Etiologic factors in Pulpal Diseases 1.According to Grossman 1.Physical A. Mechanical i.Trauma ii. Pathologic Wear iii.Cracked tooth Syndrome iv.Barodontalgia B.Thermal 2.Chemical A. Phosphoric Acid, Acrylic monomers B.Erosions 3.Bacterial A.Toxins B.Direct invasion of pulp C.Anachoresis 2.According to Ingle -5th edition I. Bacterial A. Coronal ingress 1. Caries 2. Fracture a. Complete 2. Retrogenic infection a. Periodontal pocket b. Periodontal abscess 3. Hematogenic II. Traumatic A. Acute 1. Coronal fracture 2. Radicular fracture 3. Vascular stasis 4. Luxation 5. Avulsion b. Incomplete (cracks, infraction) 3. Non fracture trauma 4. Anomalous tract a. Dens invaginatus (aka dens in dente) b. Dens evaginatus c. Radicular lingual groove (palatogingival groove) B. Chronic 1. Adolescent female bruxism 2. Traumatism 3. Attrition or abrasion 4. Erosion B. Radicular ingress 1. Caries Cavity liners 5. Restorative materials 1. Pin insertion 8. Pulp exposure 7. Restoration 1. Dentin bonding agents 6.III. Disinfectants 1. Pulp horn extensions 5. Rhinoplasty J. Laser burn H. Pulp hemorrhage 6. Silver nitrate 2. Force of cementing 4. Heat of preparation 2. Impression taking B. Chemical A. Intubation for general anesthesia IV. Intentional extirpation and root canal filling D. Plastics 3. Orthodontic movement E. Complete b. Osteotomy K.Periradicular curettage I. Electrosurgery G. Etching agents 4. Incomplete 3. Depth of preparation 3. Sodium fluoride . Periodontal curettage F. Phenol 3. Iatral A. Tubule blockage agents B. Insertion 2. Dehydration 4. Fracture a. Cavity preparation 1. Cements 2. Heat of polishing C. Desiccants 1.Hereditary hypophosphatemia E.Human immuno deficiency virus (HIV) and Acquired Immuno Deficiency Syndrome (AIDS) .C. External resorption D. Idiopathic A. Others V. Herpes zoster infection G. Alcohol 2. Ether 3. Aging B. Sickle cell anemia F. Internal resorption C. . 1.Grossman’s Classification I) Pulpitis (Inflammation) A) Reversible pulpitis 1) Symptomatic (acute) 2) Asymptomatic (chronic) B) Irreversible pulpitis 1) Acute a) Abnormally responsive to cold b) Abnormally responsive to heat 2) Chronic a) Asymptomatic with pulp Exposure b) Hyperplastic pulpitis c) Internal resorption II) Pulp Degeneration A) Calcific (Radiographic diagnosis) B) Others (Histopathologic diagnosis) III) Pulp necrosis . 2. Ingle’s classification 1) Hyperreactive pulpalgia a) Hypersensitivity b) Hyperemia 2) Acute pulpalgia i) Incipient (reversible) ii) Moderate (referred) iii) Advance (relieved by cold) 3) Chronic pulpalgia 4) Hyperplastic pulpitis 5) Pulp necrosis 1) Atrophic pulposis 2) calcific pulposis . Seltzer and Bender classification(histological) 1) Intact pulp with scattered chronic inflammatory cells. 2) Acute pulpitis 3) Chronic partial pulpitis with partial necrosis 4) Chronic partial pulpitis with partial liquefaction necrosis 5) Chronic partial pulpitis (Hyper plastic form) 6) Pulp necrosis 1) Atrophic pulp 2) Dystrophic mineralization .3. hypersensitive) i.4.Non Painful pulpitis i. a.Chronic pulpitis(carious lesion absent) iii.Chronic pulpalgia(subacute pulpitis) c.hypeactive pulpalgia.5th ed I.Chronic ulcerative pulpitis(due to caries) ii.Acute pulpalgia(acute pulpitis) ii.Chronic Hyperplastic Pulpitis . Inflammatory diseases of the dental pulp.Hyperalgesia(Reversible pulpitis.According to Weine.Hypersensitive dentin ii.Painful pulpitis/Irreversible pulpitis i.Hyperemia b. pulposis) i.Internal Resorption – which may be sequela to persistent chronic inflammation.Atrophy & Fibrosis ii.Additional pulp Changes a.2. .Dystrophic Calcification(calcific degeneration.Necrosis (squeal to inflammatory/ retrogressive change) b. Calcific pulposis) c.Retrogressive changes ( degeneration. According to Shafer's: .5. Acute Partial pulpitis Subtotal pulpitis Partial/focal pulpitis Pulpitis Chronic Total/gen eralized . . Def: H/P: Mild to moderate hyperemia.. cells along with chronic infl cells present . inflammatory changes restricted to area of involved dentinal tubules µ scopy Reparative dentin Disruption of odontoblasts Dilated b/v Extravasations of edema fluid Few acute infl..Focal Reversible Pulpitis/ Initial pulpitis/ Pulpal Hyperemia Earliest form Mild…. localized….Pulpitis 1. intermittent & of immediate onset on application of the stimulus Pain only on stimulation.Etiology: Trauma Thermal shock Recent oral prophylaxis Dehydration/ desiccation of the cavity Deep caries or restorations Chemicals Symptoms: Unilateral sharp stabbing pain. responds more to cold than hot stimuli Short duration & does not linger………. Difficulty in localization .. ZOE temp.....Signs: Large intra/ extra coronal restoration Carious lesion involving the pulp Pin placed close to the pulp/ involving