External Inflammatory Root Resorption Research Articles

Evaluation of rise in pH and oxygen release at the site of simulated external root resorption cavities using different oxygen-releasing biomaterials: An in vitro study.

External inflammatory root resorption has rapid onset and progresses aggressively. It leads to cementum loss, which allows communication between the infected pulp and the periodontium through the denuded dentinal tubules. Primary management strategy includes adequate chemomechanical debridement and lesion arrest for which maintaining alkaline pH and aerobic conditions is essential for healing and repair of the resorption defect. The aim of this study is to evaluate rise in pH and oxygen release at the site of simulated external root resorption cavities using different oxygen-releasing biomaterials. In 40 extracted single-rooted teeth access opening and chemomechanical debridement were done. Cavities simulating resorption defect are prepared on the roots. The samples are divided into four groups (n = 10) based on the biomaterial used. After placing the biomaterial, the root apices were sealed. Half of the samples from each group were tested for oxygen release using dissolved oxygen meter and the other half for rise in pH using pH meter at 7, 14, 21, and 28 days. The pH values were analyzed using Friedman 2-way analysis of variance (ANOVA) and Kruskal-Wallis test. Oxygen release was measured using the two-way and repeated-measures ANOVA. Calcium peroxide group showed the highest mean pH and oxygen release than other groups at any given point of time. Incorporating oxygen-releasing biomaterials such as calcium peroxide and perfluorodecalin into intracanal medicaments, such as calcium hydroxide, creates an alkaline and oxygen-enriched milieu in the periapical tissues.

Pulp revascularization procedure for external inflammatory dental root resorption treatment

To assess the effectiveness of pulp revascularization procedure in children with external inflammatory root resorption (EIRR) after constant teeth injury. The study comprised 17 children aged 6-10 years diagnosed with EIRR as a long-term complication of dental trauma in 19 teeth. EIRR was diagnosed with periapical radiographs and CBCT was performed to further assess the pathology extension. Pulp revascularization was carried out in all 19 teeth. There was no resorption progression in all cases. EIRR areas were substituted by bone. In 10 from 19 teeth with early stages of root development bone or cement-like tissue ingrowth into the root canal was observed radiologically. In cases of severe EIRR this ingrowth may partially compensate for lost tissues which is confirmed by a high percentage (94.7%) of functional teeth during mean follow up time of 38±10 months. Pulp revascularization is an effective method for retaining teeth with EIRR for a relatively long period of time and allows maintaining alveolar bone volume both due to functional tooth preservation and healing of bone lesions in periapical and resorption areas.

Endodontic Intervention for Managing External Inflammatory Root Resorption in Mandibular First Molar

External inflammatory resorption (EIR) is the pathological destruction of external radicular structures with a multifactorial etiology. Prompt diagnosis and meticulous intervention are obligatory to retain the salvageability of the tooth and to circumvent the premature loss of permanent dentition. Infected pulpal tissues and microbial toxins are the mainstay of the persistent inflammatory response in the periodontal tissues. This provokes odontoclastic activity, precipitating radicular loss. In this report, a 17-year-old male patient reported severe pain in the mandibular right first molar. After a thorough history and examination, the case was diagnosed as inflammatory root resorption. Nonsurgical endodontic therapy was performed under rubber dam isolation. After adequate chemomechanical preparation, intracanal, non-setting calcium hydroxide was utilized to arrest the resorptive process. This case enlightens the fact that mechanical debridement alone cannot achieve the prime goal of endodontic intervention. Chemical disinfection using intracanal medicaments can magnify the outcomes by eradicating the nidus of infection

Guided Autotransplantation of an Immature Premolar to the Maxillary Incisor Region with Immediate Restoration of Esthetics: A Case Report

