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Post-developmental Loss of Tooth Structure

Tooth wear, also termed tooth surface loss, is a normal physiologic process that occurs with aging but must be considered pathologic when the degree of destruction creates functional, aesthetic, or dental sensitivity problems. Although the four causes of tooth wear (i.e., attrition, abrasion, erosion, and abfraction), often are discussed as independent pathoses, most of these types of tooth loss are the result of a combination of influences.

 

 

 

 

 


Destruction of teeth also can occur through resorption, which is accomplished by cells located in the dental pulp (i.e., internal resorption) or in the periodontal ligament (PDL) (i.e., external resorption). Internal resorption is a relatively rare occurrence, and most cases develop after injury to pulpal tissues, such as physical trauma or caries-related pulpitis. The resorption can continue as long as vital pulp tissue remains and may result in communication of the pulp with the PDL

Factors Associated with External Resorption

  • Cysts
  • Dental trauma
  • Excessive mechanical forces (e.g., orthodontic therapy)
  • Excessive occlusal forces
  • Grafting of alveolar clefts
  • Hormonal imbalances
  • Hyperparathyroidism
  • Intracoronal bleaching of pulpless teeth
  • Local involvement by herpes zoster
  • Paget disease of bone
  • Periodontal treatment
  • Periradicular inflammation
  • Pressure from impacted teeth
  • Reimplantation of teeth
  • Tumors

Clinical and Radiographic Features

Resorption of dentin or cementum can occur at any site that contacts vital soft tissue. Internal resorption usually is asymptomatic and discovered through routine radiographs. Pain may be reported if the process is associated with significant pulpal inflammation. Two main patterns are seen: 1) inflammatory resorption and 2) replacement or metaplastic resorption

The resorption continues as long as vital pulp remains; typically, the coronal pulp is necrotic with the apical portion remaining vital. The results of pulp testing are variable. In this pattern, the area of destruction usually appears as a uniform, well-circumscribed symmetric radiolucent enlargement of the pulp chamber or canal. When it affects the coronal pulp, the crown can display a pink discoloration (pink tooth of Mummery) as the vascular resorptive process approaches the surface

When it occurs in the root, the original outline of the canal is lost and a balloonlike radiographic dilation of the canal is seen.  If the process continues, the destruction eventually can perforate the lateral root surface, which may be difficult to distinguish from external root resorption. Internal resorption secondary to infectious pulpitis may cease upon necrosis of the responsible cells within the pulp. Although many cases are progressive, some cases are self-limiting and usually arise in traumatized teeth or those that have recently undergone orthodontic or periodontal therapy.

 

         

 

 

 Clinical management

 

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