Diagnosis: Percussion Vitality tests Color Radiograph Treatment: Removal of the cause Use of Ca(OH)2 liner.monitoring apical condition & sclerosis!!. .filling Review repeat vitality tests Serial radiographs @ 3.6 & 12 months . .Prognosis: Favorable if irritant is removed early enough. Acute Pulpitis Usually a squeal of focal rev.2. pulpitis Usually irreversible & leads to suppurative pulpitis Def: H/P: Presence of chronic ´ inflammatory cells Congestion of post capillary venules Affects pulpal circulation Necrosis Attracts PMNL’s chemotaxis Acute Inflammation . .Etiology: Bacterial involvement of the pulp through caries Trauma / chemical / thermal irritation Progression of rev. worsens at night & on lying down…… Cold reduces …….temp relief! Sudden stoppage….. Radiation Spontaneous. shooting.(even up to several Hours) after removal of the stimulus.! Poorly localized until………! . Exaggerated response to hot stimuli Longer duration & lasts >15 sec. stabbing sharp pain becoming dull or throbbing type with time. pulpitis Symptoms: Unilateral pain initially piercing. !! Vitality in multiple root?? Percussion:----.. # or discolored tooth Initially may not be tender to bite on…….periodontitis! Radiographs: Treatment: Complete removal of pulp / Pulpectomy…… Posterior tooth……….! Large carious lesion/ restoration.later……….Signs: Pain increases by heat & decreases by cold although…………. Extraction as the last resort!!!! .! Diagnosis: Diagnostic LA injection may be required for localization> Vitality tests: Exaggerated response to heat & initially…. Differential Diagnosis One must distinguish between Reversible & irreversible Pulpitis . Prognosis: • Favorable if the pulp is removed & if the tooth undergoes proper endodontic therapy & restoration . C. Advanced caries. B. Inflammatory cell. .destruction of odontoblasts. No secondary dentine .A. milder than the acute form On exploration bleeding may occur but pain is absent H/P: Chronic infl.3. collagen bundle gathering towards an attempt to ward off the infection .Chronic Pulpitis: May arise on occasion through quiescence of a previous acute pulpitis / more commonly as the chronic type of disease from onset Signs & Symptoms: Large restorations Pain is not a prominent feature Poorly localized. Cells Prominent capillaries. Destruction of odontoblasts.Carious exposure with necrosis.Bacterial toxins in atubular dentin. C.A. B. . Ulcerative Pulpitis Granulation tissue formation on the surface of pulp tissue in a wide open exposure µ organisms in pulp present. Diagnosis: Vitality: A gradual reaction Reaction to thermal changes & electrical stimulus is dramatically reduced Percussion: Radiograph:……sclerosis of alveolar bone! Treatment & Prognosis: Similar to acute pulpitis Endodontic therapy / Extraction . Etiology: Slow progressive carious exposure A large open cavity …. Dental neglect Symptoms: ..Chronic Hyperplastic Pulpitis: Def: “Pulp Polyp” is a productive pulpal inflammation due to extensive carious exposure of a young pulp.4. Mechanical irritation too acts as a stimulus. more current required .! Bleeding…..! Coronal tooth ………! Diagnosis: C/F Appearance of the polyp Sensitiveness…….Signs: Seen in…………! Visible polyp in……….! Origin……! Tooth involved! Radiograph: Large open cavity with direct access to pulp chamber Vitality: Thermal-feeble or no response EPT. Internal Resorption/ Pink tooth of Mummery Def: Etiology: Unknown. but majority of patients give a H/O Trauma . H/P: Result of osteoclastic activity Lacunae seen filled with osteoid tissue…! Profuse bleeding on removal of the pulp Multinucleated giant cells…. Cells & metaplastc cells Symptoms: Asymptomatic usually “Pink Spot” in the crown .! Chronic infl.. Appearance of “Pink spot” R/F: Change in the wall………. ant tooth.Diagnosis: May involve crown / root Usually max. Routine radiographic examination.! A round/ oval radiolucent area . . Prognosis: Best before perforation In perforation cases it is guarded &depends on the formation of calcific barrier. In perforation Ca(OH)2 paste calcific barrier complete obturation .Treatment: Extirpation of the pulp stops the receptive process Routine endodontic therapy is indicated Difficulty in obturation of the defect thermo plasticized GP is used. At an early stage.Pulp Degeneration: Usually seen in teeth of older people sometimes young teeth with persistent mild infection may show degeneration.No definite clinical symptoms At a later stage discoloration of the tooth pulp does not respond to stimuli . Calcific Degeneration: A part of the pulp tissue is calcified i. deposition of Ca salts in dead & degenerating tissues Pulp chamber( denticles) Root canal( diffuse calcifications) .e. well outlined. more commonly in the pulp