This case report describes the treatment of two maxillary central incisors following a traumatic injury with tooth #8 developing replacement resorption and #9 developing inflammatory root resorption. A 10-year-old girl presented complaining of pain in her maxillary central incisors. Upon clinical examination, teeth #8 and #9 were tender to percussion and palpation of the buccal soft tissues. Thermal and electrical pulpal sensitivity tests for teeth #8 and #9 were negative. An intraoral periapical radiograph revealed resorptive defects in tooth #8, which were filled with bone-like tissue, while tooth #9 had radiolucent resorptive defects along the root surface and a periapical radiolucency. A diagnosis of replacement resorption was made for tooth #8 and external inflammatory root resorption for tooth #9. Tooth #8 was treated with a multidisciplinary approach utilizing a guided template for premolar autotransplantation with an immediate veneer restoration, while tooth #9 was managed with root canal treatment using a tricalcium silicate cement to fill the canal. At the 1, 4, 8, 12, and 24-month follow-ups, the patient remained asymptomatic, and there was no radiographic evidence of root or periapical pathosis on either tooth. The root-end of the donor tooth transplanted to the #8 site continued to develop. This case report highlights successful interdisciplinary management of two forms of root resorption using modern treatment strategies that provided immediate function and esthetics to the maxillary central incisors in a young patient following trauma.

Assessment of Digital Intraoral Periapical Radiograph for the Detection of Apical Root Resorption in Inflammatory Periapical Pathologies: A Radiovisiography Study.

Introduction Resorption often takes the form of external inflammatory root resorption. Apical periodontitis or an apical cyst is the most typical cause of external inflammatory root resorption. Failure of endodontic treatment can occur if severe apical root resorption occurs.This is due to the difficulty of reaching these sites.Apical root resorption is usually discovered during routine radiographs and is usually in its later stages. If the lesion is advanced, extraction is the only viable solution. An accurate diagnosis of incipient root resorption is essential.This research is designed to analyze the effectiveness of digital intraoral periapical radiographs in assessing apical root resorption (ARR) related to periapical pathologies. Material and methods Thiscross-sectional radiographic observational researchwas conductedin a dental college and hospital in central India. Radiovisiography (RVG) images of 190 patients' teeth with inflammatory periapical pathologies were evaluated to determine the presence or absence of resorption in the apical area of the root. After the radiographic assessment of the apical root resorption, the extraction of the affected teeth was done under all aseptic conditions. The periapical tissue was sent for histological analysis and the extracted tooth sample was examined for the presence or absence of apical root resorption. Results In comparison to apical periodontitis, the proportion of severe root resorption patients was significantly higher in abscess and periapical granuloma. Using Pearson's Chi-square test, the difference in patient proportions according to the kind of resorption in the three radiological diagnosis groups was statistically significant with a p-value of 0.0058. Conclusion It was concluded that on radiographic examination, digital intraoral periapical radiographs were found to be accurate in determining periapical apical pathologies and apical root resorption.

Endodontic Treatment Outcome of 45 Incisor Teeth in Dogs Determined by Intraoral Radiography.

A retrospective study was conducted to determine the outcome of endodontic treatment of incisor teeth in dogs. Medical and dental records from four private veterinary specialty practices over an 8-year period (2013-2021) were reviewed. Forty-five incisor teeth from 41 dogs with ages from 1 to 11-years-old were included in the study. The indications for endodontic treatment were complicated crown fracture in 23 incisors (51.1%), non-vital tooth in 15 incisors (33.3%) and complicated crown-root fracture in seven incisors (15.5%). Evaluation criteria included availability of complete medical and dental records, patient demographics, and at least one follow-up visit as recent as 6 months after the initial root canal therapy. Endodontic treatment outcome was defined as successful, no evidence of failure, or failure. Root canal therapy was successful in 42 teeth (93.3%), no evidence of failure was found in three teeth (6.6%), and none of the cases showed failure of the treatment. Duration of follow-up ranged from 6 to 64 months. Only three variables appeared to have statistical significance: presence of preoperative periapical lucency (PAL) (P = .01), postoperative PAL (P < .001) and postoperative external inflammatory root resorption (P = .014). Based on this study, following "loose criteria" (success and no evidence of failure combined), 100% of the treatments were successful, making this option an excellent therapy choice in a veterinary specialty dentistry practice.

The Effects of Calcium Hydroxide-loaded Poly(Lactic-co-glycolic Acid) Biodegradable Nanoparticles in the ex vivo External Inflammatory Root Resorption Model.

