Root Resorption

Root resorption is a natural process in children that allows them to lose their baby teeth and have effective orthodontic treatment. The tissue that connects the baby tooth to the mouth is resorbed and the teeth can then fall out. However, it is concerning in adults.


In adult teeth, root resorption is the loss of mineralised cementum (calcified substance that covers the roots of teeth) and/or dentine due to odontoclasts (type of bone cell) interacting with dental tissues. Basically, odontoclasts break down the tooth’s structure. It is an uncommon occurrence for adults as the roots are usually protected against internal and external root resorption. It is not fully understood as to what causes it but it is thought habits like teeth grinding and some dental procedures can make someone more susceptible. 

It is a painless condition so it can go undetected until it shows up as a distinct dark spot on a routine x-ray examination. The longer it’s left undiagnosed the more affected the tooth can get. Root resorption occurs in three stages; initiation, resorption and repair. In the initiation stage, if the process continues tooth tissue loss can occur which can lead to the tooth becoming unsalvageable.

Different classifications of dental resorptive lesions

  • Internal Inflammatory Resorption (IIR) - Can occur due to the predentine being damaged by physical, chemical or bacterial irritation. Normally diagnosed in the advanced stages by radiography.
  • Internal Replacement Resorption (IRR) – Quite uncommon and usually related to a history of dental trauma. There is an idea that this is an attempt of IIR to replace the damaged dentine. Usually diagnosed in advanced lesions. Needs to be managed by root canal treatment or surgery needed.
  • External Inflammatory Resorption (EIR) – Occurs in teeth with infected root canals. This case is frequently found after severe dental injuries. The injury triggers external resorption; however if the tooth doesn’t lose its blood supply resorption will be minimal as the osteoclasts will focus on repairing the damaged tooth. Though if the root canal gets infected the bacterial toxins can advance resorption. Root canal treatment needed.
  • External Replacement Resorption (ERR) – Appear due to severe luxation (abnormal separation in the joint) or avulsion (fracture due to trauma). No effective management. Affected teeth can survive for years till they need to be totally replaced.
  • External Cervical Resorption (ECR) – Thought to be caused by osteoclastic cells invading the exposed root surface to form a lesion which then calcifies and develops into tissue. Most of the lesions created usually exhibit a prolonged resorption phase. Management depends on circumstances. Options include endodontic (dentistry dealing with treatment of dental pulp) treatment, extraction and root canal treatment.
  • External Surface Resorption (ESR) – Non-infective. Caused by impacted teeth, orthodontic tooth movement, tumours and cysts. Stops progressing when pressure has been removed.
  • Transient Apical Breakdown (TAB) – Could be linked to repair and removal process of injured tissue. Is basically EIR but with a short resorption phase that is the followed by repair.

There is lots of confusion around the topic due to the many different factors that can cause root resorption. In 1914 it was suggested root resorption is directly linked to orthodontic treatment. However, many studies have shown other explanations for the causes but the factors still remain controversial.

I hope you found this interesting!

Written by Lizzie Nash

Sources
https://www.nature.com/articles/sj.bdj.2018.352
http://www.deardoctor.com/inside-the-magazine/issue-28/root-resorption/
https://www.sciencedirect.com/topics/medicine-and-dentistry/tooth-resorption

https://www.newyorkendodontics.com/
 

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