chamber.Denticles/ Pulp stones Larger. According to location Attached Embedded . large enough at times……! Classification: Free a. laminated. According to structure true false Studies reveal around 60% of teeth have pulp stones Signs & symptoms: Harmless concretions Referred pain may be seen in some cases Diagnosis: R/F: calcified or radio opaque mass Difficult to distinguish 3 type R/f Treatment: Usually pose problem in endodontic treatment Use of chelating agents like EDTA is recommended .b. Atrophic Degeneration: Atrophy means ‘wasting away’ or decrease in the size of an organ. It is attributed to faulty nutrition Usually occurs as the teeth grow older Increase in collagen fibers & decrease in the no. of cells No clinical diagnosis exists . Fibrous degeneration: Replacement of cellular elements by fibrous connective tissue On removal from root canal appears like a leathery fiber No distinguishing diagnostic features . Pulp Artifacts: Vacuolization of odontoblasts was ounce thought to be a type of pulp degeneration Empty spaces formed by odontoblasts Actually an artifact caused by poor fixation of the tissue specimen Other Ex. Reticular atrophy .Fatty degeneration. Pulp Necrosis: Def: Necrosis is death of the pulp partial / total Usually a squeal of inflammation May occur following a traumatic injury…….! Coagulation Necrosis Liquefaction . chemicals or trauma. liquid or amorphous debris. Etiology: Any noxious stimuli / insult injurious to the pulp. Bacteria. Caseation is a type characterized by a cheesy mass. .Coagulation necrosis: The soluble portion of tissue is precipitated or is converted into a solid material. Liquefaction Necrosis: Results when proteolytic enzymes convert the tissue into a softened mass. Symptoms: No painful symptoms Discoloration is a first indication of pulpal death. . current due to moisture content / viable apical nerve fibers at times.! Diagnosis: Mostly only by chance as no significant findings Radiograph: Large cavity / filling or an open approach to the root canal H/O trauma or severe pain followed by complete cessation of pain at times by patients Vitality tests: no response to thermal / cold or test cavity EPT may give minimum response to max. Crown--…….. H/P: Necrotic pulp tissue. cellular debris & microbes Periapical tissue may be normal / slight evidence of the inflammation of apical PDL ligament . . Inflammatory cells. Monocytes.A. C. B. . Necrosis. Treatment: Proper Endodontic therapy Prognosis: Favorable if proper endodontic therapy is instituted . . If irreversible institute endodontic therapy/ extract Refer for investigation & treatment of Sinusitis . Treatment: Monitor: pulpitis might prove to be rev. teeth are involved Diagnostic tests: Radiograph : possible antral opacity on paranasal radiograph.Aerodontolgia/ Barodontolgia Dental pain occurring due to reduced atmospheric pressure Symptoms: Acute pulpitic pain ./ Irreversiblle. only during decompression / flying at high altitude Signs: Recently restored teeth Aerosinusitis may be a contributing factor if max. Corrosion deposits or damage may be evident.is well localized & does not refer Signs: Recent metallic restoration abutting/ opposing an existing metallic restoration.Galvanism: Etiology: Symptoms: Intermittent pain Occurs only after placement of a new metal restoration . Treatment: Application of varnish over the restoration May diminish over in a few days by formation of corrosion products . Diseases of the Periradicular Tissues Acute periradicular disease Acute alveolar abscess Acute apical periodontitis Vital Nonvital . Chronic periradicular diseases with areas of rarefaction Chronic alveolar abscess Granuloma Cyst Condensing osteitis External root resorption Diseases of the periradicular tissue of non endodontic origin . Acute Alveolar Abscess . Definition: An acute alveolar abscess is a localized collection of pus in the alveolar bone at the root apex of a tooth following death of pulp . severe throbbing pain.Symptoms: The first symptom . Later. .mere tenderness of the tooth. attendant swelling of the overlying soft tissues. . and mobile. .As the infection progresses. elongated. The pain may subside or cease entirely while the adjacent tissue continuous to swell.The swelling becomes more pronounced and extends beyond the original site. The tooth becomes more painful. At other times. periostitis. or osteomyelitis. such as the skin of the patient’s face or neck. usually opening in the labial or buccal mucosa. The contained pus may break through to form a sinus tract. it may exit anywhere near the tooth. cellulitis. the infection may progress to osteitis. or even the antrum or nasal cavity. .If left unattended. . the resulting cellulitis may distort the patient’s