To evaluate the calcium ions (Ca2+) diffusion of calcium hydroxide-loaded poly(lactic-co-glycolic acid) biodegradable nanoparticles [Ca(OH)2-loaded PLGA NPs] compared with conventional Ca(OH)2 in a simulated external root resorption ex vivo model using inductively coupled plasma mass spectrometry (ICP-MS). Thirty human mandibular premolars were prepared by sectioning the root segments to create roots measuring 10 mm from the anatomical apex. The root canals were instrumented and irrigated. The external root surface cavities were created. The specimens were randomly divided into the following three groups: Poly(lactic-co-glycolic acid) (PLGA; control group, n = 10), conventional calcium hydroxide [Ca(OH)2] (Metapaste, n = 10), and Ca(OH)2-loaded PLGA NPs [15% Ca(OH)2, n = 10]. The intracanal materials were placed in the root canals, and the teeth were stored in phosphate-buffered saline at 37°C. The release of Ca2+ was measured at 7, 30, and 60 days using ICP-MS. Both Ca(OH)2-loaded PLGA NPs and Metapaste groups exhibited higher levels of Ca2+ release compared to the PLGA group at all time points. During the initial 7-day period, the Ca(OH)2-loaded PLGA NPs exhibited a significantly greater release of Ca2+ compared to Metapaste. From day 7 to day 30, Metapaste displayed a significantly higher release of Ca2+ than the Ca(OH)2-loaded PLGA NPs, but it experienced a subsequent decline in Ca2+ release after the 30-day period. After the 30-day mark, the Ca(OH)2-loaded PLGA NPs once again exhibited a significantly higher release of Ca2+ compared to Metapaste. The Ca(OH)2-loaded PLGA NPs exhibited sustained release of Ca2+ that exceeded conventional Ca(OH)2, particularly during the first week, demonstrating a greater amount of Ca2+ release. The utilization of Ca(OH)2-loaded PLGA NPs as an intracanal medication for external inflammatory root resorption provided sustained release and had the potential to enhance the efficacy of inhibiting root resorption more effectively than conventional Ca(OH)2.

Treatment options for external inflammatory root resorption

Was to compare the efficacy of various treatment options for external inflammatory root resorption according to literature data. Literature was searched in electronic databases «eLibrary» and «PubMed» for key words «external inflammatory resorption treatment», «external inflammatory resorption management». Inclusion criteria comprised publications in Russian or English, clinical and experimental studies, full description of treatment protocol and obtained results. Studies with no full text, describing root resorption of orthodontic origin, clinical cases and clinical case series were excluded from the study. The problem of external inflammatory root resorption is poorly described in the Russian scientific literature. There are no registered protocols for its prevention and treatment or therapeutic agents with proved efficacy available in Russia. The only accessible approach for external inflammatory root resorption remains timely pulp extirpation after dental trauma which importance is underlined by all authors involved in the field of dental trauma studies. MTA and calcium hydroxide being popular as intracanal medications still have significant inconveniences as they potentially provoke root dentine fractures or replacement resorption. There is a need for elaboration and implementation of new prevention and treatment options for external inflammatory root resorption after dental trauma.

Marginal logistic regression with a cure fraction in a cluster design: An application in dental traumatology

Logistic regression model is the first option to deal with binary outcomes in cross-sectional health studies. However, some conditions, such as the presence of a cure fraction, characterized when an unknown portion of the population is no longer at risk of developing the event of interest, can lead to the non-adequacy of the model. Therefore, the presence of a cure fraction requires an extension in the standard form of the logistic regression model or the use of an alternative one. The present work aims to identify risk factors for the presence of External Inflammatory Root Resorption (EIRR) using a real application. The data set consisted in replanted permanent teeth referred to treatment at the Dental Trauma Clinic of the School of Dentistry from the Federal University of Minas Gerais (DTC-SD-UFMG) after emergency care at the Metropolitan Hospital Odilon Beherns in Belo Horizonte, Brazil. A logistic regression type model is considered to study the association between clinical and radiographic factors and the presence/absence of EIRR, measured radiographically at the first patient appointment at DTC-SD-UFMG. Considering that EIRR is only expected in those cases where the root canal become infected following pulp necrosis, those teeth whose pulp healing is favorable are not at risk of developing EIRR. However, pulpal status usually can only be defined in the long term, such that information is not available at the time of data collection, characterizing the presence of a latent cure fraction. Moreover, in the present sample some patients contributed with more than one replanted tooth, forming clusters of correlated measurements. In the present work we followed the methodology proposed by Hall &amp; Zhang (2004) in which they used an adaption of the EM (expectation-maximization) algorithm, called ES (Expectation-Solution) algorithm combined with GEE (Generalized Estimation Equations) to accommodate the cluster (individual) multivariate response in a logistic cure fraction model.

