acquired (non carious) lesions of tooth or (regressive

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Dr. Ibtisam Briek SENUSSI Department of oral pathology

Faculty of dentistry Misurata

Dr. Ibtisam Briek SENUSSI

Tooth surface loss is a process that results in non-carious lesions. Several categories of tooth surface loss exist, including erosion, attrition and abrasion. There can be many causes of this condition, including bruxism, clenching, disease, dietary factors, habits and lifestyle, incorrect tooth brushing, abrasive dentifrices, the craniofacial complex, iatrogenic dentistry, and aging.

Acquired (non carious) lesions of tooth Or (regressive alteration in teeth)


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Management of this process includes prevention,

tooth remineralization, and active treatment by

restoring the involved teeth.

Treatment can range from minimally invasive and

adhesive dentistry, to total mouth rehabilitation, to

restoring the lost vertical height.




Age changes in dentin age changes in pulp Attrition Abrasion Erosion Resorption of teeth External resorption Internal resorption Hypercementosis Cementicles


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Age changes in dentin

o Age changes in dentin is a physiological secondary

dentin tubular & regular

o Reparative dentin (Tertiary dentin)

Occur due to stimuli like caries or tumor

o Sclerosis dentin : due to response to caries

o Dead tracts formation



a,b Tertiary dentin showing absence of dentin tubuli. Also the odontoblastic rim is missing in this area (a). Sometimes, excessive deposition of tertiary dentin may wall of the dental pulp temporarily against the advancing carious decay (b).

Tertiary dentin

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o Increase fibrosis that means less number of cells

more number of fibers.

o Pulp calcification

Diffuse calcification

Pulp stone

* False pulp stone no dentin tissue

* True pulp stone contain dentin tissue

Age changes in pulp


o Is a physiological wearing away of tooth as a result of the contact

between two teeth as we see in mastication.

o The attrition occurs only on occlusal, incisal and proximal surface

of teeth.

o Attrition may start at the time of contact or occlusion occurs

between adjacent or opposing teeth, it begins on occlusal & incisal

surface as a small circular or oval polished facets on tip of cusp or

cuspal ridge or slight flattening on incisal edge.

o This result from active mastication or form non-masticatory

contact between opposing teeth.

Attrition


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oThe attrition becomes more with age there is gradual

reduction in cusp hight and flattening of occlusal plan

o Interproximally it shows oval facets in the area

where the contact point between the teeth, this can

cause flatting of proximal surface and given rise

reduction of M-D diameter of teeth then the dental

arch becomes shorter chewing .

Attrition


o Attrition is more sever in male than female more

masticatory force.

o The rapid attrition can be due to coarse diet,

chewing & masticatory force, bruxism, in

hypomineralized teeth as presented in amelogensis &

dentinogensis imperfecta.

Attrition


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o In advanced attrition the enamel is completely lost on one or

more area, the occlusal surface becomes flat, the dentin in

exposed and becomes stained.

o Sometimes the attrition is very sever (tooth wearing up to

gingival area.

o The pulp reacts to attrition by rapid deposition of

reparative dentin

o There may be dead tract formation and sclerosis.

Attrition


Attrition


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o It is pathological wearing away of tooth substance

through some abnormal mechanical process causes by :-

1. Improper tooth brushing; It show a notching in cervical

third of teeth

2. Coarse dentifrice (tooth paste).

3. Habits or occupation like pipe smoker; It show the

notching in the incisal

o Improper use of dental floss & tooth pick

Abrasion


o Abrasion is usually seen in cervical area of the crown and it may be occur on exposed root surface

o There is pulp reaction like that seen in attrition but the loss of tooth substance is more rapid then then the pulp may be get exposure .

Abrasion


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Abrasion


o It is a loss of tooth substance by chemical process which

does not result from bacterial activity

o Erosion commonly seen in labial or buccal surface of teeth

o It is appears as shallow hard smooth, highly polished

depression in enamel which may be near to CEJ this occurs due

to :-

Citrate content of saliva (more taken of fruits)

Drinking a large quantity of acids

In Pts have chronic vomiting & anoxia nervosa,

these patients show erosion in the lingual surface of teeth by

gastric HCL

Erosion


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Erosion


Erosion


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I. External resorption II. Internal resorption

Resorption of teeth Resorption is condition related or associated with loss of tooth

substance such as dentin, cementum and alveolar bone, there may be

physiological or pathological tooth resorption. The physiological resorption of teeth is seen in shedding of deciduous teeth. The pathological resorption There is two types


I.External resorption

o External resorption is initiated in the periodontium and

affects the external or lateral surfaces of a tooth. It is a

common sequelae following traumatic injuries, orthodontic

tooth movement, or chronic infections of the periodontal

structures.

o It can occur as a single entity or a combination of internal

and external resorption can occur simultaneously on the same

tooth and they may appear as separate or joined defects.

External resorption is often confused with internal

resorption.


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o Etiology of external resorption

Periapical inflammation (Granuloma) Reimplantation Tumors & cysts Excessive mechanical or occlusal force Impaction of tooth Idiopathic (Maxillary PM)




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II. Internal resorption

o It is an unusual type of resorption in the tooth which begins centrally with in the tooth it’s initiated in most of the cases by particular inflammatory hyperplasia of the pulp. o The involved tooth may have dentin caries or it may be filled this condition may be affecting single tooth or multiple teeth but usually seen in the anterior teeth and most commonly the incisor. o The symptoms are not seen in the beginning its detected by routine radiography in extensive cases. o The resorption at the dentin and part of enamel in crown region lead to visibility proliferating vascular pulp tissue, through the translucent of enamel this gives reddish or the pink color to the crown (pink spot).



o Radiographically; It shows round or ovoid radiolucent area in the radicular or coronal regions associated with pulp, in the root usually symmetrically and irregular appearance in the crown.

o Histologically It shows variable degree of resorption and inner the pulpal surface of dentin and proliferation of the pulp tissue which face the defect. Irregular lacuna filled with giant cells called (odontoclast)


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http://www.drpaulcaputo.com/wp-content/uploads/2012/08/Radiograph-Ext-Resortion.jpg

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Hypercementosis

o It is an extra deposition of cementum, it regarded or regressive change of teeth characterized by excessive deposition of secondary cementum on root surface. o It may involve a complete root area or it may be focal in the apex of the root the common causes are :- Age Inflammation Tooth repair Paget’s Disease of bone Idiopathic Non functional teeth * Loss of opposite tooth * occlusal trauma * apical inflammation and repair


Hypercementosis

o Clinically; There is no signs and symptoms, extracted tooth appears larger in diameter and the apex is round and smooth.

o Histologically It shows excessive amount of cementum which arranged in concentric range round the root and show resting lines.


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Periapical radiograph showing the mass delimited by a thin radiolucent halo and the lamina durra Dr. Ibtisam Briek SENUSSI

Cementicles

o They are calcified bodies sometimes found in the periapical ligament. o These bodies are seen in older individuals and they may be remain free in the connective tissue, that possible these bodies fuse in to large calcified masses or joined with the cementum


http://dmfr.birjournals.org/content/33/4/267/F2.large.jpg

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(a,b) Periodontal ligament space showing presence of spherical basophilic structures representing cementum deposits, the so-called cementicles. They may lie embedded in the collagenous fibres of the periodontal ligament or attached to or engulfed by the root cementum (a) but they can also be found more remote from the root surface surrounded by cancellous bone (b)

Dr.

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Cementicles


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acquired (non carious) lesions of tooth or (regressive

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