Cervical Root Resorption Research Articles

Conservative Management of Class 4 Invasive Cervical Root Resorption Using Calcium-enriched Mixture Cement

Class 4 invasive cervical root resorption (ICRR) presents a treatment dilemma in endodontics. The widely accepted treatment options for a class 4 ICRR are to leave these teeth untreated for as long as they are asymptomatic or extraction. This report presents a conservative approach for the management of class 4 ICRR. A 28-year-old woman was referred for root canal treatment of tooth #26. The patient had a history of orthodontic treatment. Radiographic evaluation showed class 4 ICRR that had perforated the root canal space, a radiolucent crestal bony defect, and a periapical lesion. Clinically, a deep (6-mm) probing area was found on the mesial side of the tooth that bled on probing. The tooth was sensitive to percussion. After the treatment options were discussed with the patient, she chose to save the tooth. After complete chemomechanical preparation of the root canal, the entire canal space and perforation area were filled with calcium-enriched mixture cement. No attempt was made to mechanically remove the resorptive lacuna. Twenty four months after treatment, the tooth was functional and asymptomatic, and probing was within normal limits (<3 mm) with no bleeding during probing. Radiographic examination revealed no progression of resorption, osseous healing of the crestal bony defect, and healing of the periapical lesion. Obturation of the root canal space with calcium-enriched mixture cement may be a viable treatment option for an otherwise non-treatable tooth with class 4 invasive cervical root resorption.

A Familial Pattern of Multiple Idiopathic Cervical Root Resorption With a 30-Year Follow-Up.

Multiple idiopathic cervical root resorption (MICRR) is a rare entity distinct from pathologic root resorption that occurs as a result of several local and systemic factors. This report describes a familial pattern of MICRR, including a recently identified case and a 30-year follow-up on previously described cases. The previously reported father (aged 95 years) and son (aged 64 years), and the recently affected daughter (aged 61 years) recounted non-contributory medical history. The resorptive lesions were asymptomatic, unassociated with any predisposing factors, and first identified during the fourth to sixth decades of life. All tooth types were affected, with posterior teeth being affected earlier and with greater frequency; however, distal root surfaces were never affected. The resorptive lesions were progressive in nature, with additional teeth becoming involved as the condition was followed over time. In many instances, surrounding alveolar bone extended into the existing resorptive defects, but without clinical evidence of ankylosis. Gingival tissues, periodontal probing, and tooth mobility were within normal limits. Microcomputed tomography of extracted teeth demonstrated that the lesions were more extensive than clinically evident and rarely invaded the pulp chamber. Histologically, many resorptive lesions were noted along the cementum surface, with evidence of isolated cemental repair. Management of MICRR focused on restoring damaged root surfaces and extracting teeth with extensive root resorption. MICRR is a challenging entity with unknown etiology and a lack of well-established preventive and management strategies. The familial pattern noted in this report necessitates future studies to investigate the role of genetic components in MICRR development.

Management of External Cervical Root Resorption in Mandibular Molar

ABSTRACT External root resorption of teeth takes its origin from periodontal tissues but is often an endodontic enigma. A combined endoperio management is required if the external resorption involves both entities. This article describes the management of an external resorption in mandibular first molar by intentional reimplantation using cone-beam computed tomography (CBCT) as an adjunctive diagnostic aid. Following atraumatic extraction of 36, endodontic treatment was performed extraorally, followed by sealing of the resorptive site using Biodentine. The periodontal procedures included guided tissue regeneration using a bioresorbable membrane and placement of osseograft for bone regeneration. After a follow-up period of 10 months, the patient was totally asymptomatic. Intentional reimplantation is a viable treatment option for external root resorption of inaccessible sites. How to cite this article Kavitha M, Shobana S. Management of External Cervical Root Resorption in Mandibular Molar. J Oper Dent Endod 2016;1(1):39-45.

Cytotoxicity of two available mineral trioxide aggregate cements and a new formulation on human gingival fibroblasts.

Aim:The purpose of this study was to investigate the cytotoxicity of nanohybrid mineral trioxide aggregate (MTA) in comparison with calcium-enriched mixture (CEM) cement and MTA-Angelus, using human gingival fibroblasts (HGFs).Materials and Methods:Nine disc-shaped specimens of each material (in 2 set stat: A, set for 24 h; B, set for 30 min; and C, fresh stat) were prepared. HGFs were exposed to tested materials’ extracts or control media. Cytotoxicity testing was performed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide assay in two time intervals.Statistical Analysis:Results were evaluated by one-way ANOVA and t-test. Statistical significance was set at P < 0.05.Results:CEM cement demonstrated favorable cell viability values when completely set (24 h set MTA = 24 h set CEM) at both time intervals. Interestingly, 24 h after incubation, CEM in Groups B and C demonstrated higher cell viability values than MTA (P < 0.05). However, after 72 h of incubation, these groups of CEM and MTA showed equal cell viability. All samples of nanohybrid MTA had slight cytotoxic effects after 24 h of incubation, and moderate cytotoxic effects after 72 h of incubation.Conclusion:Set CEM and set MTA-Angelus exerted similar, favorable effects on cell viability. However, within the limitations of this in vitro study, the results suggest that nanohybrid MTA could not be recommended as a material of choice for cervical root resorption.