Radiographic Outcome of the Endodontic Treatment of 55 Fractured Canine Teeth in 43 Dogs (2013-2018).

Medical records from 4 private practice veterinary dentistry specialty clinics were reviewed for a 5-year period (2013-2018) to identify dogs that had a fractured canine tooth treated by root canal therapy and returned for subsequent follow-up evaluation. Evaluation criteria included the presence of complete medical records with diagnostic quality intraoral radiographs for each procedure visit with a minimum of 6 months between visits. Forty-three dogs with a total of 55 endodontically treated canine teeth were identified and evaluated. Root canal treatment outcome was defined as successful, no evidence of failure (NEF), or failure based on radiographic findings. Patient age, time from initial treatment to follow-up, obturation material used, radiographic quality of obturation (including voids, overfill, and retention of fractured endodontic files), radiographic evidence of periapical disease and/or presence of external inflammatory root resorption (EIRR), and the presence or absence of a full coverage metal crown were evaluated. Treatment was classified as successful in 51 (92.73%) teeth, NEF in 3 (5.45%) teeth, and failure in 1 (1.82%) tooth. The results suggest that endodontic treatment of fractured canine teeth in dogs is a successful treatment option that allows for retention of this functionally important tooth.

Does Root Development Status Affect the Outcome of Tooth Autotransplantation? A Systematic Review and Meta-Analysis.

Background: Tooth autotransplantation is defined as the surgical repositioning of an autogenous tooth in another surgical site within the same individual. Aim: The aim of this research was to analyze the outcome of tooth transplantation using immature donor teeth compared with closed apex teeth and to compare differences between donor tooth positions on the arch. Methods: Electronic and manual literature searches were performed in different databases, including the National Library of Medicine (MEDLINE), EMBASE (OVID), Cochrane Central (CENTRAL), and the digital library of the Universitat Internacional de Catalunya (UIC University) from 1978 to March 2021. Studies were selected when they fulfilled the following criteria: only human prospective clinical studies, minimum sample size of 10 patients, minimum follow-up of 1 year, studies reporting or with at least deducible data on survival rates, immediate tooth autotransplantation with completed or incomplete root formation, and publications in the English language. A meta-analysis of random effects was developed to estimate the global effect measure of the survival rate, success rate, and root resorption involving the total sample, as well as open- and closed-apex groups. Results: Twenty-four articles were eligible for analysis. The Cohen’s kappa corresponding to this review was 0.87, and the risk assessment was considered low–moderate for the included studies. Overall survival and success rates were 95.9% and 89.4%, respectively, with a mean follow-up of 4 years and an overall mean age of 25.2 ± 12.3 years. Closed apex teeth showed a survival rate of 3.9% lower than that of open apex teeth. Higher complication rates were found for both inflammatory external root resorption and replacement root resorption in the closed-apex group, without reaching statistical significance. Conclusions: Tooth autotransplantation is a viable treatment alternative, regardless of the apical condition, with high survival and success rates after a mean follow-up of 4 years. Open-apex donor teeth could be considered the gold-standard option, showing lower complication rates when compared to closed-apex donor teeth. Future randomized controlled clinical studies are needed to examine the long-term prognosis of this technique.

Radiographic outcome of root canal treatment in dogs: 281 teeth in 204 dogs (2001-2018).

