Cervical Resorption Research Articles

3D Diagnosis and management of external cervical resorption

Aim: This article reports the different clinical approaches of three external cervical resorptions (ECR) cases, based on a three-dimensional (3D) classification. Summary: Treatment planning was based on a 3D diagnosis and the cone beam computed tomography (CBCT) was fundamental to do an accurate assessment of the extension of the lesions. The three cases presented different degrees of complexity, related to the extension of the resorption. In two cases, root canal treatment was performed and internal management of the resorptive lesion was accomplished. In a third case, with a more severe extension of ECR, surgical approach with flap elevation was done to access the resorptive defect. Minimum period of 6-months radiographic and clinical follow-up showed periapical and periodontal healing. This case report presents the importance of a correct 3D diagnosis and treatment planning in maintaining teeth with ECR. Key learning points: ECR is a pathologic root resorptive process with an unclear aetiology. Beginning in a point of entry in the cervical area of the root, in later stages, the resorptive process can reach the pulpal space. Management of ECR lesions should be based on a 3D diagnosis, considering height, circumferential spread and proximity/involvement of the root canal. The use of CBCT enables the clinician to establish a proper diagnosis and evaluate the restorability of the tooth in question.

Surgical restorative treatment of periodontal disease related to external cervical root resorption: A case report

The occurrence of external cervical root resorption (ECRR) is rare. Herein, we report a case of extensive ECRR in the coronal third of the distal root of a mandibular right molar with food impaction and periapical radiolucency. The distal root was perforated and damaged due to delayed treatment. The resorptive defect was debrided, and the defect was restored with conventionally setting restorative glass-ionomer cement. Postoperative follow-up revealed complete healing.

The Disease Process, Diagnosis and Treatment of Invasive Cervical Resorption: A Review.

Invasive cervical resorption (ICR) is a localized, subepithelial, supra-osseous resorptive process of the tooth. Although there are several predisposing factors associated with ICR, its etiology and pathogenesis are poorly understood. The damage to the protective layer on the external root surface appears to allow for the attachment of clastic cells and initiate the resorptive process, which is confined by the inner protective pericanalar resorption-resistant sheet surrounding the root canal space. The use of cone-beam computed tomography (CBCT) is recommended for the diagnosis and assessment of a resorptive lesion. Based on the thorough evaluation of the size and location of the ICR lesion using CBCT, surgical or nonsurgical treatment can be chosen to address the source of the resorption. This review discusses the current status of knowledge regarding the biology of ICR lesions as well as their external or internal treatment using hydraulic calcium silicate-based materials. Future clinical outcome studies are necessary to evaluate the impact of hydraulic calcium silicate-based materials on the healing of ICR lesions.

External Cervical Resorption: A Retrospective Case-Control Study

IntroductionThe current retrospective case-control study examined the potential systemic and local risk factors in relationship to external cervical resorption (ECR). The study hypothesis stated that both local and systemic risks are associated with higher ECR rates. MethodsThe ECR group included data about 76 patients (98 teeth) diagnosed with ECR at the university graduate endodontics clinic from 2008–2018. An equivalent comparative control group without ECR was composed of the same pool of patients and matched with cases by sex and age. Information about dental and medical history, including potential local risk factors (bruxism, trauma, eruption disorders, extraction of an adjacent tooth, orthodontics, and restorations) and systemic risk factors (medical conditions, medication, and allergies), was collected for both groups. Data were analyzed at tooth and patient levels. The chi-square test or Fisher exact test compared proportions between the 2 study groups. ResultsThe overall ECR prevalence among endodontic patients during the 10-year follow-up was 2.3%. ECR was most frequent in maxillary anterior teeth (31.6%), and the Heithersay class 2 was the most frequent (38.8%) ECR diagnosis. Diabetes was the only significant systemic risk factor (P < .05). Trauma, as a local risk factor, was significantly (P < .05) more frequently reported in cases than in controls. ConclusionsThe study hypothesis stating that both systemic and local risk factors were associated with higher ECR rates was partly confirmed, as one systemic (diabetes) and one local (trauma) risk factor were associated with higher ECR rates.