appearance grotesquely.When swelling becomes extensive. . Patients with mild cases may have only a slight rise in temperature (90 to 1000 F). a general systemic reaction of greater or lesser severity may occur The patient may appear pale. irritable and weakened from pain and loss of sleep.In addition to the localized symptoms of an acute alveolar abscess. . the temperature may reach several degrees above normal (102 to 1030 F). The fever is often preceded or accompanied by chills. manifesting itself orally by a coated tongue and foul breath. Intestinal stasis can occur.Whereas in those with severe cases. . . it may be difficult to locate the tooth because of the absence of clinical signs and the presence of diffuse. annoying pain.Diagnosis: In the early stages. thickened periodontal ligament space. a radiograph may help one to determine the tooth affected by showing a cavity. .The tooth is easily located when the infection has progressed to the point of periodontitis and extrusion of the tooth. a defective restoration. The affected pulp is necrotic and does not respond to electric current or to application of cold.A diagnosis may be confirmed by means of the electric pulp test and by thermal tests. . the apical mucosa is tender to palpation.The tooth may be tender to percussion. and the tooth may be mobile and extruded. or the patient may state that it hurts to chew with the tooth. . PALPATION PERCUSSION Differential Diagnosis: Acute alveolar abscess should be differentiated from periodontal abscess and from irreversible pulpitis. A periodontal abscess is an accumulation of pus along the root surface of a tooth that originates from infection in the supporting structures of the tooth. It is associated with a periodontal pocket and is manifested by swelling and mild pain. On pressure, pus may exude near the edematous tissue or through the sulcus, the swelling is usually located opposite the root apex or beyond it. . in contrast to an acute abscess.A periodontal abscess is generally associated with vital rather than with pulp less teeth. in which the pulp is dead. tests for pulp vitally are useful in establishing a correct diagnosis. the tooth has been left open for drainage. Once the root canal is sealed. endodontic treatment is completed . one must perform careful and through debridement by instrumentation and irrigation before medicating and sealing the root canal. When symptoms have subsided.Treatment: Treatment consists of establishing drainage and controlling the systemic reaction. Acute Apical Periodontitis . .Acute Apical Periodontitis: Definition: Acute apical periodontitis is a painful inflammation of the periodontium as result of trauma. regardless of whether the pulp is vital or nonvital. irritation. or infection through the root canal. By wedging of a foreign object between the teeth such as a toothpick. .Cause: Acute apical periodontitis may occur in a vital tooth That has experienced occlusal trauma caused by abnormal occlusal contacts. By a recently inserted restoration extending beyond the occlusal plane. Acute apical periodontitis may also be associated with the nonvital tooth. It may be caused by the sequelae of pulpal diseases. the diffusion of bacteria and noxious products from an inflamed or necrotic pulp. Or its cause may be iatrogenic . The tooth may be extruded. making closure painful. . or the soreness may be severe.Symptoms: The symptoms of acute apical periodontitis are pain and tenderness of the tooth. some times only when it is percussed in a certain direction. The tooth may be slightly sore. Diagnosis: The diagnosis is frequently made from a known history of a tooth under treatment. . . whereas the mucosa overlying the root apex may or may not be tender to palpation.The tooth is tender to percussion or slight pressure. at times. the difference is only one of degree because acute alveolar abscess represents a further stage in development.Differential Diagnosis: A differential diagnosis should be made between acute apical periodontitis and acute alveolar abscess. . with breakdown of periapical tissue, rather than merely an inflammatory reaction of the periodontal ligament. The patient;s history, symptoms and clinical test results, symptoms and clinical test results help one to differentiate these diseases. Treatment: Treatment of acute apical periodontitis consists of determining the cause and relieving the symptoms. When the acute phase has subsided, the tooth is treated by conservative means. Acute Exacerbation of a chronic Lesion: Definition: This condition is an acute inflammatory reaction superimposed on an existing chronic lesion. . such as a cyst or granuloma.Acute Exacerbation of a chronic Lesion: Synonyms: Phoenix