Lecture 10 Regressive alterations of teeth

Regressive alterations are the group of retrogressive changes in the teeth, which occur due to non- bacterial causes and results in wear and tear of the tooth structures with impairment of function. Some of these regressive changes in teeth results from generalized aging process and others occur due to chronic persistent tissue injuries.

Attrition
Attrition is a constant form of retrogressive change in teeth, characterized by wear of tooth substance or restoration as a result of tooth to tooth contact during mastication or para function. It is an age related process and older individuals often exhibit more attrition in their teeth as compared to the young. The rate and severity of attrition depends upon several factors such as diet quality (abrasive foods), dentition (crowding or malposed teeth), force of masticatory muscles and chewing habits (bruxism). Clinically attrition manifested by the formation of well polished facets on the tip of the cusps, incisal edges and on the proximal contact of the teeth

Types of attrition: 1- Physiological attrition which is proportionate to the age of the individual 2- Pathological attrition which occurs due to certain abnormalities in occlusion, chewing pattern

Abrasion
Abrasion is the pathological wearing of dental tissues by friction with the foreign substances independent of occlusion. Types of abrasion: 1- Tooth paste abrasion which is associated with faulty tooth brushing technique 2- Habitual abrasion like improper and habitual use of tooth prick or dental floss can cause abrasion on the proximal surfaces of teeth 3- Occupational abrasion develops when objects or instruments are habitually held between the teeth by people during work. 4-Abrasions by prosthetic appliances that caused by faulty clasp design in removable denture Clinically abrasion produces a " V" shaped or wedge- shaped grove on the tooth with sharp angles and highly polished dentine surfaces

Erosion
Erosion can be defined as progressive irreversible loss of hard dental tissues by some chemical process that does not involve bacterial action. In erosion dissolution of the mineralized tooth structure occurs upon contact with acids which are introduced in to the oral cavity either from intrinsic sources (acids source inside the body include the gastroesophageal reflux disease) or from extrinsic sources (acidic foods and beverages, medications e.g. vitamin C and hydrochloric acid preparations) Clinically erosion manifested by shallow, broad, "scooped- out" concavities on the enamel with highly polished surfaces

Resorption of teeth
Resorption of the teeth can be defined as a chronic progressive damage or loss of tooth structures mostly roots of the teeth or sometimes crowns due to the action of some specialized cells called odontoclasts. Resorption sometimes occurs as physiological phenomenon as in case of root resorption of deciduous teeth. Resorption is generally associated with repair by apposition of cementum or bone and the involved tooth may become ankylosed to the surrounding bone.

External resorption of tooth

Is a pathological resorption of the tooth starting from the root surface or occasionally on the crown surface of the tooth called external resorption Causes of external resorption: 1- Periapical inflammation 2- Reimplanted teeth 3- Cysts 4- Tumors 5- Excessive mechanical or occlusal forces 6- Impacted tooth Radiographical appearance of external resorption Loss of continuity in the peripheral or external outlines of the tooth, however the radiographical image of the root canal remains intact External resorption sometimes appears as carious lesions In the initial stages external resorption appear as raggedness or blunting of the root apex Larger lesions may produce a 'mouth-eaten' appearance

External resorption in the endodontically treated teeth exhibits as if the root canal filling materials are projecting beyond the apex

Internal resorption
Pathological resorption of tooth which is starting from the pulpal surface. It may involve either the crown portion of the tooth or the root portion. In initial stage

there is no early symptom of the disease as long as the external surface of the tooth remains intact. In advanced cases the crown of the tooth often appears pink in color,while if resorption affects the root of the tooth no color change is usually evident.

Radiographical features of internal resorption It presents a well defined, spherical shaped, radiolucent area in the dentine which is usually continuous with the pulp.

Pulp calcification
Deposition of calcified mass within the dental pulp for no apparent reason is called pulp calcification. The etiology of pulp calcification is unknown and it appears to be not related to inflammation, trauma or any systemic disease. Types: Calcification in the pulp may be either diffuse (linear) or nodular (pulp stones)

pulp stones are nodular calcified bodies occur in relation to coronal pulp while diffuse calcifications of pulp are linear strands of calcified masses and are typically formed with in the radicular pulp. Clinically pulp stones do not cause any clinical symptoms and the affected tooth is vital. Both types may cause difficulties during root canal treatment of the affected tooth.

Hypercementosis
Increase in the thickness of cementum on the root surfaces of tooth due to excessive cementogenesis is called hypercementosis and the condition results from local or systemic disorders. The affected tooth is extremely asymptomatic and the condition is discovered during routine radiographic examination and it by radiograph as excessive cemental thickening with a typical bulbous appearance of the root. Causes 1- Periapical inflammation 2- Mechanical stimulation like orthodontic force 3- Unerupted tooth 4- Pagets disease of the bone 5- Idiopathic