Cervical Resorption Research Articles

Repairing invasive cervical root resorption by glass ionomer cement combined with mineral trioxide aggregate

Cervical invasive root resorption is a type of external inflammatory root resorption that is relatively uncommon and aggressive, and leads to loss of tooth structure. A diagnosis of cervical invasive root resorption depends on careful routine clinical and radiographic examinations. This report describes the diagnosis and successful treatment of a 41-year-old male patient with invasive cervical root resorption at tooth #21. The distinctive feature was a large resorptive defect at the cervicopalatal aspect of the maxillary central incisor involving the root-canal space. A radiographic examination revealed a large periradicular lesion and severe periodontal damage around this tooth. The defect was surgically repaired using resin-reinforced glass ionomer cement (GIC) and mineral trioxide aggregate (MTA) to restore the coronal half and apical half of the resorption cavity, respectively. Thereafter, conventional root-canal treatment was performed. The 11-month recall revealed good healing of both the periodontal and periradicular conditions and no obvious clinical symptoms. This case provides a new treatment modality to repair defects of cervical invasive root resorption and promote the healing of periodontal defects.

Invasive Cervical Resorption: Etiology, Diagnosis, Classification and Treatment

Invasive cervical resorption (ICR) is not well understood by the professional, being misdiagnosed, leading to inappropriate treatment and unnecessary loss of tooth. ICR is defined as a localized process of resorption, which begins in the cervical area of the tooth, just below the epithelial junction and above the ridge crest in the area of the connective tissue insertion. Possible predisposing factors include external trauma, orthodontic movement, surgical procedures, periodontal disease and its treatments, endogenous bleaching, pressure generated by wind instruments and herpes virus infection. Different approaches have been suggested for the treatment of ICR, depending on the extent of the lesion and its location. However, in some cases due to the severity of the injury, there is no alternative but to tooth extraction, followed by restoration of the edentulous area. Discuss etiology, diagnosis and classification of the ICR, as well as different treatment options. Also is presented a case in which extraction was carried out, installation of the implant and ceramic crown, subsequent to a treatment approach that resulted in failure in the short-term period. Early diagnosis of the ICR is critical to proper treatment and favorable prognosis. Interdisciplinary treatment should be instituted as soon as possible, avoiding the loss of the affected tooth. In advanced cases, treatment involving the installation of osseointegrated implants should be considered the first choice of treatment. Early diagnosis of the ICR is critical do prevent unnecessary tooth loss, once the prognosis for advanced cases is doubtful.

Management of external cervical resorption using mineral trioxide aggregate

External cervical resorption (ECR) is a relatively uncommon form of external root resorption, which may occur in any tooth in the permanent dentition. It is not well-understood or well-known in the dental community. Characterized by its cervical location and invasive nature, this resorptive process leads to progressive and usually destructive loss of the tooth structure. It is often misdiagnosed, leading to improper treatment or unnecessary loss of the tooth. This article describes a case report of ECR and its management. The salient features were a large resorptive defect and localized fibrous growth located on the cervicopalatal aspect of maxillary right central incisor. Treatment included root canal therapy, surgical exploration, and restoration of the defect with mineral trioxide aggregate. The 1-year follow-up shows patient's tooth was asymptomatic and there was no evidence of progression of the resorptive process. Proper diagnosis and appropriate treatment are the keys to a successful outcome in the management of ECR.

Invasive cervical resorption: treatment challenges

Invasive cervical resorption is a relatively uncommon form of external root resorption. It is characterized by invasion of cervical region of the root by fibrovascular tissue derived from the periodontal ligament. This case presents an invasive cervical resorption occurring in maxillary lateral incisor, following damage in cervical cementum from avulsion and intracoronal bleaching procedure. Flap reflection, debridement and restoration with glass ionomer cement were performed in an attempt to repair the defect. But after 2 mon, more resorption extended apically. Considering root stability and recurrence potential, we decided to extract the tooth. Invasive cervical resorption in advanced stages may present great challenges for clinicians. Therefore, prevention and early detection must be stressed when dealing with patients presenting history of potential predisposing factors.

Non surgical management of trauma induced external root resorption at two different sites in a single tooth with Biodentine : A case report

Effective management and appropriate treatment of external root resorption can only be carried out if the true nature and exact location of the lesion are known. This case report presents a nonsurgical endodontic management of trauma induced external root resorptions at two different sites (cervical and apical) in a maxillary lateral incisor using a bioactive dental material (Biodentine). On completion of root canal cleaning and shaping, cervical resorption defect was treated with trichloroacetic acid and granulation tissue was removed through the access cavity. Calcium hydroxide was placed as an intracanal dressing for ten days. After this period orthograde filling of the root canal space along with the resorption defects was performed with Biodentine. Fifteen months follow up review with Cone Beam Computed Tomography showed arrest of root resorption and progressive healing of the defect.