Abscess. with chronic chronic While periradicular diseases. . such as granulomas and cysts. these apical reactions can be completely asymptomatic. are in a state of equilibrium.Cause: The periradicular area may react to noxious stimuli from a diseased pulp periradicular disease. At times. . because of bacteria and their toxins. these apparently dormant lesions may react and may cause an acute inflammatory response. the tooth may be elevated in its socket and may become sensitive. . As inflammation progresses. the tooth may be tender to the touch.Symptoms : At the onset. The mucosa over the radicular area may be sensitive to palpation and may appear red and swollen. In such a tooth. .Diagnosis: The exacerbation of a chronic lesion is most commonly associated with the initiation of root canal therapy in a completely asymptomatic tooth. radiographs show welldefined periradicular lesions. The patient may have a history of a traumatic accident that turned the tooth dark after a period of time or of postoperative pain in a tooth that had subsided until the present episode of pain. . Lack of response to vitality tests points to a diagnosis of necrotic pulp. on rare occasions. although. or in a multirooted tooth. . a tooth may respond to the electric pulp test because of fluid in the root canal. DIFFERENTIAL DIAGNOSIS . Differential Diagnosis: An acute exacerbation of a chronic lesion causes symptoms similar to those of an acute alveolar abscess. . no differential diagnosis is needed. Because the treatment of both lesions is the same. Prognosis: The prognosis for the tooth is good once the symptoms have subsided. which is an emergency. is the same as that of an acute alveolar abscess. .Treatment: The treatment of acute exacerbation of a chronic lesion. and radicular cyst. Granuloma. .CHRONIC PERIRADICULAR DISEASES WITH AREAS OF RAREFACTION These diseases are chronic alveolar abscess. Chronic Alveolar Abscess Synonym: Chronic supportive apical periodontitis. . low –grade infection periradicular alveolar bone.Definition: A chronic alveolar abscess is a long-standing. . The source of the infection is in the root canal. or it may result from a preexisting acute abscess. .Cause: Chronic alveolar abscess is a natural sequela of a death of the pulp with extension of the infective process periapically. .Symptoms: A tooth with chronic alveolar abscess is generally asymptomatic. such an abscess is detected only during routine radiographic examination or because of the presence of a sinus tract. at times. .A radiograph taken after the insertion of a guttapercha cone into the sinus tract often shows the the involved tooth by tracing the sinus tract to its origin. When an open cavity is present in the tooth. drainage may occur by way of the root canal. . .Diagnosis: A chronic abscess may be painless or only mildly painful. At times. the first sign of osseous breakdown is radiographic evidence seen during routine examination or discoloration of the crown of the tooth. sharp pain that subsided and has not recurred. the patient may remember a sudden. or he may relate a history of traumatic injury.When asked. . The tooth does not react to the electric pulp test or to thermal tests. it is practically impossible to establish an accurate diagnosis among the periradicular diseases with radiographs alone.Differential Diagnosis: Clinically. . As a result. a proper and accurate diagnosis can be made only when tissue specimen has been examined microscopically A chronic abscess should be differentiated from cementoma or ossifying fibroma. which is associated with a vital tooth and requires no endodontic treatment. . Treatment: Treatment consists of elimination of infection in the root canal. . GRANULOMA: Definition: A dental granuloma is a growth of granulomatous tissue continuous with the periodontal ligament resulting from death of the pulp and the diffusion of bacteria and bacterial toxins from the root canal in to the surrounding periradicular tissues through the apical and lateral foramina. A granuloma may be seen as a chronic, low-grade defensive reaction of the alveolar bone to irritation from the root canal. Cause: The cause of the development of a granuloma is death of the pulp, followed by a mild infection or irritation of the periapical tissues that stimulates a productive cellular reaction. A granuloma develops only some time after the pulp has died. Symptoms: A granuloma may not produce any subjective reaction. Usually. except in rare cases when it breaks down and undergoes supuration. a granuloma is asymptomatic . Diagnosis: The presence of a granuloma. is generally discovered by routine radiographic examination. The area of rarefaction is well defined. which is symptomless. with