Invasive Cervical Root Resorption Research Articles

Treatment options for impacted maxillary canines and occurrence of ankylotic and resorptive processes: a 20-year retrospective study

BackgroundThis 20-year retrospective study aimed to evaluate the treatment methods used in patients with impacted maxillary permanent canines and to determine the occurrence of ankylotic and resorptive processes and their association with potential risk factors.MethodsThe cohort consisted of 351 consecutive Caucasian patients (120 males and 231 females, mean age 18.4 and 19.9 years, respectively) with 420 impacted maxillary permanent canines. CT and CBCT findings were subsequently confirmed during surgery. Statistical analyses were performed by the generalized linear models, Pearson x2 and Fisher exact tests using the statistical programs R and Statistica v. 14.ResultsA total of 273 (65.0%) impacted canines were aligned in the dental arch by orthodontic traction after surgical exposure, this treatment was predominant in patients under 20 years of age. Surgical extraction was performed in 115 (27.2%) impacted canines and was more common in older patients. Ankylotic changes were recorded in 61 (14.5%) impacted canines. The probability of ankylosis increased with age, particularly after the patient’s 20th year of life (p < 0.001). Patients were 1.2% likely to develop ankylosis at age 15 years, 4.3% at age 20 years, 14.1% at age 25 years, and 96.8% at age 45 years. Invasive cervical root resorption (ICRR) was found in 8 (1.9%) canines. In 4 canines (1.0%), root ankylosis in addition to ICRR was observed. In contrast to ankylosis, whose frequency of occurrence increased with age, the occurrence of ICRR resulting from PDL damage during surgery was more typical in younger patients. Canines in a high position above the root apices of the adjacent teeth, with a horizontal inclination of the longitudinal axis, with the crown located deep in the center of the alveolar bone and with labiopalatal position, should be considered critically impacted canines with a high risk to failure of orthodontic traction.ConclusionIn conclusion, the treatment of impacted canines depends mainly on the age of the patient, and the position and inclination of the longitudinal axis of the impacted tooth. To select an adequate treatment method, we recommend CBCT examination, which allows a precise analysis of the position of impacted canines.

Invasive Cervical Root Resorption: A Comprehensive Review on Pathogenesis, Diagnosis, and Treatment.

Invasive cervical root resorption (ICRR) is a dental pathology, marked by unexpected destruction originating in the cervical region of the tooth. This comprehensive literature review provides a holistic view into the pathogenesis, clinical manifestation, and precise management of ICRR, aiming to guide endodontists and enhance patient care and treatment outcomes. The review delves into the potential etiology of ICRR, covering contributing factors such as trauma, orthodontic treatment, and other pertinent conditions. It outlines the clinical and radiographic indicators, underscoring the crucial role of early detection and precise diagnosis in effectively managing and halting ICRR progression. The exploration of treatment approaches is thorough, ranging from non-surgical methods like vital pulp therapy or root canal treatment to surgical interventions. This review accentuates the essential role of interdisciplinary collaboration among diverse dental specialties in enhancing ICRR management. It highlights the importance of a consolidated strategy in enhancing treatment outcomes and preserving tooth structure and function. Moreover, it investigates prevention methods, risk evaluation, and identifies prospective research pathways to address the existing knowledge gaps.

Identification of Candidate Genes of Familial Multiple Idiopathic Cervical Root Resorption

IntroductionMultiple idiopathic cervical root resorption (MICRR) is a disease with an unknown etiology that causes invasive cervical root resorption in multiple teeth. Although previous MICRR genomic studies have identified candidate gene variants, the etiology of the condition remains poorly understood. In the present study, we investigated the genetic causality of MICRR to explore candidate variants. MethodsSaliva samples from a family containing 2 affected and two unaffected subjects with the dominant transmission of MICRR were subjected to whole-exome sequencing. ResultsAs a result, we identified novel candidate variants of 10 genes. Each variant was confirmed by Sanger sequencing. Among them, the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) guidelines classified doublecortin domain containing 1 (c.1099 C > T) and β-defensin 114 (c.189 T > G) as “pathogenic,” and solute carrier family 45 member 2 (c.152_153del) as “likely pathogenic.” ConclusionsThese results provide new insight to help clarify the pathogenesis of MICRR, and the variants could be applied for further investigation to understand invasive cervical root resorption.

Management of invasive cervical root resorption with biodentine: A case report

Management of invasive cervical root resorption with biodentine: A case report

Multiple idiopathic invasive cervical root resorption

Multiple idiopathic invasive cervical root resorption

Management of invasive cervical root resorption in a maxillary central incisor using Biodentine: A case report

Management of invasive cervical root resorption in a maxillary central incisor using Biodentine: A case report

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

Management of different challenging cases of invasive cervical root resorption using biodentine: Case reports

Invasive cervical resorption is relatively uncommon and proceeds in a gradual and often aggressive destructive form of external root resorption. Etiology of invasive cervical resorption is not very clear. It is sometimes misdiagnosed which leads to improper management of effected tooth or tooth loss. Only accurate diagnosis and proper management can lead to successful outcome. The goal of treatment to suppress all resorbing tissues and the reconstruction of resorptive defect by the placement of a suitable filling material or some biological systems. Resorption area identified, cleaned & cautery with 90% tri chloroacetic acid, further with saline. Repaired with biodentine and sutured. The aim of this case report was to reveal the management of invasive cervical resorption by using biodentine. Keywords: Invasive cervical resorption, External root resorption, Trichloracetic acid, Biodentine.

