Management Of External Cervical Resorption Research Articles

Stress distribution in endodontically treated external cervical resorption lesions restored with MTA and biodentine – A finite element analysis

IntroductionRoot resorption poses a significant challenge in dental practice, with external cervical resorption (ECR) being a common manifestation. ECR is often asymptomatic until advanced stages, complicating its diagnosis and management. Various factors contribute to its etiology, ranging from trauma to orthodontic treatment. The classification system proposed by Patel et al. (2018) offers a comprehensive framework for characterizing ECR lesions based on location and extent. Treatment strategies for ECR involve a combination of endodontic intervention and restorative techniques, with bioactive materials like mineral trioxide aggregate (MTA) and Biodentine emerging as promising options. However, the biomechanical behavior of teeth restored with these materials in the context of ECR remains underexplored. Materials and methodsThis study utilized finite element analysis (FEA) to assess stress distribution in teeth with simulated ECR lesions of varying sizes and locations, restored with MTA or Biodentine. Three-dimensional models of maxillary central incisors were generated based on CBCT scans, incorporating periodontal ligament and surrounding bone structures. Eight experimental models representing different ECR configurations were created and subjected to FEA using Optistruct software based on dimensional classification given by Patel et al., in 2018, A70 M & A70B: 1Ap, A130 M & A130B: 1Bp, B70 M & B70B: 2Ap, B130 M & B130B: 2Bp. All the models were tested for stress distribution by restoring the lesions with either M: MTA or B: Biodentine. Oblique load of 100 N was applied at 45°angle to the long axis 2 mm lingual to incisal edge. vonMises Stress distribution in enamel, dentine, restoration and at all the interfaces were observed. ResultsThe analysis revealed that both MTA and Biodentine restorations exhibited uniform stress distribution around ECR lesions, with no significant differences based on lesion location or size. Maximum stress concentrations were observed around the restorations, particularly in subcrestal lesions. However, overall stress levels were comparable between MTA and Biodentine restorations, indicating similar biomechanical performance. ConclusionFinite element analysis provides valuable insights into the biomechanical behavior of teeth with ECR lesions restored with MTA and Biodentine. Both materials exhibit similar stress distribution patterns and offer adequate reinforcement against mechanical forces. Clinicians can confidently utilize MTA or Biodentine in the management of ECR, considering their favorable biomechanical properties and clinical outcomes. Further research is necessary to validate these findings and optimize treatment protocols for ECR.

Comparison of Reverse Sandwich Restorations Versus Composite Fillings for the Restoration of External Cervical Resorptions: An In-Vitro Study.

The aim was to compare the 'reverse sandwich restoration' to resin composite restorations re- garding marginal adaptation, fracture resistance, favourable/unfavourable fractures in the management of external cervical resorption. Forty-eight extracted maxillary central incisors were selected and endodontically treated. Cervical regions of the labial root surfaces received simulated resorptive defects and were restored as three randomly allocated groups: Reverse Sandwich Restoration (resin composite + resin-modified glass ionomer) (RSR); resin composite restoration (COMP), and no restoration (NR). Each group was further divided into two subgroups (n=8 each): Thermomechanical Aging (TA) (equivalent to one year) and No Aging (NA). Marginal adaptation was scored by scanning electron microscopy. Fracture resistance was tested using a universal testing machine. Favourable versus unfavourable fractures were classified based on fracture extent. TA decreased the marginal adaptation for both RSR and COMP. Mean fracture resistance per groups were: RSR-NA 1522.4+-94.9N, RSR-TA 939.6+-72.9N, COMP-NA 1197.6+-95.7N, COMP-TA 870.4+-86.3N, NR-NA 1057.1+-88.1N, and NR-TA 836.6+-81.9N, respectively. Fracture resistance was the highest for RSR- NA compared to all other groups (p<0.05). TA decreased the fracture resistance in all groups (p<0.05), there was no significant difference between RSR and COMP regarding fracture resistance and favourable/ unfavourable fractures (p>0.05). RSR provided comparable results to resin composite fillings to restore artificial cervical defects pertaining to marginal adaptation, fracture resistance, and favourable versus unfavourable fractures. RSR is preferable due to its inherent biocompatibility to the periodontium. (EEJ-2023-04-050).

Clinical Management of External Cervical Resorption: ASystematic Review.