To evaluate the radiographic outcome of root canal treatment (RCT) in dogs and compare outcomes with those reported for a previous study performed at the same institution in 2002. 204 dogs representing 281 teeth that underwent RCT. The medical record database of a veterinary teaching hospital was searched to identify dogs that underwent RCT between 2001 and 2018. Only dogs that had undergone at least 1 radiographic recheck appointment a minimum of 50 days after RCT were included in the study. Dental radiographs were reviewed. Treatment was considered successful if the periapical periodontal ligament space was within reference limits and preexisting external inflammatory root resorption (EIRR), if present, had stabilized. Treatment was considered to show no evidence of failure (NEF) if preoperative EIRR had stabilized and any preoperative periapical lucency (PAL) remained the same or had decreased in size but had not completely resolved. Treatment was considered to have failed if EIRR or a PAL developed after RCT, if a preoperative PAL increased in size, or if preexisting EIRR progressed. Follow-up time ranged from 52 to 3,245 days (mean, 437 days). RCT was classified as successful for 199 (71%) teeth, NEF for 71 (25%) teeth, and failed for 11 (4%) teeth. Results showed that almost 2 decades after RCT outcome in dogs was first evaluated, during which time numerous advances in dental materials and techniques had been made, the success rate of RCT was virtually unchanged.

Management of External Root Resorption Associated with a Replanted Maxillary Central Incisor in an 11-Year-Old Patient: A Rare Case Report

Avulsion of permanent teeth is one of the serious injuries that require immediate attention in a dental setup and immediate replantation and splinting is the treatment of choice. The replantation of avulsed tooth improves aesthetics, occlusion, and function. Most common complication of tooth replantation is inflammatory external root resorption. Mineral trioxide aggregate is a calcium silicate-based material that maintains high alkaline pH for a longer duration and it helps in preventing inflammatory external root resorption. The purpose of this article is to report the successful management of inflammatory external root resorption associated with a replanted maxillary right central incisor using MTA in an 11-year-old girl with one-year follow-up.

Effects of Intracanal Curcumin and Aloe vera on pH Changes in Simulated Root Surface Resorption Defects: An In vitro Study.

Commonly used medicaments in the treatment of external inflammatory root resorption (EIRR) have shown adverse effects; resulting in an increasing tendency to employ natural and/or herbal medication. The present in vitro study aimed to evaluate the effects of curcumin and aloe vera, as two natural medicaments, on the changes of pH in external root surface defects; and compare their outcomes with the results obtained from the application of calcium hydroxide, as a conventional medicament used in endodontic treatments. In the current investigation, 92 permanent teeth, with a single root canal, were randomly divided into four groups. Similar cavities were created on the buccal surfaces of roots, 5 mm from their apices. The root canals in each of the study groups were filled with curcumin, aloe vera, calcium hydroxide or normal saline. The pH was measured after 20 min (i.e. the baseline), 1, 7, 14, 21, and 28 days using a digital pH meter. The data were analysed using repeated-measures ANOVA and the statistical significance was set at P<0.05. At the baseline, day 1 and day 7, the mean pH of both curcumin and aloe vera groups was higher than the mean pH of calcium hydroxide and normal saline groups (P<0.05). On day 14, the mean pH of aloe vera group was higher than that of calcium hydroxide and normal saline groups (P<0.05). On days 21 and 28, the mean pH of aloe vera group was higher than the mean pH of all the other groups (P<0.05). All other intergroup differences were not statistically significant at each time point (P>0.05). The current in vitro study demonstrated that aloe vera was more alkaline than curcumin; nevertheless, both groups exhibited more alkalinity than calcium hydroxide.