Management of complicated crown‐root fractures using intentional replantation: two case reports

The management of complicated crown-root fractures is a challenge. Intentional replantation with 180° rotation may be a useful procedure to overcome this problem. In Case 1, a 23-year-old woman with complicated crown-root fractured teeth #11, #21, and #22 was referred for treatment. All fractured teeth were extracted, rotated 180°, and replanted in a slightly extruded position. After 3 months, root canal treatment was completed and the final restorations fabricated. At the 18-month follow up, the patient was asymptomatic, the tooth was functional, and no root resorption was observed radiographically. At the 90-month follow up, slight cervical root resorption of tooth #11 was noted. In Case 2, a 27-year-old woman with a crown-root fractured tooth #21 was referred for treatment. Despite immediate repositioning of the coronal fragment and a 2-week stabilization with a wire splint, the coronal fragment remained separated from the apical tooth segment. The apical segment was extracted, rotated 180°, and replanted in a slightly extruded position. After 1 and 4 weeks, the root canal treatment was completed and the final restoration fabricated, respectively. At the 24-month follow up, the patient was asymptomatic and apical healing was completed.

Crown Lengthening vs Forced Eruption

Once the biologic width of the supporting periodontal attachment apparatus has been severely violated, more extensive procedures are often necessary to manage compromised root structure and supporting bone. Surgical techniques advocated are primarily corrective in nature and consist of root movement and repositioning or root removal and alteration of tooth morphology, with concomitant correction of the periodontium.
 Some indications for surgical corrective intervention to manage radicular perforations include extensive cervical resorption or traumatic perforation which extends well below the osseous crest in both single and multirooted teeth and damage to the furcation region of multirooted teeth which is not responding to nonsurgical therapy, is not amenable to simple surgical correction, or is complicated and compromised further by extensive periodontal disease.
 Common indications for orthodontic root extrusion include fractured tooth margins below crestal bone, deep carious margins, some isolated infrabony defects, and perforations from resorptions, post space preparation and aberrant access openings. When root extrusion is indicated to elevate a perforative root defect above the osseous crest; seldom is the desired result achieved without surgical crown lengthening. This is necessary to compensate for the coronal movement of the gingival attachment and alveolar bone which occurs with the tooth during eruption resulting in unacceptable esthetics. Although it is possible to extrude nearly any tooth the simplest cases are those that have single roots and an immediate proximal tooth on either side for appliance anchorage. Molars are generally difficult to treat as are the terminal teeth in the arch or free standing teeth.

Nightguard Vital Bleaching: Side Effects and Patient Satisfaction 10 to 17 Years Post‐Treatment

The long-term patient satisfaction and safety of nightguard vital bleaching (NGVB) requires further evaluation. The purpose of this study was to evaluate patients' satisfaction and identify side effects of NGVB up to 17 years post-treatment. Thirty-one participants who had completed previous NGVB studies using 10% carbamide peroxide were contacted at least 10 years post-treatment (range 10-17 years, average 12.3 years). Participants reported shade satisfaction (very satisfied [VS], partially satisfied [PS], or not satisfied [NS]) as well as potential complications. Participants had teeth # 6 to 11 examined for tooth vitality, gingival inflammation (Löe's Gingival Index [GI]), and radiographically for external cervical resorption (ECR). All of the participants had successful lightening of their teeth. Sixty-one percent (19) had not retreated their teeth. Of those who had not retreated their teeth and who responded to the question of whitening satisfaction, 31% (4/13) were VS, 54% (7/13) were PS, and 15% (2/13) were NS with their current shade. Of those who had retreated their teeth, all were VS or PS. Ninety-one percent of the examined teeth had GI = 0 (normal), 7% had GI = 1 (mild inflammation), and 2% had GI = 2 (moderate inflammation). Sixty-nine percent of teeth tested responded to a cold stimulus. Radiographs did not detect ECR or apical lesions. No participant reported having a gingival biopsy post-treatment, and 87% would whiten again. Patient satisfaction with NGVB may last as long as 12.3 years in average (range 10-17 years) post-treatment. GI and ECR findings were considered within the normal expectations for the sample studied, suggesting minimal clinical post-NGVB side effects up to 17 years. Nightguard vital bleaching provides patient satisfaction with minimal side effects up to 17 years post-treatment.