lack of continuity of the lamina dura . Differential Diagnosis: A granuloma cannot be differentiated from other periradicular diseases unless the tissue is examined microscopically. . .Treatment: Root canal therapy may suffice for the treatment of a granuloma. BAY AND TRUE CYSTS A= True cyst B= Bay cyst C= Granuloma D= Epithelium E= Alveolar bone F= Dentine G= Root canal H= Cementum I= Periodontal ligament . Radicular Cyst: . . the center of which is filled with fluid or semisolid material.Definition: A cyst is a closed or sac internally lined with epithelium. A radicular or alveolar cyst is a slowly growing sac at the apex of a tooth that lines a pathologic cavity in the alveolar bone. which are normally present in the periodontal ligament: Symptoms: No symptoms are associated with the development of a cyst. . or bacterial injury resulting in death of the pulp. chemical. followed by stimulation of the epithelial rests of Malassez.Cause: A radicular cyst presupposes physical. The presence of the cyst may be sufficient to cause movement of the affected teeth. the root apices of the involved teeth become spread apart. The teeth may also become mobile.A cyst may become large enough. If left untreated. owing to accumulation of cystic fluid. . however. to become obvious as a swelling. a cyst may continue to grow at the expense of the maxilla or the mandible. so the crowns are forced out of alignment. In such cases. in which case it may be flattened and may have an oval shape. except where it approximates adjacent teeth.Diagnosis: The pulp of a tooth with a radicular cyst does not react to electrical or thermal stimuli. The radiolucent area is generally round in outline. and results of other clinical tests are negative. except the radiograph. Neither the size nor the shape of the rarefied area is a definitive indication of a cyst . .Differential Diagnosis: A cyst is usually larger than granuloma and may cause the roots of adjacent teeth to spread apart because of continuous pressure from accumulation of cystic fluid. Prognosis: The prognosis depends on the particular tooth. the extent of bone destroyed.Treatment: Resolution of these areas of rarefaction occurs following root canal therapy in 80 to 98% of cases. and the accessibility for treatment . CHRONIC PERIRADICULAR DISEASE WITH AREA OF CONDENSATION: Condensing Osteitis: . chronic inflammation of the periradicular area as a result of a mild irritation through the root canal.Definition: Condensing osteitis is the response to a lowgrade. . Symptoms: This disorder is usually asymptomatic. .Cause: Condensing osteitis is a mild irritation from pulpal disease that stimulates osteoblastic activity in the alveolar bone. It is discovered during routine radiographic examination. . Condensing osteitis appears in radiographs as a localized area of radiopacity surrounding the affected root.Diagnosis: The diagnosis is made from radiographs. Treatment: Endodontic treatment is indicated. and if the tooth is restored . Prognosis: The prognosis for long-term retention of the tooth is excellent if root canal therapy is performed satisfactorily. the suspected cause of external resorption is periradicular inflammation due to trauma. .External Root Resorption: Definition: External resorption is a lytic process occurring in the cementum or cementum and dentin of the roots of teeth. Cause: Although unknown. Symptoms: Throughout its development. When the root is completely resorbed. It will give the appearance of “pink tooth” seen in internal resorption . If the external root resorption extends into the crown. external root resorption is asymptomatic. the tooth may become mobile. Diagnosis: External resorption is usually diagnosed by radiographs. . a ragged area. a “scooped – out” area on the side of the root. if the area is superimposed on the root canal. the root canal clearly traverses the area of resorption. In external resorption. .Differential Diagnosis: External resorption needs to be differentiated from internal resorption. or. the radiograph shows a blunting of the apex. but it may leave a weak tooth unable to sustain functional forces. If the etiologic factor is known and it is removed. .Treatment: Internal resorption ceases when the pulp is removed or becomes necrotic Prognosis: The prognosis of a tooth with external resorption is guarded. the resorptive process will stop. . such as multiple neurofibromatosis or they may have other causes. Such lesions may be manifestations of systemic diseases.Diseases of the Periradicular Tissues of Nonendodontic Origin: Periradicular lesions not only arise as extensions of pulpal diseases. but they may also originate in the remnants of odontogenic epithelium. such as periodontal diseases.