Regressive

Alterations of Teeth
 Regressive changes in dental
tissues are alterations that
could be:

A-associated with the aging process

B-Resulting from injury to dental
tissues
Attrition
• Definition:
physiological
wearing away of a
tooth as a result of
tooth to tooth
contact in
mastication. It is
associated with
the aging process.
Attrition
• Affected tooth
surfaces: occlusal,
incisal and proximal.
Except in cases of
malocclusion.
 
• Affected
dentitions:
primary and
permanent
 Attrition
• Clinical appearance:
•      Attrition is first seen as a small
polished facet on the tip of cusp, or
as a flattening of the incisal edge.
• Similar facets occur on the proximal
surfaces as a result of slight mobility
of teeth in sockets (resilience of
periodontal ligament.)
 Attrition
  As the person becomes older, there
is:
1-   gradual reduction in cusp height,
which may progress to loss of cuspal
interdigitation.
2-   Flattening of the occlusal plane.
3-   Shortening of the length of dental
arch due to proximal attrition.
• The amount of attrition depends on:
1-   Age: more attrition is seen with
aging.
2-   Sex: more attrition is seen in
males due to greater masticatory
forces.
3-   Consistency of diet: coarse diet is
associated with increased attrition.
4-Habits: Such as chewing tobacco or
bruxism
Secondary dentine formation:
The exposure of dentinal tubules
following the wearing down of
enamel result in irritation of the
odontoblastic processes and
formation of secondary dentine,
this prevent pulp exposure
through attrition.
 
 Abrasion
• Definition: It is the pathologic
wearing away of tooth through
abnormal mechanical processes.

• Site: Exposed root surface,

sometimes on incisal or proximal
surfaces.
• Causes of abrasion:
• 1-    abrasive dentifrice, with
forceful use of tooth brush in
horizontal direction. This leads
to V-shaped or wedge shaped
ditch on root surface at the
cemento-enamel junction.
Causes of abrasion

•2-    Habits or
occupations:
Opening of bobby pins
or holding nails with
teeth result in notching
of the incisal edge of
maxillary central incisors
 Causes of Abrasion
3- Pipe smokers
4- Improper use of
tooth picks
• Secondary dentine formation: The
exposure of dentinal tubules
following abrasion results in
irritation of the odontoblastic
processes and formation of
secondary dentine, this prevent pulp
exposure unless abrasion is severe
and rapidly progressing.
 Erosion
• Definition: Loss of tooth surface by
non-bacterial chemical processes.
• Clinical appearance: smooth, non-
chalky shallow, broad, scooped-out
depression on the labial and buccal
surfaces adjacent to the cemento-
enamel junction (gingival 1/3).
• Causes: Acids
from: external
sources (work
environment eg.
Battery
manufacturing or
excessive use of
citrous fluids in
diet).
or internal sources
(regurgitation of
gastric contents as
in chronic
vomiting and
anorexia nervosa).
Vomiting causes
generalized
abrasion on
lingual surfaces.
 Dentinal sclerosis (translucent
dentine)
Definition: Regressive alterations
characterized by calcification of
dentinal tubules.
Causes:
• 1-   Normal age change in dentine.
• 2-Injury of dentine by caries or
abrasion
Microscopicappearance:
• by transmitted light, a
ground section of shallow
caries shows a translucent
zone of dentine underlying
the caries cavity. This is
due to difference in
refractive indices between
calcified dentinal tubules
and adjacent normal ones.
Significance:
Increased
mineralization or
sclerosis:
• 1-   Decreases
conductivity of
dentine.
• 2-   Slows the
advancing caries
process.
 Secondary dentine

• Definition: Dentine having irregular

morphologic pattern formed
physiologically in response to stimuli
associated with aging process, or
pathologicaly as a result of stimulation of
dentinal tubules and odontoplastic
processes from caries, attrition, abrasion,
erosion tooth fracture and cavity
preparation.
 Microscopic
appearance:
• Physiologic secondary
dentine: similar to
primary dentine but
with fewer dentinal
tubules. 
• Pathological
secondary dentine:
irregular, few tortuous
dentinal tubules.
Some odontoblasts
may be entrapped in
the rapidly formed
tissue, so it is called
osteodentine.
 Resorption of teeth

• Physiological resorption occurs in the

roots of deciduous teeth due to pressure
from successors. In deciduous teeth, a
period of resorption is followed by repair.
Occasionally excessive repair tissue
deposited during the resting phases of
resorption results in fusion of the roots
with adjacent bone, preventing shedding.
 :Types of resorption

• External: Occurs on the external

surface of root or crown due to
tissue reaction in the pericoronal or
periodontal tissues.
• Internal: Occurs on the inside of the
tooth due to pulpal reaction
Mechanism: Resorption
occurs by the action
of osteoclasts
activated by pressure.
Osteoclasts are derived
from fusion of blood
monocytes. They are
multinucleated cells
with ruffled border.
Osteoclast are seen
lying in lacunae in
hard tissue.
 :
Causes of external
resorption
Periapical periodontitis:
A long standing
periapical granuloma
may cause root
resorption. This
appears in x-rays as
a slight raggedness
or blunting in the
root apex.
Causes of resorption: Tumours & cysts 

Malignant tumours
causes root
resorption, but
benign tumors causes
root displacement.
Cysts cause root
resorption by
pressure though
displacement is more
common.
Causes of external resorption
   Excessive
mechanical or
occlusal forces:
e.g. Orthodontic
treatment.
Causes of external resorption
   Trauma: trauma causes injury or
necrosis of the periodontal ligament
leading to root resorption. Trauma
may result from a single event or as a
result of malocclusion.
Causes of external resorption:
Impacted teeth
Resorption may
affect crown or root of
impacted teeth. This is
related to partial loss
of the protective effect
of the periodontal
ligament or reduced
enamel epithelium.
Impacted teeth may
cause resorption of
roots of adjacent teeth
Causes of external resorption
Reimplanted or
transplanted teeth:
These are non-
vital teeth that
undergo root
resorption. The
resorped root is
replaced by bone
producing
ankylosis.
 Internal resorption (chronic
perforating pulp hyperplasia,
pink spot
• Definition: unsual form of tooth
resorption that begins in the
dentine of the pulpal walls in the
pulp chamber or root canal.
 Internal resorption
• Cause: it is initiated by an
inflammatory hyperplasia of the
pulp, possibly as a result of
vascular changes.
 As crown resorption progresses, a pink- -
hued area of crown may be seen
.representing the hyperplastic vascular pulp
 Histologically

•       Vascular connective tissue replaces

the pulp with osteoclasts bordering the
affected dentine or enamel.
•      Chronic inflammatory cell infiltration
and increased vascularity of the pulp.
• Areas of irregular bone formation may be
seen.
 Hypercementosis

• Definition: This is a regressive

change of teeth characterized by the
excessive deposition of secondary
cementum on root surface.
Localized hypercementosis occurs
:in   Periapical
periodontitis: at
the center of
inflammation
(tooth apex)
resorption is seen.
Further away,
coronally,
cementum is laid
by cementoblasts.
• 2-Accelerated
elongation of
tooth due to loss
of its antagonist
• 3- in cases of root
fracture,
cementum tears
are repaired by
deposition of new
cementum
4- Paget’s disease of bone