A Volumetric Assessment of External Cervical Resorption Cases and Its Correlation to Classification, Treatment Planning, and Expected Prognosis

IntroductionExternal cervical resorption (ECR) is a relatively uncommon type of external resorption; its treatment planning and prognosis are largely dependent on the clinician’s subjective assessment. This study aimed to provide a volumetric assessment of ECR cases while correlating them to the Heithersay classification, treatment decision, and prognosis determined by 3 calibrated, independent evaluators. MethodsA total of 168 ECR cases with corresponding periapical radiographs and cone-beam computed tomographic (CBCT) imaging were included in this study. An oral and maxillofacial radiologist calculated the volume occupied by the resorptive defects in root structures on CBCT imaging using Amira software (Thermo Scientific, Waltham, MA). Also, 3 board-certified endodontists evaluated anonymized and randomized periapical radiographs and corresponding CBCT images in separate sessions. Examiners were asked to provide a Heithersay classification, whether they would surgically repair the ECR lesion, and the expected prognosis of each case. ResultsThe percentage of radicular volume affected by ECR ranged from 0.5%–58% with a median of 12%. The volumetric quantification of ECR best correlated with classification and prognosis assigned by the independent examiners using CBCT evaluation. The greatest variation in agreement was observed on whether to surgically repair the ECR. However, examiners agreed more uniformly on not to treat when the resorptive port of entry was found on either the lingual or proximal surfaces of the tooth. ConclusionsFor the first time, the volumetric quantification of resorptive defects was calculated in vivo and correlated to the Heithersay classification and prognosis. Because the longevity of teeth affected with ECR depends on the integrity of the remaining root, the findings of this study provide important information to help clinicians decide on treatment planning and inform their patients of the expected prognosis. Future studies should focus on automating volumetric assessments of ECR to aid in unbiased chairside treatment planning decisions.

External cervical resorption: assessment and management

External cervical resorption: assessment and management

The Surgical Management of External Cervical Resorption: A Retrospective Observational Study of Treatment Outcomes and Classifications

IntroductionThe aims of this study were to assess the survival and clinical success of patients with teeth with external cervical resorption (ECR) who underwent surgical repair, to assess the reliability of using 2 different classification systems for ECR (Heithersay 2-dimensional classification and Patel 3-dimensional classification), and to identify if a 3-dimensional classification is a viable alternative. MethodsA retrospective study was performed in a teaching dental hospital in England. The inclusion criteria were limited to patients who underwent surgical management of ECR between 2015 and 2018. Both periapical radiographs and cone-beam computed tomographic scans of 13 patients were assessed by 2 independent dental practitioners using the Heithersay and Patel classifications. The same radiographic assessment of those records was then repeated 3 weeks later by 1 operator. These data were tested using the Cohen kappa analysis to determine inter- and intraobserver agreement. ResultsA total of 14 teeth affected with ECR were identified in 13 patients (6 women and 7 men) with a mean age of 41 years. The mean follow-up was 20 months. At follow-up, survival was noted in all cases; however, clinical success describing endodontic success, comprehensive restorative integrity, and arrest of the resorptive process was only met in 11 cases. Although helpful in describing the lesions, both classification systems displayed considerable limitations in predicting treatment outcome. A measure of Cohen kappa regarding interobserver reliability found the Heithersay classification to provide a moderate level of agreement (0.69), whereas the Patel classification provided a weak level of agreement (0.40). ConclusionsECR is a complex, aggressive, and uncommon form of external resorption. The long-term success of the treatment is predictable but strictly related to careful case selection and operative skill. In reference to ECR classifications, ambiguity still exists between their distinctive categories, leading to moderate and weak levels of interobserver agreement. Further improvement is required to enhance their use in future research.

Surgical management of class 3 invasive cervical resorption

Invasive cervical resorption (ICR) is a pathologic loss of dental hard tissue at the cervical region of tooth beneath the epithelial attachment. ICR is multifactorial in origin and has various predisposing factors such as orthodontic treatment, trauma, and internal bleaching. Thus, a multidisciplinary approach comprising of surgical repair with root canal treatment is required for its successful treatment outcome.

The association of external cervical resorption with modern internal bleaching protocols: what is the current evidence?

