Management of Multiple Idiopathic Root Resorption in a Rheumatoid Arthritis Patient: A Case Report with 4-year Follow-up

Abstract

Cervical root resorption is a rare destructive disease that originates from the external cervical root surface. It has a multifactorial etiology. Cervical root resorption may affect several teeth and its treatment can be complicated due to the size, location, and extension of the resorptive defect. Rheumatoid arthritis is a chronic inflammatory autoimmune disease that has systemic effects. The objective of this article was to report a rare case of multiple idiopathic cervical resorptions in a patient with rheumatoid arthritis. A 52-year-old male patient with a 20-year history of rheumatoid arthritis was diagnosed with multiple idiopathic cervical resorptions through cone-beam computed tomography (CBCT) and clinical examination. All known causes for cervical resorption were ruled out after a detailed anamnesis. This report details inflammation due to rheumatoid arthritis as a possible cause of idiopathic cervical resorption. The systemic alterations wrought by rheumatoid arthritis could be related to the etiopathogenesis of cervical root resorption. Non-surgical endodontic treatment was done for the maxillary left canine. The defect was surgically repaired using bioceramic putty. The 12-month recall revealed the good healing of the periodontal and periradicular conditions with no obvious clinical symptoms. At the 36-month recall visit, clinical and radiographic evidence of deterioration in the repair material was observed. At the 54-month follow-up, deterioration of repair material was observed with an increase in the extension of resorption in tooth 14 was detected. Reasons for this deterioration remain unclear. Ruling out all other factors for cervical root resorption, how rheumatoid arthritis contributes to cervical root resorption is still lacking/unclear. Dental care providers must be vigilant for signs of cervical root resorption in vulnerable patients with rheumatoid arthritis for early diagnosis and prompt treatment. Keywords: External root resorption, Inflammatory markers, Multiple root resorption, Rheumatoid arthritis, Resorption repair.