Regressive alteration

Are the group of retrogressive changes in the teeth,

which occur duo to non-bacterial causes & results in
wear and tear of the tooth structures with impairment
of function.

Some result from generalized aging process

Others duo to chronic persistent tissue injury
Tooth wear
Causes of tooth wear:
1. Attrition
2. Abrasion
3. Erosion
4. Abfraction
 Attrition
It is the loss of tooth structure caused by tooth-to-
tooth contact during occlusion & mastication.

Types :
• Physiological A.
• Pathological A.
Etiological factors for pathological attrition:
Developmental
Acquired
Abnormal chewing habits
Occupation
Structural defect
 Clinical features:

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Abrasion
It is the pathological loss of tooth structure or
restoration secondary to the action of an external
agent (abnormal mechanical process).
The most common cause of abrasion is tooth
brushing that combines an abrasive toothpaste
with heavy pressure and a horizontal brushing
stroke.
Other items: pencils, toothpicks, pipe stems and
bobby pins (hair grips).
Chewing tobacco, biting thread, inappropriate
use of dental floss.
Clinical features:
 Erosion
It is the loss of tooth structure caused by chemical
process beyond that associated with bacterial
interaction with the tooth.
Types ( depending on etiology):
Intrinsic
Extrinsic
Etiology :
Medications
Acidic foods and beverages
Chronic involuntary regurgitation
Voluntary regurgitation (Anorexia Nervosa)
Industrial environmental exposure
Clinical features:
Abfraction
Loss of tooth structure that results from repeated tooth
flexure caused by occlusal stresses.

Schematic view of abfraction – enamel prism fracturing due to stress effect of

occlusal load which is focused on the area along the marginal edges of the crowns.
Clinical features:
 Dentinal sclerosis
(Transparent dentin)

Sclerosis of 1ry dentin is a regressive alternation

in tooth substance that is characterized by
calcification of dentinal tubules.
Etiology: injury to dentin by caries or abrasion,
normal aging process, abrasion or erosion.
Mechanism :
Not well understood.
Dead tracts

http://210.44.214.13/lab/oral%20histology%20slides/images/03_17bb.jpg
Secondary dentin
It is dentin that is formed and deposited in
response to a normal or slightly abnormal
stimulus, after the complete formation of the
tooth.
Types :
Physiological 2ry dentin
Reparative 2ry dentin

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%20slides/images/03_16bb.jpg
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James K. Oral development and histology. 3rd e,2002
 Reticular atrophy of the pulp
Clinically symptomless & responds normally to
vitality tests.
Histologically, presence of large vacuolated spaces in
pulp, with reduction of cellular elements.
Degeneration and disappearance of odontoblasts.
Presently, this condition is purely an artifact brought
about by autolysis of the pulp tissue and doesn’t occur
in vivo.
 Pulp calcification
Two morphological forms of pulp calcifications are
discrete pulp stones (denticles, pulp nodules) and
diffuse calcification.
Types:
 True denticles: made up of localized masses of
calcified tissue that resemble dentin because of their
tubular structure.
1. Free D. 2. Attached D.
 False denticles: composed of localized masses of
calcified material & don’t exhibit dentinal tubules.
1. Free D. 2. Attached D.
 True denticle False denticle

http://www.mc.uky.edu/oaa/curriculum/md828/module4/lab/images/main/image07.gif

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 Diffuse calcification “Calcific degeneration”
Its usual pattern is in amorphous, unorganized linear
strands or columns paralleling the B.Vs and nerves of the
pulp.

Etiology of pulp calcifications: unknown

Pathogenesis:
Local metabolic dysfunction Trauma

hyalinization of injured cells Vascular damage

(Thrombosis)
Fibrosis
Mineralization
(Nidus formation)
Growth with time

PULP STONE
Resorption of teeth
It is chronic progressive damage or loss of tooth
structure due to the action of cells called
odontoclasts.
Pathological resorption may be external or internal.
 External resorption
• It is lytic process occurring in the cemetum or cementum and
dentin of the roots of teeth.
• Factors associated with external resorption:
1. Cyst & tumors.
2. Dental trauma.
3. Excessive mechanical forces.
4. Excessive occlusal forces.
5. Grafting of alveolar clefts.
6. Hormonal imbalances.
7. Intracoronal bleaching of pulpless teeth.
8. Local involvement by herpes zoster.
9. Paget’s disease of bone.
10. P.D treatment.
11. P.A inflammation.
12. Pressure from impacted teeth.
13. Reimplantation of teeth.
14. Idiopathic.
Radiographically, appears as a “moth-eaten” loss of
tooth structure in which the radiolucency is less well
defined and demonstrates variation in density.
Invasive cervical resorption