Internal bleaching is an effective and minimally invasive way of bleaching non-vital teeth. A commonly cited risk associated with it is external cervical resorption (ECR), which is a potentially significant complication that could result in loss of the tooth. This is an important point of discussion with a patient during the consent process. Legally, patients are required to be made aware of material risks to which they would be likely to attach significance, such as the loss of a tooth. The risk of ECR is therefore a key component in the patient's decision-making process as they weigh it against the perceived benefits. Over the last ten years, both clinical and legal reasons have resulted in a number of changes in the materials and protocols used for internal bleaching. This leads to the question of what the current quality of evidence is regarding the association of ECR following internal bleaching with modern protocols. Other restorative options for discoloured teeth, such as veneers or crowns, involve the irreversible removal of tooth tissue and these may be chosen by patients over internal bleaching based on out-of-date evidence.

Invasive Cervical Resorption—Distribution, Potential Predisposing Factors, and Clinical Characteristics

IntroductionThe purpose of this study was to investigate the distribution, predisposing factors, and clinical characteristics of invasive cervical resorption (ICR). MethodsCases with ICR from 2009–2019 were collected. Clinical records and radiographs were reviewed. Descriptive analysis was performed in combination with univariate analysis and the Fisher exact test. ResultsA total of 63 ICR teeth from 31 patients (14 men and 17 women) were found. The patients’ ages ranged from 18–81 years, with a mean age of 45.77 years. Most patients had a single ICR lesion. Among the 63 ICR teeth, maxillary anterior teeth (47.62%) were the most commonly affected followed by maxillary premolars (20.63%). Maxillary teeth (76.19%) were more prone to ICR than mandibular teeth (23.81%). Most patients denied all major systemic diseases. The most common dental-related factors were dental/orofacial trauma (33.33%), periodontal treatment (26.98%), restoration/crown (17.46%), and orthodontic treatment (15.87%). Most teeth showed no percussion/palpation pain, probing depth >3 mm, abscess formation, sinus tracts, or periapical lesions. The pulp status was mainly vital (73.02%). The presence of percussion pain and probing depth differed significantly among Heithersay ICR classification groups. ConclusionsICR showed no difference in sex or age. Maxillary anterior teeth were the most affected in a Taiwanese population. Traumatic injury, periodontal treatment, and orthodontic treatment were the significant predisposing factors. Furthermore, affected teeth typically lacked clinical signs and symptoms. Radiographic examination is critical for early diagnosis. In advanced cases, deep pockets and abscess formation were seen. These results are helpful for the diagnosis of ICR and further effective treatment.

Clinical performance of whitening on devitalized teeth: a retrospective observational study

Objective: This retrospective observational study evaluated the clinical performance of intracoronal whitening and correlated the main factors that interfere with its stability and patient satisfaction. Material and Methods: The paper was designed following the STROBE statement. Patients from the Institute of Science and Technology - ICT/UNESP database who underwent nonvital tooth whitening from August 2010 to July 2015 were selected. Data collection was performed by researching the institution records, patients interview, clinical and radiographic examination. Data were analyzed using Mann-Whitney test and Spearman's correlation (p&lt;0.05). Results: The initial search on 1275 records resulted in 43 patients, of whom 18 were selected according to eligibility criteria. There was positive correlation only between the degree of patient’s satisfaction and the perception of color difference after whitening treatment (p&lt;0.05). Color relapse was observed in all conditions, independently of the period of follow-up (p&gt;0.05). There was no case of external cervical root resorption. Conclusion: Color changes after whitening influenced patient’s satisfaction. There was no correlation among the color relapse and height of gutta-percha, return interval or cause of darkening.KEYWORDSTooth discoloration; Tooth nonvital; Tooth whitening.

Small case series suggests positive outcomes of vital pulp therapy for treating invasive cervical root resorption

Small case series suggests positive outcomes of vital pulp therapy for treating invasive cervical root resorption

Radiation diagnostics of cervical invasive resorption and treatment planning according to cone beam computed tomography