English

Resorption of the tooth represents a multifactorial and a perplexing problem for all clinicians resulting in complete or partial loss of tooth structure. The present clinical demonstration describes management of the permanent maxillary left central incisor (tooth number #21) affected by external root resorption involving the mesial and distal surface of middle one-third of the root. Conventional nonsurgical endodontic treatment followed by MTA (Mineral trioxide aggregate) obturation (PRoRoot MTA, Dentsply, Tulsa Dental Specialties) was planned. The root canal of the affected teeth was debrided with Dual Rinse HEDP (Medcem Weinfelden, Switzerland) containing etidronate powder and chemomechanical preparation of the root canal was performed with XP endo shaper file system (FKG Dentaire, SA, Switzerland). Thirtysix months’ post-operative follow-up revealed complete healing of the external root resorption defect with no clinical and radiological signs and symptoms. In the present case simple non-surgical endodontic management of severe external root resorption was done in a permanent maxillary tooth by using a continuous chelation irrigation technique, intracanal medicament followed by obturation with bio-ceramic material produced satisfactory results in contrast to the recommended surgical management. Resorption of the tooth being a multifactorial and a perplexing problem for all clinicians results in complete or partial loss of tooth structure. According to the Glossary of Endodontic terms, Resorption is defined as a condition associated with either a physiologic or a pathologic process resulting in the loss of dentine, cementum, and/or bone.1 Traditionally resorption can present either as internal or as external resorption.2 External root resorption occurs on the outer surface of the root and are of dissimilar nature such as external surface resorption, external inflammatory root resorption, ankylosis, and external replacement resorption, the most common being external inflammatory root resorption.3 According to the Glossary of Endodontics, “Inflammatory resorption is defined as an internal or external pathologic loss of tooth structure and possibly bone, resulting in a defect; occurs as the result of microbial infection; characterized radiographically by radiolucent areas along the root”.1 It may result due to dental trauma, forceful orthodontic tooth movement, long standing infection of the pulp or periodontal tissues. External resorption presents as a major resorptive condition of the root without any clinical signs and symptoms.2 The non-surgical management of external inflammatory root resorption is based on its aetiology, which needs to be eliminated

Frequency and risk factors of root resorption in endodontic practice

The frequency of root resorption and correlated factors in patients were seen at the Endodontics Clinic of the Universidade Federal da Bahia. Objective: To evaluate the clinical and radiographic features of endodontic root resorption, considering that it is important to further our knowledge about root resorption frequency and pathogenesis. Material and methods: A cross[1]sectional study was conducted with a representative sample of 120 teeth indicated for endodontic treatment. Clinical and radiographic evaluation was accomplished to detect the presence and type of root resorption, etiology, presence of caries, dental trauma, and periapical lesion. Gender and affected teeth were also collected. The data were analyzed by the χ2 test, Fisher’s exact test, and multiple logistic regression (p &lt; 0.05). Results: A total of 53 teeth presented with root resorption. Female and the maxillary incisors were the most affected. Inflammatory root resorption was the most prevalent resorption type (p = 0.0013), and the apical third was the most affected portion (p = 0.001). Conclusion: There was a significant occurrence of external inflammatory root resorption in the apical third of the root. A large follow-up of these patients is necessary for preventing undesirable tooth loss.

Expression of matrix metalloproteinases 2 and 9 in replanted teeth with external root resorption: A cross-sectional study

ObjectiveTo evaluate matrix metalloproteinase (MMP) expression in replanted permanent teeth with external root resorption (ERR). DesignThe present cross-sectional study included 42 patients with replanted permanent teeth, presenting with progressive forms of ERR, and referred for extraction according to the rehabilitation treatment plan or due to root fractures. The control group consisted of 12 healthy premolars, from 5 patients with good periodontal health and no radiographic evidence of root resorption, referred for extraction for orthodontic reasons. Root fragments were processed soon after extraction, and the supernatant was collected to measure matrix metalloproteinase 2/tissue inhibitor of metalloproteinase 2 (MMP-2/TIMP-2) and matrix metalloproteinase 9/tissue inhibitor of metalloproteinases 2 (MMP-9/TIMP-2) complexes through a double-ligand enzyme-linked immunosorbent assay (ELISA). ResultsCase groups with external inflammatory root resorption (EIRR) or external replacement root resorption (ERRR) showed significantly higher levels of MMP-2/TIMP-2 and MMP-9/TIMP-2 complexes than the control group. Additionally, comparisons between the case groups demonstrated that the MMP-2/TIMP-2 complex also had significantly higher levels in the ERRR group (p < 0.001). ConclusionsOur results suggest that MMP-2 and MMP-9 participate in the pathobiology of both types of ERR. In addition, the higher levels of MMP-2/TIMP-2 complex in the ERRR group support common modulation mechanisms with physiological bone turnover.

Prognostic markers of post-traumatic dental external root resorption in children-a pilot study.