Influence of bone marrow stromal cell secreted molecules on pulpal and periodontal healing in replanted immature rat molars.

To investigate the effect of paracrine factors secreted from human bone marrow stromal cell (BMSC-CM) on pulpal and periodontal healing following immediate replantation of maxillary rat first molars. Fifty maxillary rat first molars were elevated and replanted after 2min. The left teeth were replanted without treatment, whereas BMSC-CM was injected into the right socket prior to replantation. Twelve un-operated teeth served as reference teeth. The expression of vascular endothelial growth factor A, alkaline phosphatase, Runt-related transcription factor 2 and osteoclast stimulating factor 1 was studied by real-time reverse transcription polymerase chain reaction at day 3 and 14. The dentin thickness together with Laminin- and PGP 9.5-immunoreactivity were studied after 3, 14 and 90days. Real-Time qRT-PCR data showed up-regulated expression of ALP mRNA in the socket specimens of conditioned medium treated replanted teeth after 3days. No morphological differences were found for the expression of Laminin and PGP 9.5 between control and conditioned medium treated replanted teeth. At day 14, external cervical and surface root resorption was found in one BMSC-CM and one control tooth. At 90days, all control replanted teeth had external cervical and surface root resorptions, whereas only one sample was seen among the conditioned medium treated teeth. At day 90, more extensive dentine formation with narrowing of the pulpal space was observed in the control compared with conditioned medium treated teeth. The present findings showed that BMSC-CM treatment reduced the number of replanted teeth with external root resorption and resulted in a significant reduction in new dentin formation.

Root Resorption a 6-Year Follow-up Case Report.

This paper describes the clinical course of a pediatric patient developing cervical external root resorption (CERR). An 11-year old male patient had sustained dental trauma and was diagnosed with crown fracture affecting the incisal and middle thirds of the maxillary right permanent central incisor and the maxillary right permanent lateral incisor with pulp exposure and CERR after 24 months. Diagnosis and treatment of CERR are a challenge for dental practitioners. In this case, preservation of natural dentition is shown as a successful treatment in a 6-year follow-up.

Endodontic and periodontal treatment of external cervical root resorption: a case report

Endodontic and periodontal treatment of external cervical root resorption: a case report

Cervical root resorption: Report on two clinical cases

Cervical root resorption: Report on two clinical cases

A case report of the healing ability of low-density Nd:YAG laser irradiation and MTA compaction on invasive cervical root resorption

A case report of the healing ability of low-density Nd:YAG laser irradiation and MTA compaction on invasive cervical root resorption

External cervical resorption case report and a brief review of literature

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, predisposing factors, diagnosis, and management of ECR have been reviewed here. Effective management and appropriate treatment can only be carried out if the true nature and exact location of the ECR lesion are known. This paper reports on the management of a case of external cervical root resorption (ECRR), which involved root canal treatment and removal of the resorbing area of the affected tooth as well as filling the resorbed area with mineral trioxide aggregate (MTA) and resin-modified glass ionomer filling material (RMGIC). The defect was filled with bone graft material and guided tissue regeneration (GTR) membrane. This case highlights the importance of using MTA and successful management of cervical resorption with a stable uneventful clinical recovery.

Cervical root resorption.

Abstract Cervical resorption is an inflammatory-mediated external resorption of the root, which can be seen after trauma and following internal bleaching techniques. It is initiated in the periodontal ligament, but the exact pathogenesis is not known. Once triggered the resorption phenomenon can lead to fracture and loss of the tooth

Expression of Toll‐like receptors 2 and 4 and the OPG–RANKL–RANK system in inflammatory external root resorption and external cervical resorption