Resorption of permanent tooth tissues is always a patho-logical process, the cause of which is not known, and an asymptomatic course in the early stages makes it difficult to diagnose. The pathogenesis of the disease and clini-cal and radiological prisms have been studied, as well as the main predisposing factors for the occurrence of re-sorption are known. Objective: timely detection of the disease by doctors in dental patients remains relevant. The purpose of this study is to find the possibility of early and accurate diagnosis of cervical invasive dental resorp-tion and to plan treatment based on the obtained data of targeted cone-beam computed tomography. Mate-rial and metods: data from outpatient records of dental patients with detected dental resorption. We analyzed cases of cervical invasive resorption in 67 patients. When applying, patients complained about the condition of the causal tooth with diagnosed resorption only in isolated cases, and the diagnosis was made according to compu-ter tomography. Cone beam computed tomography was also the only method that allowed determining the entry point of cervical and invasive resorption, and with this in mind, planning the location of the dosupa for treatment. Diagnostics of resorption is based mainly on x-ray me-thods, and mainly on cone-beam computed tomography (CBCT) data. Results: complaints about teeth related to resorption were made by only 11.9% of patients out of the total number of people who were diagnosed with cervical invasive resorption. Complaints related to issues of various discomfort due to the presence of defects, dis-coloritis of the teeth, pain in the area of the causal tooth was indicated by 2 people. 67.2% of patients were diag-nosed with various clinical forms of periodontitis. 26.9% are undergoing or were undergoing orthodontic treat-ment. 7.5% of the subjects had a history of dental trauma. The average age: in the group of men was 39.4 years, in women — 42.9 years. The entry point of cervical invasive resorption was most often determined in the incisors and canines of the upper and lower jaw. The localization of the entry point was most often determined on the ves-tibular surface of the teeth in 31.1%, on the oral surface in 35.6%, on the approximal surfaces in 26.7%. the Asymp-tomatic course of CIR suggests the priority of using mo-dern methods of full-fledged informative high-tech x-ray examination of dental patients, in particular, CLCT. The ability to determine the localization of the resorption en-try point according to CLCT data, allows you to plan sur-gery for treatment. Conclusion: the developed standard for examination of patients using cone-beam computed tomography makes it possible to diagnose early cervical invasive resorption when drawing up a treatment plan for a primary patient and in all cases planning primary or re-peated endodontic treatment.

Management of root canal stenosis and external inflammatory resorption by surgical root reconstruction using biodentine

Root canal stenosis and external inflammatory root resorption are potential consequence of trauma that can occur depending on the severity of the injury. Luxation injuries induce reduced blood supply to the pulp, which leads to calcification/narrowing of root canals leading to root canal stenosis. External inflammatory cervical resorption occurs when there has been the loss of cementum due to damage to the external surface of tooth root during trauma, plus root canal system becoming infected with bacteria. External inflammatory resorption can ultimately lead to loss of tooth if it is not managed in a timely manner. The treatment should aim toward the complete suppression of all tissues undergoing resorption and the reconstruction of the resorptive defect by the placement of a suitable bioactive material. This case report presents the management of root canal stenosis in the maxillary left central incisor in 35-year-old female and management of Class IV external invasive cervical and apical inflammatory resorption in maxillary right central incisor, both of which were diagnosed with the help of cone-beam computed tomography scan. The treatment of external inflammatory resorption included surgical excision of granulation tissue and root reconstruction with Biodentine. Twelve months follow-up showed successful outcomes for both the teeth treated for root canal stenosis and external invasive inflammatory resorption leading retention of the traumatized teeth with otherwise poor prognosis.

Management of traumatically intruded permanent maxillary central incisors

The management of intrusive luxation varies depending on the patient's age, stage of root development, and severity of the trauma. These kinds of injuries are associated mostly with severe damage to the pulpal tissue, periodontium, and the tooth. The aim of this case report is to present multidisciplinary management of complete intrusion of maxillary central incisors in a 9-year-old healthy girl with external root resorption. The root canals were cleaned and medicated with calcium hydroxide then the teeth were extruded by an orthodontist. After two months, a 4 mm apical plug with mineral trioxide aggregate was placed in the apical third of the canals and the remaining of the canal was obturated with thermoplasticized gutta-percha. Cervical root resorption was noticed during the follow-up evaluation and was surgically managed.

Research of the occurrence of external cervical resorption and cement caries in clinical practice

Research of the occurrence of external cervical resorption and cement caries in clinical practice

A comparative evaluation of the fracture resistance of endodontically treated teeth with simulated invasive cervical resorption cavities restored with different adhesive restorative materials: An in vitro study.

