Radiographic Changes Due to Tooth Resorption

Radiographic Changes due to Resorption

Radiographic Changes due to Resorption

Two types of resorption are associated with teeth: physiologic

Two types of resorption are associated with teeth: physiologic

and pathologic.

and pathologic.

Physiologic resorption is a process that is seen with the

Physiologic resorption is a process that is seen with the

normal shedding of primary teeth. The roots of a primary

normal shedding of primary teeth. The roots of a primary

tooth are resorbed as the permanent successor moves in an

tooth are resorbed as the permanent successor moves in an

occlusal direction, the primary tooth is shed when resorption

occlusal direction, the primary tooth is shed when resorption

of the roots is complete. Pathologic resorption is a regressive

of the roots is complete. Pathologic resorption is a regressive

alteration of tooth structure that is observed when a tooth is

alteration of tooth structure that is observed when a tooth is

subjected to abnormal stimuli. Resorption of teeth can be

subjected to abnormal stimuli. Resorption of teeth can be

described as external or internal depending on the location of

described as external or internal depending on the location of

the resorption process.

the resorption process.

External resorption is seen along the periphery of the root

External resorption is seen along the periphery of the root

surface and is often associated with reimplanted teeth,

surface and is often associated with reimplanted teeth,

abnormal mechanical forces, trauma, chronic inflammation,

abnormal mechanical forces, trauma, chronic inflammation,

tumors and cysts, impacted teeth, or idiopathic causes. External

tumors and cysts, impacted teeth, or idiopathic causes. External

resorption most often affects the apices of teeth, the apical

resorption most often affects the apices of teeth, the apical

region appears blunted, and the length of the root appears

region appears blunted, and the length of the root appears

shorter than normal. Both the lamina dura and bone around the

shorter than normal. Both the lamina dura and bone around the

blunted apex appear normal. External resorption is not

blunted apex appear normal. External resorption is not

associated with any signs or symptoms and is not detected

associated with any signs or symptoms and is not detected

clinically. Teeth that undergo external resorption do not

clinically. Teeth that undergo external resorption do not

exhibit mobility. There is no effective treatment for external

exhibit mobility. There is no effective treatment for external

resorption.

resorption.

Internal resorption  occurs within the crown or root of a tooth

Internal resorption  occurs within the crown or root of a tooth

and involves the pulp chamber, pulp canals, and surrounding

and involves the pulp chamber, pulp canals, and surrounding

dentin. Precipitating factors such as trauma, pulp capping, and

dentin. Precipitating factors such as trauma, pulp capping, and

pulp polyps are believed to stimulate the internal resorption

pulp polyps are believed to stimulate the internal resorption

process. Internal resorption appears as a round-to-ovoid

process. Internal resorption appears as a round-to-ovoid

radiolucency in the midcrown or midroot portion of a tooth.

radiolucency in the midcrown or midroot portion of a tooth.

Internal resorption is generally asymptomatic. Treatment is

Internal resorption is generally asymptomatic. Treatment is

variable, endodontic therapy may be used if the resorptive

variable, endodontic therapy may be used if the resorptive

process has not physically weakened the tooth. If the tooth is

process has not physically weakened the tooth. If the tooth is

weakened by the resorptive process, extraction is

weakened by the resorptive process, extraction is

recommended.

recommended.

In many dental procedures, information about the size and location of

In many dental procedures, information about the size and location of

the pulp cavity must be obtained before treatment. Without dental

the pulp cavity must be obtained before treatment. Without dental

radiographs, examination of the pulp chambers and canals is

radiographs, examination of the pulp chambers and canals is

impossible. Pulpal sclerosis, pulpal obliteration, and pulp stones are

impossible. Pulpal sclerosis, pulpal obliteration, and pulp stones are

common conditions of the pulp cavity that can be seen on dental

common conditions of the pulp cavity that can be seen on dental

radiographs.

radiographs.

Pulpal Sclerosis

Pulpal Sclerosis

Pulpal sclerosis is a diffuse calcification of the pulp chamber and pulp

Pulpal sclerosis is a diffuse calcification of the pulp chamber and pulp

canals of teeth that result in a pulp cavity or decreased size. For

canals of teeth that result in a pulp cavity or decreased size. For

unknown reasons, pulpal sclerosis is associated with aging. Pulpal

unknown reasons, pulpal sclerosis is associated with aging. Pulpal

sclerosis appease as a pulp cavity that is reduced in size. No clinical

sclerosis appease as a pulp cavity that is reduced in size. No clinical

features are associated with pulpal sclerosis. Pulpal sclerosis is

features are associated with pulpal sclerosis. Pulpal sclerosis is

generally considered an incidental radiographic finding that is of little

generally considered an incidental radiographic finding that is of little

clinical significance unless endodontic therapy is indicated.

clinical significance unless endodontic therapy is indicated.