Treatment of Invasive Cervical Resorption With Sandwich Technique Using Mineral Trioxide Aggregate: A Case Report

This article presents two cases of large invasive cervical resorption (ICR) with maintenance of pulp vitality after treatment with mineral trioxide aggregate (MTA) in a sandwich technique.Invasive cervical resorption is a relatively uncommon but aggressive form of external resorption, primarily caused by dental trauma or injury of the cervical periodontal attachment. The resorptive process does not penetrate into the root canal, and the pulp is not involved in the first phase of the resorption. This feature differentiates external resorption from internal resorption. In most cases, invasive cervical resorption is found during routine radiographic or clinical examination. Different materials have been proposed for the treatment of external cervical resorption. Therapy can be effective when it 1) removes the etiological factors and 2) interrupts the progressive resorption mechanism.The key learning points of this article are the following: treatment strategy to arrest the cervical resorption process and to prevent further resorption without changing pulpal vitality and successful seal of invasive cervical resorption defect using MTA with a sandwich technique.

Surgical endodontic management of an invasive cervical resorption class 4 with mineral trioxide aggregate: A 6-year follow-up

Invasive cervical resorption is a type of external resorption rarely seen as an adverse effect after a guided tissue regeneration procedure for a periodontal condition. This case report summarizes the surgical endodontic management of an invasive cervical resorption class 4 (Heithersay) with mineral trioxide aggregate, in a mandibular incisor of a 67-year-old man. A 6-year clinical follow-up with radiovisiography and cone-beam computerized tomography revealed complete healing. A surgical endodontic management could promote healing and survival of a tooth with advanced root resorption due to a periodontal condition.

Diagnosis and Treatment Modalities of Internal and External Cervical Root Resorptions: Review of the Literature with Case Reports

The clinical presentation of internal and external cervical lesions vary considerably, and detection of lesions is often made incidentally. Accurate diagnosis is the most important step of the treatment plan because these pathologies are quite different from each other concerning their treatment procedures. This paper gives a literature review of internal and external root resorptions with respect of their etiology and addresses the difference in treatment modalities. 
 How to cite this article: Yiğit Özer S. Diagnosis and Treatment Modalities of Internal and External Cervical Root Resorptions: Review of the Literature with Case Reports Int Dent Res 2011;1:32-37.
 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Reverse Sandwich Restoration for the Management of Invasive Cervical Resorption: A Case Report

Introduction Invasive cervical resorption (ICR) may occur as a consequence of trauma, orthodontic treatment, intracoronal bleaching, and surgical procedures and may lead to the progressive and destructive loss of tooth structure. The restoration of these resorptive defects is a challenging task because no single restorative material possesses good sealing ability, reinforcement of remaining tooth structure, and biocompatibility simultaneously. Methods This case presented with invasive cervical resorption class 2 (Heithersay) and apical inflammatory resorption caused by trauma in tooth #9. The surgical management of ICR was performed, and, finally, the roots were externally reinforced by filling the resorptive defect with a combination of composite and resin-modified glass ionomer cement, proposed as reverse sandwich restoration (RSR). Results This novel RSR was well tolerated by the periodontal tissues. A follow-up x-ray showed no pathological changes and no recurrence of resorption. Conclusions This case report presents a treatment strategy for root reinforcement that might improve the healing outcomes for patients with invasive cervical resorption.

A influência de imagens tridimensionais no plano de tratamento ortodôntico

INTRODUÇÃO: a tomografia computadorizada de feixe cônico (TCFC) foi introduzida no final da década de 90 e estudos têm aprimorado o seu emprego na Odontologia. OBJETIVO: o objetivo desse artigo foi verificar a influência de imagens tridimensionais (3D) no plano de tratamento ortodôntico. MÉTODOS: duas situações clínicas (reabsorção cervical e deiscência óssea) foram descritas por meio de imagens 3D. RESULTADOS: a conduta ortodôntica foi redirecionada para a simplificação da mecânica e o controle das lesões durante o tratamento ortodôntico. CONCLUSÃO: imagens 3D são capazes de aumentar a acurácia do diagnóstico e redirecionar o plano de tratamento ortodôntico.