External inflammatory root resorption (EIRR) is a frequent complication of traumatic dental injuries (TDI). The aim of this cohort study was to identify novel non-invasive markers of post-traumatic EIRR by assessing the changes in the pulp's blood flow and the composition of gingival sulcus fluid (GCF) in children after dental trauma. Thirty-two children were enrolled and assessed within 48h of a TDI to their permanent incisors and during an additional three visits over a 6-months follow up period. During each visit, a radiograph and laser Doppler flow (LDF) measurements of the pulp blood flow were performed on the injured tooth, and the GCF was sampled. The permanent first molar tooth of the same subject served as a control for the LDF measurements and the GCF sampling. Concentrations of IL-1α in the GCF were measured using enzyme-linked immunosorbent assays. Radiographs were used to confirm EIRR. EIRR occurred in fourteen (43.8%) teeth in 32 patients. The teeth with EIRR showed diminished LDF readings when compared with controls at all visits. The LDF readings of the injured teeth continued to decrease at follow up visits. In the EIRR group, levels of IL-1α in the GCF of teeth with EIRR were increased and significantly higher than those of the control teeth at the visit when EIRR was diagnosed. The IL-1α levels were significantly higher in the EIRR group when compared to the injured teeth of patients without EIRR at the last follow-up visit. The occurrence of EIRR after mechanical trauma of permanent teeth with complete root development is accompanied by a significant reduction in the blood flow of the tooth's pulp. It is accompanied by an increase in concentrations of IL-1α in the GCF of EIRR affected teeth. The results of this pilot study identified the use of IL-1α in GCF and LDF as non-invasive markers of EIRR.

External apical root resorption after orthodontic treatment: Incidence, severity and risk factors.

Background. This study aimed to evaluate the incidence and severity of orthodontically induced inflammatory external apical root resorption (OIIEARR) and the relationship between OIIEARR and possible risk factors such as orthodontic treatment type, treatment duration, gender, and age of the patients. A further aim was to determine the prevalence of OIIEARR in different tooth groups. Methods. The study sample consisted of 1356 orthodontically treated patients (857 females and 498 males; mean age: 14.4±2.8 years). OIIEARR was evaluated using pre- and post-treatment panoramic radiographs for all the tooth groups. Teeth with severe resorption were also assessed. Patient- and treatment-related risk factors for OIIEARR were assessed statistically using Pearson’s chi-squared test, independent-samples t test, and one-way ANOVA. Results. The incidence of severe root resorption following orthodontic treatment was 14.8%. Males exhibited a higher incidence of root resorption compared to females. Orthodontic treatment duration and treatment with extractions were positively correlated with OIIEARR (P < 0.05). OIIEARR was observed most frequently in maxillary incisors, followed by mandibular incisors. Conclusion. Orthodontic treatment with extraction, prolonged treatment duration, and large movements of the incisors should especially be taken into consideration for OIIEARR risk. Routine radiographic follow-up during orthodontic treatment is recommended.

Survey based assessment of diagnosis through periapical radiograph and CBCT and treatment of root resorption with Brazilian and American dentists and endodontists.

BackgroundThis study assesses and compares the knowledge level of endodontists (ENDs) and general dental practitioners (GPs) from Brazil and United States of America (USA) in the diagnosis and treatment of internal and external inflammatory root resorptions through periapical radiographic (PA) and cone beam computed tomography (CBCT) examinations. Material and MethodsA cross-sectional online questionnaire-based survey was presented to the volunteers containing questions regarding personal and professional profile, as well as three clinical cases of internal and external inflammatory root resorption. A series of multiple-choice questions about the diagnosis and treatment options were surveyed. The data collected was analysed by the Chi-square test with Yates correction with a significance level of 5 %. ResultsMost answers were considered adequate when all three questions about the diagnosis and all two questions relating to the treatment were answered accurately. A total of 374 dentists answered the survey (n: 229 from Brazil vs. 145 from USA) being 41% END and 59% GP. END presented higher level of knowledge than GP regarding to diagnosis and treatment of inflammatory root resorptions both in Brazil and USA (p<0.05); USA presented higher level of adequate responses than Brazil (p<0.05). ConclusionsEND achieved a level of knowledge of the diagnosis and treatment of root resorption superior to the GP. Comparing the results obtained in both countries, it was observed that the USA had a higher correct response rate than Brazil. Key words:Internal root resorption, external root resorption, management, diagnosis, treatment.