long treatment period were found to be significantly more frequent in the group exhibiting resorption than in the control group. Pathogenesis of treatment-induced root resorption is discussed in respect to histological results.

Adolescent

Effect of placement of occlusive membranes on root resorption and bone regeneration during healing of circumferential periodontal defects in dogs.

Previous studies indicate that root resorption is a frequent sequela to significant amounts of periodontal repair in animal models. A model was developed in labrador dogs to study periodontal wound healing in large circumferential defects in the absence of influence from the oral environment. A polytetrafluorethylene membrane of 1 micron pore size (GORE-TEX) was used to occlude cells from specific tissues from populating the healing dentin-connective tissue wound. 3 modalities were studied: (1) control, in which no membrane and therefore no cell occlusion was used, (2) flap occlusion, in which the internal surface of the flap was lined with the membrane preventing contribution of cells from the flap, (3) bone occlusion, in which the reduced alveolar bone was lined with the membrane preventing contribution from bone cells. Wound closure included total submergence of teeth and membranes. The membranes remained incorporated and no exposure of membranes or teeth occurred during the 3 months healing period. Histology revealed bone regrowth in all 3 treatment modalities. It is suggested that inductive elements in the connective tissue or dentin, or bone cells from periosteum were responsible for bone regrowth in the bone membrane treatment modality. No significant difference was seen for root resorption between the 3 treatment modalities. This study found that physical occlusion of cells from the inside of the surgical flap, or from the pre-existing bone, is not sufficient to prevent root resorption in periodontal wound healing.

Alveolar Process

Patient characteristics and treatment variables associated with apical root resorption during orthodontic treatment.

Multivariate analysis of patient characteristics and clinical variables was carried out with the maximum single maxillary incisor apical root resorption for each patient as the dependent variable. Root lengths were measured in standardized intraoral radiographs from 485 consecutively treated patients, 11.5 to 25 years of age. The correlation matrix revealed a complex pattern of positive and negative associations between the six pretreatment and seven treatment variables. Variables found to contribute significantly to apical root resorption were overjet, history of trauma to maxillary incisors before initiation of treatment, time of treatment with rectangular arch wires, time of treatment with Class II elastics, lip/tongue dysfunction, and/or history of finger-sucking habits persisting beyond the age of 7 years, and impacted maxillary canines to be corrected orthodontically. Clinical application of an open activator was significantly correlated with overjet but negatively correlated with apical root resorption, with the use of rectangular arch wires and/or Class II elastics, and with total banding time.

Adolescent

Multiple idiopathic external root resorption. A case report.

An unusual case of multiple idiopathic external apical root resorption affecting all four quadrants, in a patient with a history of narcotic intravenous drug addiction and liver disease, is reported. The literature relating to a systemic etiology for external root resorption is briefly reviewed.

Adult

[Rates of root resorption in orthodontically moved, periodontally affected and healthy teeth].

The aim of this SEM-study was to obtain a quantitative analysis for comparing the extent of root resorption in orthodontically treated teeth, in teeth with reduced periodontium and in healthy teeth. By using a statistically valid method the highest amount of root resorption was established in orthodontically moved teeth. The teeth with loss of attachment showed a significantly higher amount of root resorption than healthy teeth. This finding complicates orthodontic treatment in teeth with reduced periodontal attachment.

Adolescent

Assessment of external root resorption using digital subtraction radiography.

Digital subtraction radiography was investigated for its capability to detect and quantify experimentally produced external root resorptive defects in teeth. Using a long source to object X-ray technique and E-speed film, serial radiographs of teeth with artificial lesions in a dry human skull (soft tissue simulated) were obtained. Receiver operating characteristic analysis was used to evaluate the diagnostic performance for each imaging system (conventional versus subtraction). To explore the quantitative assessment potential of digital subtraction radiography, images were produced after sequential demineralization by HCl. The acid solution was analyzed for calcium concentration by atomic absorption spectrophotometry. Three-dimensional histogram quantification for each subtracted image was performed. In overall performance for detecting experimentally produced external root resorption, digital subtraction radiography was found to be significantly superior to conventional radiography. In addition, digital subtraction radiography can provide quantification of experimentally produced external root resorptive defects.

Humans

Orthodontic root resorption studied by electron microscopy.

The present study supports previous findings that root resorption takes place simultaneously with and after the elimination of hyalinized tissue. The cementoid layer and the more mature periodontal collagen fibers adjacent to cementum are possible barriers preventing root resorption. The microenvironment around hyalinized tissue is favorable for the introduction of hard-tissue resorbing cells. The findings show that the elimination of hyalinized tissue leads to the removal of the cementoid and the mature collagen thus leaving a raw cemental surface without a barrier. It is therefore hypothesized that such an area is readily attacked by odontoclasts. Once resorption lacunae are established, the cementum is resorbed from the rear as an undermining process. By continued orthodontic force application the resorption process will proceed even after all hyalinized tissue is eliminated. If the orthodontic force is discontinued or falls under a certain level, the resorption lacunae are repaired.

Animals

Multiple idiopathic root resorption in monozygotic twins: case report.

Idiopathic root resorption of the permanent dentition is encountered occasionally during routine dental examinations. A case is presented of this relatively rare condition in monozygotic twins. Examination of siblings and the patients' mother did not show a resorptive process. A 6-month follow-up examination revealed the resorption to be arrested.

Adolescent

[Root resorption and endodontic treatment].

Some types of tooth root resorption respond favourably to endodontic treatment. Sometimes compromising factors demand particular treatment approaches and techniques. These will be described, in connection with their genesis.

Humans