4.1.5 Differential diagnosis
Amelogenesis imperfecta
Dentinogenesis imperfecta
Tooth defects from trauma
4.1.6 Diagnosis
History: diet, habits (clenching/bruxism), use of pipes and smokeless tobacco, tooth‐brushing techniques, regurgitation of gastric contents (bulimia, gastro‐oesophageal reflux disease), etc.
Clinical examination: location and type of wear facets and tooth defects
4.1.7 Management
Attrition: no treatment is required unless symptomatic or aesthetically unpleasant
Abrasion: restorative treatment for tooth defects to avoid abrasion
Switch to a minimally abrasive toothpaste
Erosion: removal of the cause
Fluoride application for dentinal hypersensitivity and use of a straw for soft drinks
Medical referral for those with a history of bulimia or gastro‐oesophageal reflux disease
4.1.8 Prognosis
Prognosis is good with appropriate restorative treatment
4.2 Pathological Resorption of Teeth
4.2.1 Definition/Description
Resorption of teeth:A condition associated with either a physiological or a pathological process resulting in the loss of dentin, cementum, and/or bonePhysiological resorption is a feature of shedding of deciduous teethOnly pathological resorption of permanent teeth is discussed in this chapter
External resorption:Resorption is initiated in the periodontium and initially affects the external surfaces of the toothExternal resorption may be further classified as surface, inflammatory, or replacement resorption, or by location as cervical, lateral, or apical resorption
Internal resorption:A defect of the internal aspect of the root following necrosis of odontoblasts because of chronic inflammation and bacterial invasion of the pulp tissue
4.2.2 Frequency
External resorption: common
Internal resorption: rare
4.2.3 Aetiology/Risk Factors
Causes of external resorption:Periapical periodontitisImpacted tooth pressing on the root of an adjacent tooth as evidenced on radiographyUnerupted teeth over time may show signs of resorptionReplanted teethPressure from periapical granuloma, cysts or tumoursOrthodontic treatment (common)
Causes of internal resorption:Unknown (idiopathic)
4.2.4 Clinical Features
External resorption:Asymptomatic in most casesLocalized to one tooth or a group of teethMay occur on any surface of the root and occasionally on the crown of an unerupted tooth
Internal resorption:AsymptomaticClinically, a ‘pink spot’ may be seen at the centre of the crown
4.2.5 Radiographical features
External resorption:Apex of the root is shortened (Figure 4.2a)Opening of the apical foramen may be visibleResorbed areas may show irregular marginsRadiodensity of the resorbed area shows variation
Internal resorption:May be an incidental finding on radiographsRoot canal or pulp chamber shows enlarged radiolucent area (Figure 4.2b)Resorbed area may be symmetrical and the walls may balloon outMargins of the resorbed area are smooth and clearly defined
4.2.6 Microscopic Features
External resorption:Numerous multinucleated dentinoclasts near the resorbed surfaceResorbed areas may show deposition of osteodentin (sign of repair)Granulation tissue in large areas of resorption
Internal resorption:Cellular and vascular fibrous connective tissueMultinucleated dentinoclastsInflammatory cells: lymphocytes, histiocytes and polymorphonuclear leukocytesPresence of woven bone as a sign of repair processFigure 4.2 Resorption. (a) External: cropped orthopantomograph shows external resorption of roots of 47 caused by impacted 48. (b) Internal: radiograph showing radiolucency in the dentinal wall of the pulp chamber of first mandibular molar.(Source: by kind permission of Dr Amar Sholapurkar, James Cook University School of Dentistry, Cairns, Australia.)
4.2.7 Differential diagnosis
Carious lesions for internal resorption and periapical lesions for external root resorption should be considered in the differential diagnosis
4.2.8 Diagnosis
History of dental procedures (orthodontic treatment in particular)
Radiography (cone beam computed tomography preferred)
4.2.9 Management
External resorption:Identification and elimination of the cause
Internal resorption:Root canal treatment
4.2.10 Prognosis
Good prognosis if the cause has been identified and eliminated and appropriate treatment is carried out
4.3 Hypercementosis
4.3.1 Definition/Description
Apposition of excess amounts of normal cementum on the root surface
Also called cemental hyperplasia
Two types occur: isolated and diffuse
4.3.2 Frequency
The prevalence of hypercementosis is not well established
4.3.3 Aetiology/Risk Factors
Isolated (single or a group of teeth) hypercementosis:Most cases are idiopathic and age relatedSome cases show periapical pathosis, parafunctional occlusal trauma, and lack of functional opposition
Diffuse or generalized (involving all teeth) hypercementosis:May be associated with various syndromes and systemic diseases, such as Paget's disease of bone, acromegaly, thyroid goitre, calcinosis, arthritis, and rheumatic fever
4.3.4 Clinical Features
Asymptomatic