Some conditions (e.g., attrition, abrasion, caries, dental restorations,

Some conditions (e.g., attrition, abrasion, caries, dental restorations,

trauma, and abnormal mechanical forces) may act as irritants to the pulp

trauma, and abnormal mechanical forces) may act as irritants to the pulp

and stimulate the production of secondary dentin, which results in

and stimulate the production of secondary dentin, which results in

obliteration of the pulp cavity. On a dental radiograph, a tooth with

obliteration of the pulp cavity. On a dental radiograph, a tooth with

pulpal obliteration does not appear to have a pulp chamber or pulp

pulpal obliteration does not appear to have a pulp chamber or pulp

canals. Teeth that exhibit pulpal obliteration are nonvital and do not

canals. Teeth that exhibit pulpal obliteration are nonvital and do not

require treatment.

require treatment.

Pulp Stones

Pulp Stones

Pulp stones are calcifications that are found in the pulp chamber or pulp

Pulp stones are calcifications that are found in the pulp chamber or pulp

canals of teeth. The cause of pulp stones is unknown. On a dental

canals of teeth. The cause of pulp stones is unknown. On a dental

radiograph, pulp stones appear as round, ovoid, or cylindrical

radiograph, pulp stones appear as round, ovoid, or cylindrical

radiopacities, some pulp stones may conform to the shape of the pulp

radiopacities, some pulp stones may conform to the shape of the pulp

chamber or canal. Pulp stones may vary in shape, size, and number.

chamber or canal. Pulp stones may vary in shape, size, and number.

Pulp stones do not cause symptoms and do not require treatment.

Pulp stones do not cause symptoms and do not require treatment.

Radiographic Features of Periapical Lesions

Radiographic Features of Periapical Lesions

A periapical lesion is a lesion that is located around the apex

A periapical lesion is a lesion that is located around the apex

(tip of the root) of a tooth. The use of dental radiographs is

(tip of the root) of a tooth. The use of dental radiographs is

particularly important in the identification of periapical

particularly important in the identification of periapical

problems. Periapical lesions cannot be evaluated on a clinical

problems. Periapical lesions cannot be evaluated on a clinical

basis alone. On dental radiographs periapical lesions may

basis alone. On dental radiographs periapical lesions may

appear either radiolucent (dark or black) or radiopaque (light or

appear either radiolucent (dark or black) or radiopaque (light or

white).

white).

Periapical Radiolucencies

Periapical Radiolucencies

Periapical granulomas, cysts, and abscesses are common

Periapical granulomas, cysts, and abscesses are common

periapical radiolucencies that can be seen on dental

periapical radiolucencies that can be seen on dental

radiographs. These lesions cannot be diagnosed by their

radiographs. These lesions cannot be diagnosed by their

radiographic appearances alone, instead, diagnosis is based on

radiographic appearances alone, instead, diagnosis is based on

the clinical features and radiographic and microscopic

the clinical features and radiographic and microscopic

appearances. Because it is impossible to distinguish between

appearances. Because it is impossible to distinguish between

these three periapical lesions based on their radiographic

these three periapical lesions based on their radiographic

appearance, the dental radiographer should refer to these

appearance, the dental radiographer should refer to these

lesions simply as periapical radiolucencies.

lesions simply as periapical radiolucencies.

A periapical granuloma is a localized mass of chronically inflamed

A periapical granuloma is a localized mass of chronically inflamed

granulation tissue at the apex of a nonvital tooth. The periapical

granulation tissue at the apex of a nonvital tooth. The periapical

granuloma results from pulpal death and necrosis and is the most

granuloma results from pulpal death and necrosis and is the most

common sequela of pulpitis (inflammation of the pulp).

common sequela of pulpitis (inflammation of the pulp).

A periapical granuloma may give rise to a periapical cyst or periapical

A periapical granuloma may give rise to a periapical cyst or periapical

abscess. A tooth with a periapical granuloma is typically asymptomatic

abscess. A tooth with a periapical granuloma is typically asymptomatic

but has a previous history of prolonged sensitivity to heat or cold.

but has a previous history of prolonged sensitivity to heat or cold.

Treatment for a periapical granuloma may include endodontic therapy or

Treatment for a periapical granuloma may include endodontic therapy or

removal of the tooth along with curettage of the apical region.

removal of the tooth along with curettage of the apical region.