Clinical study on root resorption of autotransplanted teeth with complete root formation

Introduction The main reasons for the unsuccessful autotransplantation of teeth are the failure of initial healing and root resorption. The aim of this study was to elucidate the relationship between donor teeth factors and the prognosis of the transplants in which root resorption occurred. Materials and methods The study evaluated 110 patients with 117 transplants. The successful group included the cases which healed well, with only minor problems. The unsuccessful group included the cases with transplant-loss and progressive problems. The unsuccessful group and minor-trouble cases were judged with the type of problems; i.e. failure of initial healing, root resorption, and others. Root resorption was classified into 3 types; inflammation resorption, replacement resorption and cervical root resorption. The prognostic factors were evaluated to analyze the difference between rapidly progressing root resorption and the stable resorption. Results There were 20 unsuccessful transplants. In the unsuccessful group, rapidly progressing replacement root resorption was observed in 11 transplants. In the successful group, minor problems such as stable root resorption were found in 16 transplants. At least one of the atypical root shapes (divergent, curve, and hypertrophy), probing pocket depth of more than 4 mm, and/or extrusion were significantly more frequent in the replacement root resorption cases compared to cases with no significant findings. Probing pocket depth of more than 4 mm and/or extrusion, dental caries, history of restoration, root canal treatment were significantly more frequent in rapidly progressing replacement root resorption cases compared to stable root resorption cases. Conclusions Abnormal root shape, deep periodontal pocket, dental caries, restoration and root canal treatment of donor teeth are factors associated with progressive replacement root resorption after the autotransplantation of teeth.

Observer Ability to Detect Ex Vivo Simulated Internal or External Cervical Root Resorption

Introduction The objective of this study was to assess observer ability to detect ex vivo simulated internal and external cervical root resorption. Methods A total of 90 single-rooted mandibular anterior teeth were split along the coronal plane. By using a 0.5-mm diameter round bur, 50 of the teeth were drilled to simulate resorptive cavities (25 internal and 25 external cervical resorption), and the remaining 40 teeth were left without surface defects. The sectioned teeth were rejoined and placed in the alveolar sockets of a dry human mandible in groups of 6 and imaged with intraoral film by using 3 different angulations and with a cone-beam computed tomography (CBCT) unit. Film and CBCT image sets were evaluated twice by 3 separate observers. Teeth were scored for the presence and location of resorption by using a 5-point scale. Intraobserver and interobserver kappa coefficients and Az values were calculated for each observer and image set. Differences between modalities were compared by using z statistics, with the significance level set at α = 0.05. Results Both intraobserver and interobserver agreements were statistically higher ( p < .05) for the Iluma CBCT images than for the intraoral images. Az values for CBCT images were also statistically higher ( p < .05) than for film images for all observers and readings. In addition, kappa and Az values of external cervical resorption cavities were statistically higher ( p < .05) than those of internal cervical resorption cavities for all observers, image types, and readings. Conclusions High-resolution Iluma CBCT images performed better than film in the ex vivo detection and localization of simulated internal and external cervical root resorption.

Effect of Calcium Hydroxide on pH Changes of the External Medium after Intracoronal Bleaching

This in vitro study evaluated the effect of calcium hydroxide on pH changes of the external medium after intracoronal bleaching. A total of 50 extracted human premolars were prepared and filled with gutta-percha and endodontic sealer. The teeth were randomly divided into five groups according to the bleaching agents employed: (a) Sterile cotton pellet with distilled water (control group); (b) sodium perborate and distilled water; (c) sodium perborate and 10% carbamide peroxide; (d) sodium perborate and 35% hydrogen peroxide; (e) 35% hydrogen peroxide. The teeth were stored in vials containing distilled water and the pH values of the medium surrounding the teeth were analyzed. After 7-day storage, the bleaching agent was removed and replaced by calcium hydroxide, and the distilled water was changed, in which the teeth were kept stored for further 14 days. Measurement of pH of the external medium (distilled water) was performed 7 days after insertion of the bleaching agents, immediately, 7 and 14 days after insertion of the calcium hydroxide. Data were submitted to statistical analysis by the two-way ANOVA and Tukey,s test. There were pH changes of the external medium at 7- day period after bleaching procedures. These results confirmed the diffusion of bleaching agents to the external medium. Calcium hydroxide increased the external medium pH and was effective for pH alkalinization after intracoronal bleaching. Intracoronal bleaching of endodontically treated teeth may cause cervical root resorption. A possible explanation for this process is the passage of bleaching agents to the periodontal tissues yielding an inflammatory process. In an attempt to keep the neutrality of the periodontal pH, the calcium hydroxide has been recommended.Results of this study showed that this material should be always used after intracoronal bleaching.