This review investigated whether any therapeutic options influenced the outcome of treatment for teeth with external cervical resorption. Out of 870 articles identified by an electronic search, 60 clinical case reports and six case series were included. No randomised clinical trials were found. Risk of bias was assessed using Joanna Briggs Institute's tools. External surgical intervention was the preferred method of accessing the lesions. Removal of resorptive tissue was most often achieved mechanically. Bioactive endodontic cements were the preferred materials for restoring teeth. The outcome measures were based on clinical and radiographic parameters. Of the cases included in the review, no specific treatment approach had a superior outcome in relation to Heithersay's classification. Furthermore, due to the absence of randomised clinical trials, and the low level of evidence associated with case reports/case series, it was not possible to define the optimum clinical treatment for external cervical resorption.

Management of external cervical resorption with internal approach: 18 months of follow-up

Introduction: External cervical resorption (ECR) in advance stages may have a probable pulp involvement. In some of these cases, the accessibility of the resorptive process can be performed by an intraradicular approach. Aim: To report the management of an ECR, classified as Class 2cp according to Patel classification, with an internal approach. Case report: A 22-year-old male patient presented a complaint of dentin hypersensitivity related to left maxillary lateral incisor and reported a history of previous dental trauma. Based on the clinical, radiographic and tomographic findings, the left maxillary lateral incisor was diagnosed as symptomatic irreversible pulpitis with ECR class 2cp of Patel classification. The patient was scheduled for endodontic treatment, with an internal approach, and repair of the resorbed area. Intracanal dressing of calcium hydroxide paste was used in the root canal and resorption gaps. The root canal filling was performed in two steps: obturation of the apical and middle third with gutta-percha by lateral condensation technique and obturation of the cervical third and filling the resorbed area with MTA. After 18 months signs and symptoms compatible with success were observed, and the tomographic and radiographic images suggested a successful endodontic treatment and evolutionary process of repair of bone and mineralized dental tissues. Conclusion: Patel class 2cp ECR treatment through an internal approach, including conventional endodontic treatment and recovery of the reabsorbed area with calcium hydroxide and MTA is a viable treatment option, but may cause tooth discoloration.

Influence of Cone-beam Computed Tomography in Clinical Decision-making among Different Specialists in External Cervical Resorption Lesions: A Before-After Study

IntroductionInadequate management of external cervical resorption (ECR) lesions may impact the treatment outcome. This study aimed to ascertain the influence of cone-beam computed tomography (CBCT) in clinical decision-making choices in cases of ECR among dentistry specialists (endodontics, prosthodontics, oral surgery, periodontics orthodontics, and general dentistry). A secondary objective was to evaluate the self-reported level of difficulty in choosing a treatment plan before and after viewing the CBCT images. MethodsSixty examiners from different specialties were chosen to evaluate 12 cases of ECR lesions. Each case included clinical photographs, digital periapical radiographs, and a small-volume CBCT scan. In the first assessment, the examiners were given all the relevant information of each case, except the CBCT scan. Each examiner was asked to select 1 of the proposed treatment options and assess the difficulty of decision-making. Four weeks later, the examiners randomly reviewed the same 12 cases with additional information from the CBCT data. ResultsAfter the CBCT evaluation, the clinicians changed their treatment plan in 72.2% of the cases (P < .05). The self-reported level of difficulty in choosing a treatment changed in all groups after evaluating the CBCT scans (P < .05). After viewing the CBCT scan, the extraction option increased significantly in all groups (P < .05). ConclusionsCBCT scan had a significant impact on clinical decision-making in cases of ECR evaluated by different specialists.

Management of External Cervical Resorption in Mandibular Molar Furcation Area - A Case Series

&lt;p&gt;External cervical resorption (ECR) is an aggressive form of root resorption causing loss of tooth structure and sometimes leading to destruction of adjacent alveolar bone. In the advanced extent of ECR lesion, surgical intervention is inevitable. Several studies presented favorable treatment outcomes on advanced ECR lesions at single teeth. In the light of these studies, this article reports on surgical management of two ECR cases. Materials and Methods: Two cases had ECR combined with bony defect in left mandibular first molar. Case 1 had ECR lesion over buccal furcation area combined with buccal bone plate loss. Following root canal treatment, the resorptive defect was restored by mineral trioxide aggregate and the bony defect was treated with guided tissue regeneration (GTR). Case 2 had class II furcation defect with ECR over furcal surfaces of mesial and distal roots. The resorptive defect was restored with bioceramic putty and class II furcation bony defect was treated by GTR. Root canal treatment of tooth 36 was done later after case 2 suffered from symptomatic irreversible pulpitis of tooth 36. Result: At one-year follow-up of case 1, no inflammatory signs with probing pocket depth (PPD) less than 3mm clinically and regeneration of buccal bone plate radiographically were found of tooth 36. At half year follow-up of case 2, there was a healthy gingiva with PPD less than 3mm clinically and the furcation area has been partially filled with regenerated bone radiographically of tooth 36. Conclusion: These case series presented an interdisciplinary surgical management of two cases with external cervical resorption combined with bony defect over lower molar furcation area which were successfully treated with biocompatible restorative material in combination with GTR technique in short-term follow-up.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Management of External Cervical Resorption in Maxillary Central Incisor with Biodentine and Collagen Membrane: A Case Report