Multiple idiopathic root resorption: several teeth may be

involved, and underlying cause for the accelerated destruction
may not be obvious.
Histopathologically,
numerous multinucleated
dentinoclasts located in
the areas of structure loss.
Areas of resorption often
are repaired through
deposition of osteodentin.
In large defects, external
inflammatory R. results in
deposition of inflamed
granulation tissue, and
areas of replacement with
woven bone may also be
seen.
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Histologic appearance of
a tooth exhibiting
external inflammatory
root resorption, showing
multinucleated clast cells
adjacent to resorbed
dentin and bone. A
chronic inflammatory
cellular infiltrate is also
evident in the area.

http://www.endodoncja.pl/zdj/rozne04/foto35.jpg
 Histologic appearance of an extensive
invasive cervical resorption with
radicular extensions. Masses of ectopic
calcific tissue are evident both within
the fibrovascular tissue occupying the
resorption cavity and on resorbed
dentin surfaces. In addition,
communicating channels can be seen
connecting with the periodontal
ligament (large arrows). Other
channels can be seen within the
inferior aspect of the radicular dentine
(small arrows). (Hematoxylin–eosin
stain)
Internal resorption
Two main patterns:
1.Inflammatory R.:
It occurs duo to intense
inflammatory reaction within the
pulp tissue.
The resorbed dentin is replaced by
inflamed granulation tissue.
Radiographically, a uniform,
well-circumscribed symmetric
radiolucent enlargement of
the pulp chamber or canal.

Internal resorption ( pink tooth of Mummery)

Internal resorption. Balloon like enlargement of the root canal
Histopathology :
• The pulp tissue in the area of destruction is vascular
and exhibits increased cellularity and collageniztion.
• Immediately adjacent to the dentinal wall are
numerous multinucleated dentinoclasts, which are
histologically and functionally identical to
osteoclasts.
• An inflammatory infiltrate characterized by
lymphocytes, histiocytes, and PMN leukocytes is not
uncommon.
2. Replacement or metaplastic resorption:
It occurs duo to absence of any
inflammatory reaction within the pulp.
Portions of the pulpal dentinal walls
are resorbed and replaced with bone or
cementum-like bone.
Radiographically, appears as an
enlargement of the canal that is
filled with a material that is less
radiodense than the surrounding
dentin. The outline of
destruction is less defined.

J. O. Andreasen. Textbook and color atlas of traumatic injuries to the teeth

 
Histopathologically, the normal pulp
tissue is replaced by woven bone that
fuses with the adjacent dentin.
 Hypercementosis
( Cementum hyperplasia)
It is a non- neoplastic condition in which excessive
cementum is deposited in continuation with the normal
radicular cementum.
It may be regarded as a regressive change of teeth
characterized by excessive amounts of secondary cementum
on root surfaces.
Types:
• Localized & Generalized
Etiology:
 Accelerated elongation of a tooth.
 Inflammation about a tooth.
 Tooth repair.
 Osteitis deformans, or Paget’s disease of bone.
 Others: hyperpituitarism, cleidocranial dysostosis.
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Excessive amount of secondary or
cellular cementum deposited
directly, over typically thin primary
acellular cementum. Secondary
cementum is called
osteocementum duo to its cellular
nature and its resemblance to
bone. Cementum typically
arranges in concentric layers
around the root and frequently
shows numerous resting lines
parallel to root surface.

http://www.dental.pitt.edu/informatics/periohistology/en/cementum
/histo123a2.htm
 Cementicles
• Small foci of calcified tissue, not necessarily true
cementum, which lie free in P.D.L of the lateral and
apical root areas.
• The exact cause is unknown, but they represent areas
of dystrophic calcification and thus are an example of
a regressive or degenerative change.
• Formation :

• Types:
1. Free Cementicles
2. Attached or sessile Cementicles
3. Embedded Cementicles
http://www.dental.pitt.edu/informatics/periohistology/en/cementum/histo
125Aa2.htm