To investigate and compare the expression of the pathogen recognition receptors Toll-like receptor (TLR) 2 and TLR4, and the hard tissue resorption triad osteoprotegerin (OPG)-receptor activator of nuclear factor kappa-B ligand (RANKL)-receptor activator of nuclear factor kappa-B (RANK) in external inflammatory root resorption of endodontic origin (ER) and external cervical root resorption (ECR) by immunohistochemistry. Formalin-fixed, paraffin-embedded archival specimens collected from teeth that were diagnosed clinically, radiographically and histopathologically with either ER (n = 9) or ECR (n = 9) were processed for immunohistochemistry to investigate and compare levels of TLR2, TLR4, OPG, RANKL, RANK, CD3, CD19 and CD83 expression. The histological features were evaluated via haematoxylin and eosin stain. Taylor's modification of the Brown and Brenn Gram stain was used for examining the presence and distribution of bacteria. All stained slides were digitally photographed and qualitatively analysed, and F test and unpaired Student's t-test were used for statistical analysis. Both ER and ECR showed similar immuno-histopathology characteristics of a fibrovascular connective tissue with varying degrees of inflammatory infiltrate consisting of T and B lymphocytes, dendritic cells, polymorphonuclear lymphocytes and plasma cells. Colonies of bacteria were identified in the majority of lesions, and this correlated with the cellular expression of TLR2 and TLR4 in all lesions. Similarly, all lesions showed a significantly higher (P < 0.05) level of cells expressing RANKL than OPG, indicating hard tissue resorption processes where active in the lesions. The immunohistopathology patterns of ECR samples were consistent with the bacteria-driven ER specimens, suggesting bacteria-induced inflammation may be involved in ECR.

Clareamento de dentes tratados endodonticamente: uma revisão da literatura

Na Odontologia contemporânea, a estética sofreu uma valorização significativa, ganhando destaque e importância. Nesse contexto, a beleza é influenciada pelo contorno, forma, simetria, alinhamento e, principalmente, pela cor dos dentes. O clareamento de dentes anteriores desvitalizados escurecidos tem se tornado uma terapia muito requisitada, uma vez que o escurecimento dos dentes é motivo de grande insatisfação por parte dos pacientes. Esta revisão de literatura tem como objetivo analisar os dados disponíveis na literatura sobre este assunto, uma vez que a associação entre o clareamento interno e a reabsorção radicular externa cervical é uma questão que ainda gera dúvidas na prática odontológica. O clareamento interno apresenta resultados esteticamente satisfatórios, no entanto, apresenta como possível efeito colateral a reabsorção radicular cervical externa, que prejudica ou até mesmo inviabiliza a permanência do elemento dental na cavidade bucal. A etiologia da reabsorção radicular externa relacionada ao clareamento é complexa, no entanto acredita-se que o agente clareador alcance os tecidos periodontais através dos túbulos dentinários, desnature a dentina, que passa a ser considerada um tecido imunologicamente diferente, sendo reconhecida como um corpo estranho e inicia uma reação inflamatória que resulta na perda localizada de tecido dental. Outra limitação do clareamento de dentes tratados endodonticamente é a recidiva da cor, ainda pouco compreendida. Apesar do clareamento de dentes desvitalizados ter um alto índice de sucesso e de sua natureza minimamente invasiva, os possíveis efeitos colaterais, tais como a reabsorção cervical externa e a recidiva de cor devem ser levados em consideração no momento de sua indicação.

Failure of treatment of impacted canines associated with invasive cervical root resorption

To propose invasive cervical root resorption (ICRR) as an unrecognized and/or overlooked etiologic factor in the failure of response of an impacted tooth to orthodontic traction and to underline the importance of cone beam computerized tomography (CBCT) for early and accurate diagnosis of ICRR. Fourteen patients (age 13-21 years) with impacted canines (15 canines) that had failed to respond to orthodontic forces and that exhibited ICRR formed the case series for this investigation. The initial diagnosis, treatment, clinical and radiographic expression of failure, and adverse effects on adjacent teeth were analyzed. Initial diagnosis had been performed on plane radiographs. The orthodontist was absent during surgery in 11 patients. Nine canines had been exposed by open procedures. ICRR was not related to the severity of impaction. Its diagnosis was made on existing radiographs, new films, and/or new CBCT. The severity of the lesions was Class 3 or 4, and the teeth were finally extracted. Loss of anchorage characterized 11 patients. Apical resorption of the roots of adjacent teeth was diagnosed in 9 patients. ICRR is a frequently undiagnosed or unrecognized cause of failure of orthodontic resolution of impacted canines and should be distinguished from replacement resorption. CBCT should be used for its early detection and accurate assessment of potential damage to adjacent anchor teeth.