On a dental radiograph a periapical granuloma is initially seen as a

On a dental radiograph a periapical granuloma is initially seen as a

widened periodontal ligament space at the root apex. With time, the

widened periodontal ligament space at the root apex. With time, the

widened periodontal ligament space enlarges and appears as a round or

widened periodontal ligament space enlarges and appears as a round or

ovoid radiolucency. The lamina dura is not visible between the root apex

ovoid radiolucency. The lamina dura is not visible between the root apex

and the apical lesion.

and the apical lesion.

A periapical cyst (also known as a radicular cyst) is a

A periapical cyst (also known as a radicular cyst) is a

lesion that develops over a prolonged period of time,

lesion that develops over a prolonged period of time,

cystic degeneration takes place within a periapical

cystic degeneration takes place within a periapical

granuloma and results in a periapical cyst. The periapical

granuloma and results in a periapical cyst. The periapical

cyst results from pulpal death and necrosis. Periapical

cyst results from pulpal death and necrosis. Periapical

cysts are the most common of all tooth-related cysts and

cysts are the most common of all tooth-related cysts and

comprise 50 to 70% of all cysts in the oral region.

comprise 50 to 70% of all cysts in the oral region.

Periapical cysts are typically asymptomatic. Treatment

Periapical cysts are typically asymptomatic. Treatment

may include endodontic therapy or extraction of the tooth

may include endodontic therapy or extraction of the tooth

as well as curettage of the apical region. On a dental

as well as curettage of the apical region. On a dental

radiograph the typical periapical cyst appears as a round

radiograph the typical periapical cyst appears as a round

or ovoid radiolucency.

or ovoid radiolucency.

The periapical abscess is a localized collection of pus in the periapical

The periapical abscess is a localized collection of pus in the periapical

region of a tooth that results from pulpal death. Periapical abscesses may be

region of a tooth that results from pulpal death. Periapical abscesses may be

acute or chronic. An acute periapical abscess has features of an acute pus-

acute or chronic. An acute periapical abscess has features of an acute pus-

producing process and inflammation. An acute abscess may result from an

producing process and inflammation. An acute abscess may result from an

acute inflammation of the pulp or an area of chronic infection, such as a

acute inflammation of the pulp or an area of chronic infection, such as a

periapical granuloma. A chronic periapical abscess has features of a long-

periapical granuloma. A chronic periapical abscess has features of a long-

standing, low-grade, pus-producing process. A chronic abscess may develop

standing, low-grade, pus-producing process. A chronic abscess may develop

from an acute abscess or a periapical granuloma.

from an acute abscess or a periapical granuloma.

An acute periapical abscess is painful; the pain may be intense, throbbing,

An acute periapical abscess is painful; the pain may be intense, throbbing,

and constant. The tooth is nonvital and is sensitive to pressure, percussion,

and constant. The tooth is nonvital and is sensitive to pressure, percussion,

and heat. Chronic periapical abscesses are usually asymptomatic because

and heat. Chronic periapical abscesses are usually asymptomatic because

the pus drains through bone or the periodontal ligament space. Clinically, a

the pus drains through bone or the periodontal ligament space. Clinically, a

gumboil may be seen in the apical region of the tooth at the site of drainage.

gumboil may be seen in the apical region of the tooth at the site of drainage.

Treatment of the periapical abscess includes drainage and endodontic

Treatment of the periapical abscess includes drainage and endodontic

therapy or extraction.

therapy or extraction.

With an acute periapical abscess, no radiographic change may be evident.

With an acute periapical abscess, no radiographic change may be evident.

Early radiographic changes include an increased widening of the

Early radiographic changes include an increased widening of the

periodontal ligament space. A chronic periapical abscess appears as a round

periodontal ligament space. A chronic periapical abscess appears as a round

or ovoid apical radiolucency with poorly defined margins. The lamina dura

or ovoid apical radiolucency with poorly defined margins. The lamina dura

cannot be seen between the root apex and the radiolucent lesion.

cannot be seen between the root apex and the radiolucent lesion.

Condensing osteitis, sclerotic bone, and hypercementosis are a

Condensing osteitis, sclerotic bone, and hypercementosis are a

few of the common periapical radiopacities that can be seen on

few of the common periapical radiopacities that can be seen on

dental radiographs. Unlike periapical radiolucencies, periapical

dental radiographs. Unlike periapical radiolucencies, periapical

radiopacities can be diagnosed based on their radiographic

radiopacities can be diagnosed based on their radiographic

appearance, clinical information, and patient history.

appearance, clinical information, and patient history.