Aim:The aim of the study was to compare the fracture resistance of endodontically treated teeth with simulated invasive cervical resorption cavities, restored with different restorative materials, namely, conventional glass-ionomer cement (CGIC), resin-modified glass-ionomer cement (RMGIC), flowable composite (FC), and giomer.Methods:Sixty extracted human permanent maxillary central incisor teeth were assigned to six groups,which were, Group 1 (intact teeth, control), Group 2 (teeth with biomechanical preparation and resorption cavity), Group 3 (CGIC), Group 4 (RMGIC), Group 5 (FC), and Group 6 (giomer). Except for Group 1, other groups were subjected to endodontic treatment. Teeth of Group 2 were left unobturated and teeth of Groups 3–6 were obturated. A simulated resorption cavity was prepared labially in the specimens belonging to Groups 2–6 and restored with respective restorative materials. The specimens were subjected to compressive load until failure in an Instron testing machine and the load at failure was recorded in Newtons.Statistical Analysis:The data obtained were statistically analyzed using one-way ANOVA, pair-wise comparison was made with Tukey's multiple comparison test, and P < 0.05 was considered statistically significant.Results:There was a statistically significant difference in the fracture resistance of intact teeth and endodontically treated teeth with simulated invasive cervical resorption cavities restored with different adhesive restorative materials. Among the restored teeth, there was no significant difference.Conclusion:Intact teeth were found to have the highest resistance to fracture followed by those restored with giomer, FC, RMGIC, and CGIC in that order.

Management Of Perforating External Cervical Root Resorption

Introduction: External cervical resorption (ECR) is the loss of dental hard tissue as a result of odontoclastic action; it usually begins on the cervical region of the root surface of the teeth. The etiology and predisposing factors are not very clear. The aim of this case report is to show the management of maxillary right canine diagnosed with ECR. Case Report: A 54-year old female patient was referred to our clinic with the history of dentin hypersensitivity in maxillary right anterior area. Radiographic examination revealed a radiolucent lesion located on the cervical third of maxillary right canine. The tooth was clinically asymptomatic. The patient did not report any traumatic history. CBCT scans revealed the extent of the resorption cavity and confirmed the diagnosis of the lesion. Due to perforation of the resorption into the root canal space, the access cavity was opened and temporarily occluded with a gutta-percha point. Then the surgical repair of the resorptive defect was carried out without blocking the root canal with filling material. A mucoperiosteal flap was elevated to clean the granulamatous tissue. The lesion was apparent after complete degranulation of soft tissue. It was repaired with MTA-Angelus (Angelus, Londrina, PR, Brazil) , a glass ionomer and a composite resin. The flap was replaced and sutured. Once the ECR cavity was restored, then endodontic treatment was completed in the same appointment. The root canal was obturated with gutta percha and root canal sealer by cold lateral condensation. . Conclusion: In the 9-month follow-up examination, the tooth including ECR defect was completely asymptomatic and functional. Early detection is necessary for successful management and outcome of ECR. CBCT should be considered for the assessment and/or management of ECR.

How to assess and manage external cervical resorption.

External cervical resorption (ECR) is a type of pathological resorption which starts below the epithelial attachment to the root of a tooth. Various aetiologies relating to exposure of root dentine have been proposed. However, this is poorly investigated in the literature. Due to the nature of this lesion, early detection via thorough examination is essential to maintaining restorability of affected teeth. This article aims to summarise the available literature and describe management strategies for ECR, highlighting the role of clinical findings and patient-related factors in treatment planning.

Intentional Replantation with an Atraumatic Extraction System in Teeth with Extensive Cervical Resorption

External cervical resorption (ECR) often renders a tooth nonrestorable, especially if it extends deeply within the dental hard tissue. Intentional replantation is sometimes performed as the last resort to save the tooth but may limit conventional forceps extraction because of the high risk of periodontal ligament cell damage or crown fracture.This case report describes the intentional replantation of an upper central incisor with extensive ECR using an axial, atraumatic extraction system to save the otherwise hopeless tooth. The patient was an asymptomatic 37-year-old man with no contributing medical history. The treatment protocol included atraumatic extraction followed by granulation tissue removal, extraoral root canal treatment, and adhesive restoration of the extensive resorption defect. During extraoral manipulation, the utmost care was taken to prevent root surface drying, contamination with dental adhesive, or heat-induced periodontal ligament damage during curing. Two and a half years after replantation, clinical and radiographic examinations revealed normal healing and no symptoms but a slight reduction of bone level compared with the preoperative level and no signs of root resorption or ankylosis. The successful outcome in this case supports the idea of performing intentional replantation with an atraumatic extraction system to save teeth with extensive cervical root resorption and a high risk of fracture during extraction.