Cervical root resorption and non vital bleaching

Tooth-bleaching techniques today mostly employ hydrogen peroxide as the active agent. It is applied directly, or produced in a chemical reaction from sodium perborate or carbamide peroxide. More than 90% of success rate has been reported for intracoronal bleaching of non-vital teeth. Intracoronal bleaching is a conservative alternative to the more invasive esthetic treatment of non-vital discolored teeth. Careful examination is necessary, since the method requires healthy periodontal tissues and a root canal that is properly obturated to prevent the bleaching agent from reaching the peiapical tissues, and an effective gingival barrier which prevents the bleaching agents from leaching into the periodontium. Cervical root resorption is a possible sequel of internal bleaching and is more frequently observed in teeth treated with the thermo-catalytic bleaching method. A high concentration of hydrogen peroxide in combination with heat or etching also seems to promote cervical root resorption. Cervical root resorption is an inflammatory-mediated external resorption of the root, which can be seen after trauma and following intracoronal bleaching.

Regenerative periapical surgery: A case report

Introduction: Periapical surgery is an important treatment alternative in the presence of a large periapical cyst. To achieve optimal healing and regeneration of the bone different bone substitutes can be used. Case Report: A 35 year old male patient reported with the soft diffuse swelling in anterior palatal region and drainings in us with 21 labially. He had a history of trauma 5 years back. The clinical and radiographic diagnosis of infected periapical cyst with 11,21; invasive cervical root resorption with 21 and internal root resorption with 11 was made. Endodontic treatment was performed with11,2 followed by periapical curettage. A picectomy and retrograde filling with white mineral trioxide aggregate (MTA) was carried out with 11,21. The cervical resorption defect with 21 was restored with white MTA. Platelet rich fibrin (PRF) was mixed with demineralised bone matrix (Osseograft) and used as a regenerative biomaterial in the periapiacl defect. 14 months follow up shows satisfactory healing and regeneration of periapical region. Discussion: There is considerable clinical interest in using PRF alone or in combination with graft materials as it is a reservoir of many growth factors and have potential for accelerated soft-and hard tissue healing. PRF is a new generation of platelet concentrate, derived from patients own blood.

Invasive cervical root resorption 15 years after modified Widman flap surgery

Invasive cervical root resorption is a relatively uncommon form of external root resorption. Creeping attachment is defined as postoperative coronal migration of the gingival margin. We describe a case of invasive cervical root resorption following coronal shift of interdental papillae 15 years after modified Widman flap surgery.

Invasive cervical root resorption: Engineering the lost tissue by regeneration

Invasive cervical resorption (ICR) is a localized resorptive process that commences on the surface of the root below the epithelial attachment and the coronal aspect of the supporting alveolar process, namely the zone of the connective tissue attachment’ early diagnosis, elimination of the resorption and restorative management are the keys to a successful outcome. Treatment done was a combined non-surgical root canal therapy, surgical treatment to expose the resorptive defect and the resorptive defect was filled up with reverse sandwich technique and finally the bony defect filled with platelet rich fibrin (PRF), hydroxylapatite and PRF membrane. Significant bone fill was obtained in our case after a 2 year follow-up period. This case report presents a treatment strategy that might improve the healing outcomes for patients with ICR.

Intracanal management of a post traumatic perforative invasive cervical root resorption using calcium enriched matrix cement

Invasive cervical root resorption (ICR) is a consequence of a resorptive soft-tissue penetrating into dentin that starts below the gingival attachment and tends to be asymptomatic unless dental pulp involvement. Prompt diagnosis is the key to retention of the involved tooth. Treatment procedure includes non-surgical elimination of the resorptive soft-tissues and restoration of the cavity. In case of pulp involvement, endodontic treatment is indicated. This is a report of a non-surgical intra canal treatment case in a maxillary central incisor, which involved the pulp and was successfully treated with calcium enriched mixture (CEM) cement. Based on favorable long-term treatment outcomes, CEM cement may be a promising biomaterial in treatment of ICR cases.

Unusual Case of Inflammatory Myofibroblastic Tumor in Maxilla

Inflammatory myofibroblastic tumor (IMT) is a rare lesion found mostly in children and young adults and originates from the lung, abdominopelvic region, and retroperitoneum. Clinical manifestations of IMT or imaging are nonspecific and diagnosis is based on histopathological and immunohistochemical findings. Minority of all IMTs will metastasize. IMT in the oral cavity is an extreme rarity and this is a first case report of IMT in maxilla causing delayed tooth eruption and multiple cervical root resorption with an 11-year-old child. The IMT reported here was positive for smooth muscle actin, vimentin, and anaplastic lymphoma kinase (ALK1) with immunohistochemistry. Only three IMTs of the jaws have been reported so far and none of them had delayed root eruption and tooth resorption. This unusual case of IMT in a child was also ALK1- positive supporting neoplastic origin of her tumor. The case presented here underscores the importance of histopathological examination of the tissue found in any root resorption especially in the case of multiple resorptions.