Resoprtion and Bleaching
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How is resorption classified?
Tronstad – transient inflammatory (surface), progressive inflammatory, internal & external (progressive external, cervical, and replacement)
How do you differentiate internal from external resorption?
Gartner & Mack – radiographic differences: internal – symmetrical, cannot trace canal through lesion, stays centered in shift shots; external – irregular, can trace the canal through the lesion, moves on shift shots
What causes resorption?
- Trope – Two things must happen: 1) the loss or alteration of the protective layer (pre-cementum or pre-dentin); 2) inflammation must occur to the unprotected root surface
- Osteoclasts will not adhere to or resorb unmineralized matrix; if the cemental layer is lost or damaged, the inflammatory stimulators can pass from an infected pulp space through the dentinal tubules into the PDL resulting in both bone resorption and root resorption
Discuss internal resorption and tx approach?
- Wedenberg – normal pulp is replaced with periodontal-like connective tissue
- Turkun - >90% success with non-perforating using 1 wk CaOH2 and warm GP; 25% success with perforating defect
- Stamos – ultrasonics & warm GP
Discuss external inflammatory resorption and tx approach?
- Johnson – Necrotic teeth with AP had more apical resorption than those with a normal periapex or IP
- Trope – Long term (12 wk) CaOH2 tx may be more effective than 1wk for established inflammatory root resorption
Discuss external cervical resorption an tx approach?
- Heithersay – strong association with ortho, trauma & bleaching; distinguished class 1-4 defects; recommended topical 90% trichloracetic acid, curettage & GI restoration (endo tx)
- Frank – Tx and prognosis based on complete debridement of the defect
Can ortho tx cause resorption?
Reitan – ortho movement too quickly = resorption
Who described internal bleaching?
- Spasser – described Na perborate walking bleach
- Nutting & Poe – recommended Super oxol + Na Perborate for greater efficacy; change every week
Can bleaching cause resorption?
- Madison & Walton – bleaching factors associated with resorption were heat with 30% hydrogen peroxide
- Papadopoulos – gaps at the CEJ lead to increased leakage of hydrogen peroxide
What can you do to prevent resorption?
Rotstein – use a 2mm base material at the CEJ; also recommends water instead of super oxol
Can tetracycline stained teeth be bleached?
Walton – only internal bleaching is effective
Does bleaching affect bonding of composite restorations?
- Titley & Torneck – H2O2 may inhibit resin polymerization
- Demarco – short term use of Ca(OH)2 restores bonding capabilities
Is internal bleaching effective?
Glockner - 5 yrs later; pts are 98% satisfied; 80% subjective success for dentists
Is vital tooth bleaching effective?
- Haywood – 92% experience some lightening; 66% experienced transient side effects
- Ritter – safe for the pulp up to 10 yrs post-op; bleaching effectiveness may decline
What would you like to do?
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