Vital Pulp Therapy as a Conservative Approach for Management of Invasive Cervical Root Resorption: A Case Series

IntroductionClear treatment guidelines with predictable outcomes for invasive cervical root resorption (ICRR) do not exist. Recent studies show that an internal approach for the excavation and repair of resorptive lacunae using bioactive materials might be preferred over external surgical approaches in cases with extensive ICRR. The procedure appears to interrupt and stop the resorptive process and preserves the periodontium. The aim of this case series was to report on the clinical and radiographic outcomes in cases with ICRR treated with vital pulp therapy techniques using calcium-enriched mixture cement. MethodsTeeth with the diagnosis of ICRR and normal pulpal and periodontal status were included. After rubber dam isolation and the removal of existing restorations, the resorptive lacunae were accessed internally, and the contents were partially or fully removed. A vital pulp therapy technique was chosen based on the accessibility of the resorptive lacunae during excavation. Teeth were then restored and followed up. ResultsSix teeth with ICRR (Heithersay class 2, 3, or 4) were selected. One tooth was treated with pulp capping, 1 with partial pulpotomy, 2 with full pulpotomy, and 2 with partial pulpectomy. The average follow-up time was 19.6 months. After treatment, all teeth remained functional and asymptomatic with a normal periodontium. No progression of the resorption or development of new resorption was observed. ConclusionsInternal excavation of the contents of resorptive lacunae in combination with vital pulp therapy with calcium-enriched mixture cement could be a reliable approach for the treatment of ICRR.

Endodontic management of invasive cervical resorption: Report of two cases

Invasive cervical resorption of the tooth is a relatively rare and uncommon phenomenon where the etiology remains idiopathic and unclear, and if not treated may lead to ultimate loss of tooth structure. Advancements in digital imaging have made the clinician to diagnose the pathological changes with great precision. Proper diagnosis and management of this condition is key to the successful outcome. The aim of this article was to elaborate two case reports of invasive cervical root resorption with surgical management using biocompatible restorative material.

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 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

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.

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.

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.

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: 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.

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 Root Resorption: Treatment Rationale with an Interdisciplinary Approach

Invasive cervical resorption (ICR) is a significant and often aggressive pathologic process that, unfortunately, might lead to tooth loss. The presence of such a lesion in the cervical area is always a clinical challenge. This article presents an ICR case in which successful treatment was achieved by combining 4 disciplines: endodontics, orthodontics, periodontics, and prosthetics. Forced eruption combined with fiberotomy was used in this case for pulling the root rapidly from within the alveolar socket, thus exposing sound and healthy tooth material beyond the affected zone suitable for crown preparation. The presented interdisciplinary technique is offered for the prudent clinician as a solution in ICR cases of severe destructive nature.

Hydroxyl radical activity in thermo‐catalytically bleached root‐filled teeth

Intra-coronal bleaching of root-filled teeth has been associated with invasive cervical root resorption. It is considered that during bleaching hydrogen peroxide diffuses through the tooth structure into the cervical periodontium, resulting in periodontal tissue destruction and initiating a resorptive process. Hydrogen peroxide is capable of generating hydroxyl radical, an oxygen-derived free radical, in the presence of ferrous salts. Hydroxyl radicals are extremely reactive and have been shown to degrade components of connective tissue, particularly collagen and hyaluronic acid. The aim of the present study was to determine whether hydroxyl radicals are generated during the bleaching of root-filled teeth which have been discoloured by blood. Forty extracted human premolar teeth were root-filled with gutta-percha and AH26 sealer cement. Twenty of the teeth were experimentally discoloured by blood. All teeth were then thermo-catalytically bleached using 30% hydrogen peroxide while tooth roots were seated in a test solution of sodium salicylate. Hydroxyl radical generation was determined by the detection of reaction products of this radical with salicylate using high performance liquid chromatography with electrochemical detection (HPLC-ECD). The presence of hydroxyl radicals was detected in twenty-five of the teeth. There was a significant association between the production of hydroxyl radicals and the presence of tooth discolouration caused by blood components. Greatest yields of hydroxyl radicals occurred in teeth in which EDTA had been used to clean the pulp chamber prior to bleaching. It was concluded that hydroxyl radicals are generated during the thermo-catalytic bleaching of root-filled teeth. Generation of this toxic chemical species may be one mechanism underlying periodontal tissue destruction and root resorption after intra-coronal bleaching.