Management of tooth discoloration in non-vital endodontically treated tooth - A report of 6 year follow-up

Discoloration of teeth, especially the anteriors, can result in considerably cosmetic impairment in young children. It is the pediatric dentist’s responsibility to supervise those children who seek to undergo a whitening treatment to ensure the maximum cosmetic benefit within the boundaries of oral and systematic health. Among bleaching tech niques, the walking bleach technique with sodium perborate and distilled water stands out because of its superior esthetic results with no side effects. This paper presents a case of tooth discoloration in non-vital tooth which was successfully bleached using walking bleach method. After 6 year follow up the prognosis was good with no reversal of tooth discoloration and absence of external cervical resorption.

Microleakage comparison of glass-ionomer and white mineral trioxide aggregate used as a coronal barrier in nonvital bleaching

There is some evidence that the pH at the root surface is reduced by intracoronal placement of bleaching pastes, which is known to enhance osteoclastic activity. Therefore, it is recommended that a protective barrier be used over the canal filling to prevent leakage of bleaching agents. Glass-ionomer (GI) is commonly used as a coronal barrier before nonvital bleaching. Because mineral trioxide aggregate (MTA) creates high alkalinity after mixing with water, using MTA as a protective barrier over the canal filling may not only prevent leakage of bleaching agents and microorganisms, but may prevent cervical resorption. The aim of this study was to evaluate sealing ability of white mineral trioxide aggregate (WMTA) as a coronal barrier before nonvital bleaching. Root canals of one hundred thirty human maxillary incisors were instrumented and filled with gutta-percha without sealer. Gutta-percha was removed up to 3 mm below the cementoenamel junction (CEJ). The teeth were randomly divided into six experimental groups of 20 teeth each and two control groups of 5. In three experimental groups, WMTA was packed into the canal to the level of CEJ. In the remaining experimental groups, glass-ionomer (GI) was used as a coronal barrier. After a 24-hour incubation period, one of the following three bleaching agents was placed in the access cavity of each of the WMTA or GI groups. These three bleaching agents were 30% hydrogen peroxide, sodium perborate mixed with 30% hydrogen peroxide, and sodium perborate mixed with distilled water. The bleaching agents were replaced every 3 days for three times. In the positive controls, no coronal barrier was used. In the negative controls, all the tooth surfaces were covered by two layers of nail varnish. Microleakage was evaluated using protein leakage test. Statistical analyses were performed with the Kruskal-Wallis and Mann-Whitney tests. The experimental groups showed minimum leakage which was not significantly more than tha in the negative controls. There was no statistically significant difference in leakage between the experimental groups (p<0.05). This study indicated that different bleaching agents have no effect on sealing ability of WMTA.

Playing wind instruments as a potential aetiologic cofactor in external cervical resorption: two case reports

To present two cases of external cervical resorption (ECR) on maxillary incisors, in which the primary aetiologic factor is suggested to be pressure trauma by frequently playing wind instruments. The exact aetiological spectrum of ECR is still poorly understood. For resorption to occur, a defect in the cementum layer (trigger) is a likely prerequisite. Whilst the mechanism for continuation (stimulus) is still unclear, knowledge of potential predisposing factors is important in assessing patients at risk. Pressure generated by playing wind instruments could present an aetiological factor in ECR because it affects the cervical region of the root surface. The cases that are presented may confirm this hypothesis and the extent of resorption defects is shown by cone-beam computer tomography (CT) and micro-focus CT imaging techniques.

Tracionamento ortodôntico: possíveis consequências nos caninos superiores e dentes adjacentes. Parte 3: anquilose alveolodentária, reabsorção dentária por substituição, metamorfose cálcica da polpa e necrose pulpar asséptica

Canine forced eruption comprises one among a number of procedures that can be used in orthodontic treatment to ensure that cuspids are positioned in the dental arch in normal es-thetic and functional conditions. Canine forced eruption should be characterized as an orth-odontic movement. Unfortunately, in discussions of clinical orth-odontic practice some professionals are reluctant to indicate orthodontic forced eruption, especially of maxillary canines. These professionals believe that orthodontic forced eruption can cause many clinical problems during and after surgery. Among the most widely cited reasons for restricting the in-dication of orthodontic forced eruption are: 1) Lateral root resorption in lateral incisors and premolars.2) External cervical resorption of canines due to forced eruption.3) Dentoalveolar ankylosis of the canine involved in the process.4) Calcific metamorphosis of the pulp and aseptic pulp necrosis.In two previous works, we reviewed the first two topics. In this last article in the series we ad-dress the biological foundation of dentoalveolar an-kylosis, replacement resorption, calcific metamor-phosis of the pulp and aseptic necrosis cases either directly or indirectly related to the orthodontic forced eruption of canines.