Condensing Osteitis

Condensing Osteitis

Condensing osteitis (also known as chronic focal sclerosing

Condensing osteitis (also known as chronic focal sclerosing

osteomyelitis (inflammation of bone) is a well-defined

osteomyelitis (inflammation of bone) is a well-defined

radiopacity that is seen below the apex of a nonvital tooth with

radiopacity that is seen below the apex of a nonvital tooth with

a history of long-standing pulpitis. The opacity represents a

a history of long-standing pulpitis. The opacity represents a

proliferation of periapical bone that is a result of a low-grade

proliferation of periapical bone that is a result of a low-grade

inflammation or mild irritation. The inflammation that

inflammation or mild irritation. The inflammation that

stimulates condensing osteitis occurs in response to pulpal

stimulates condensing osteitis occurs in response to pulpal

necrosis. Condensing osteitis may vary in size and shape and

necrosis. Condensing osteitis may vary in size and shape and

does not appear to be attached to the tooth root.

does not appear to be attached to the tooth root.

Condensing osteitis is the most common periapical radiopacity observed

Condensing osteitis is the most common periapical radiopacity observed

in adults. The tooth most frequently involved is the mandibular first

in adults. The tooth most frequently involved is the mandibular first

molar. Teeth associated with condensing osteitis are nonvital and

molar. Teeth associated with condensing osteitis are nonvital and

typically have a large carious lesion or large restoration. Because

typically have a large carious lesion or large restoration. Because

condensing osteitis is believed to represent a physiologic reaction of

condensing osteitis is believed to represent a physiologic reaction of

bone to inflammation, no treatment is necessary.

bone to inflammation, no treatment is necessary.

If chronic osteomyelitis is suspected from the clinical examination, in

If chronic osteomyelitis is suspected from the clinical examination, in

addition to a complete series of plain films, CT is the imaging method of

addition to a complete series of plain films, CT is the imaging method of

choice. CT, with the ability to demonstrate sequestra and periosteal new

choice. CT, with the ability to demonstrate sequestra and periosteal new

bone, is important for a correct diagnosis and allows accurate staging of

bone, is important for a correct diagnosis and allows accurate staging of

the disease, which is important for future assessment of healing.

the disease, which is important for future assessment of healing.

Sclerotic bone (also known as osteosclerosis or idiopathic

Sclerotic bone (also known as osteosclerosis or idiopathic

periapical osteosclerosis) is a well-defined radiopacity that

periapical osteosclerosis) is a well-defined radiopacity that

is seen below the apices of vital, noncarious teeth. The

is seen below the apices of vital, noncarious teeth. The

cause of sclerotic bone is unknown, however, it is not

cause of sclerotic bone is unknown, however, it is not

believed to be associated with inflammation. The lesion is

believed to be associated with inflammation. The lesion is

not attached to a tooth and varies in size and shape. The

not attached to a tooth and varies in size and shape. The

margins may appear smooth or irregular and diffuse. The

margins may appear smooth or irregular and diffuse. The

borders are continuous with adjacent normal bone, and no

borders are continuous with adjacent normal bone, and no

radiolucent outline is seen. Sclerotic bone is asymptomatic

radiolucent outline is seen. Sclerotic bone is asymptomatic

and is usually discovered during routine radiographic

and is usually discovered during routine radiographic

examination.

examination.

Hypercementosis is the excess deposition of cementum on root

Hypercementosis is the excess deposition of cementum on root

surfaces. Hypercementosis results from supraeruption,

surfaces. Hypercementosis results from supraeruption,

inflammation, or trauma, sometimes there is no obvious cause. On

inflammation, or trauma, sometimes there is no obvious cause. On

dental radiographs hypercementosis is visible as an excess amount

dental radiographs hypercementosis is visible as an excess amount

of cementum along all or part of a root surface. The apical area is

of cementum along all or part of a root surface. The apical area is

most often affected and appears enlarged and bulbous. Root areas

most often affected and appears enlarged and bulbous. Root areas

affected by hypercementosis are separated from periapical bone by

affected by hypercementosis are separated from periapical bone by

a normal appearing periodontal ligament space, the surrounding

a normal appearing periodontal ligament space, the surrounding

lamina dura appears normal as well.

lamina dura appears normal as well.

No signs or symptoms are associated with hypercementosis, most

No signs or symptoms are associated with hypercementosis, most

cases are discovered during routine radiographic examination.

cases are discovered during routine radiographic examination.

Teeth affected by hypercementosis are vital and do not require

Teeth affected by hypercementosis are vital and do not require

treatment.

treatment.