Root Resorption: The Interconnection between Dental Trauma, Endodontics and Orthodontics

J. O. Andreasen

《中華民國兒童牙科醫學會雜誌》 1卷3期 (2001/08) Pp. 2-11

https://doi.org/10.6319/JTAPD.2001.1(3).1

並列摘要

By its very nature a traumatic injury may Injure the pulp and/or the periodontium. In such cases progresSIve resorption activity may occur, which after some time may lead to loss of the affected tooth. In other cases a self limiting resorption process is elicited, which presents no hazard to the long term survival of the tooth. In this survey article the emphasis is placed on recent theories of osteoclast activity which may explain the different types of resorption. According to an infection related activity of osteoclasts the stimulus originates from the presence of bacteria on the root surface and/or the pulp cavity. In these cases a progressive root resorption occurs, which continues until the bacteria are eliminated (infection related resorotion)In case of a traumatic injury which is not contaminated with bacteria of the POL and/or the pulp two variations of healing may be seen in the POL or the pulp according to the extent of damage. In case of small damage, a localized resorption attack will take place removIng areas of cementum and sometimes dentine. This occures because the root surfaces is devoid of its protecting cementoblast or )dontoblast covering layer. In these instances he exposed hard tissue surface becomes thetarget of a combined macrophage and osteoclast lttack in preparation to healing. This process is I'elated to an effort to clean up the area before the later influx of healing cells. The origin of l the influx of cells determines the outcome of the healing process. In case of the PDL two sources of cells can become recruited, either POL derived cells wiht a capacity to form new cementum and PDL fibers(repair related resorption), in case of larger injuries (extending 4-9 mm2) alveolar bone recruited cells enter the injury zone forming a dento-alveolar ankylosis (ankylosis related resorption). The above mentioned resorption types should be considered in pedodontic, orthodontic and endodontic treatment planning. Presently, it is has been shown that orthodontic therapy subsequent to traumatic dental injuries a slightly higher risk of repair related esorption. In respect to pedodontics With the rapid decline of caries dental trauma in many countries represent the most important thread to he anterior region. Teeth exhibiting progressive root resorption should imply treatment plans where either early replacement is carried out (i.e. orthodontic closure, transplantation of a premolar to the region, an acid etch bridge, alternatively later insertion of an implacnt can be a treatment solution. Finally,in regard to special endodontic techniques have to be applied in order to cope with the combined pulpal and periodontal pathology.