Invasive cervical resorption is a relatively uncommon form of a chronic inflammatory process that results in loss of dentine and is usually initiated in the pulp space. It begins as a localised resorptive process that initiates in the area of the root beneath the epithelial attachment and the coronal part of the alveolar process. The lesion is mainly detected on radiographs and exhibits no external signs. The limitations of conventional radiography make Cone Beam Computed Tomography (CBCT) an effective and accurate method of diagnosing root resorptions. The tooth is normally asymptomatic, and the diagnosis is usually made based on a routine examination. Most authors refer to dental trauma, whitening agents, and orthodontic treatment as aetiologic factors. This disorder necessitates a thorough study of the pathologic process in order to determine the source and stop the resorptive phenomenon. The treatment should seek to completely remove the resorptive defect and rebuild it with an appropriate filling substance. Biodentine, a calcium silicate-based material, can be used to fill resorptive defects in the teeth. Furthermore, biodentine has some desirable additional properties over Mineral Trioxide Aggregate (MTA), such as improved antibacterial properties, bioactivity-inducing hard tissue formation, good handling, self-adhesion to dentine, and shorter setting time. Hence, this article presents a case report of external cervical resorption of the maxillary central incisor. Biodentine along with collagen membrane was used to fill the resorptive defect. One year radiographic follow-up showed stability of the resorption site.

External cervical resorption: Radiological diagnosis and literature (Review).

External cervical resorption (ECR) is a relatively unknown and insidious pathology characterized by the loss of hard dental tissues such as: Enamel, cementum and dentine due to clastic function. It begins as a localized resorptive process that initiates on the area of the root beneath the epithelial attachment and the coronal part of the alveolar process, involving vital and non-vital tissues. Despite the fact that there are several potential predisposing factors related to ECR, its aetiology still remains poorly understood and more research is needed to establish the cause-and-effect relationship of all the etiological factors. Improved radiographic detection using cone-beam computed tomography (CBCT) is required in order to correctly classify and assess this entity. This provides a three-dimensional insight into the lesion, regarding the location, the size, the depth and the circumferential spread of the ECR defect. It also allows establishment of the most efficacious treatment plan and management. The purpose of this literature review is to cover the relevant literature concerning the etiology, pathogenesis, clinical and radiological presentation and management of ECRs (based on the CBCT findings).

Management of external cervical resorption using mineral trioxide aggregate

External cervical resorption (ECR) is a relatively rare form of external root resorption, which may occur in any tooth in the permanent dentition. The etiology is usually obscure. It is characterized by its cervical location and the invasive nature; this resorptive process leads to the progressive and usually destructive loss of the tooth structure. It is often misdiagnosed, leading to improper treatment or unnecessary loss of the tooth. The article describes a case report of the ECR and its management. The salient features were a sizeable resorptive defect and localized fibrous growth located on the cervico-palatal aspect of the maxillary right central incisor. Treatment included root canal treatment, surgical exploration, and restoration of the defect with mineral trioxide aggregate. Proper diagnosis and the appropriate treatment is the key to a successful outcome in the management of ECR.

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.

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.

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.

European Society of Endodontology position statement: External Cervical Resorption.

This Position Statement represents the consensus of an expert committee convened by the European Society of Endodontology (ESE) on External Cervical Resorption (ECR). The statement is based on current clinical and scientific evidence as well as the expertise of the committee. The primary aim is to provide a current authoritative position on the aetiology, histopathology, clinical presentation and management of ECR, and also to highlight areas where there is minimal evidence. Previously published review articles provide more detailed background information and the basis for this position statement (International Endodontic Journal 51, 1205, 2018, International Endodontic Journal 51, 1224, 2018). It is intended that this position statement will be updated at appropriate intervals, as further evidence emerges.

External cervical resorption: part 2 - management.

Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2-week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues.

The Assessment and Management of External Cervical Resorption with Periapical Radiographs and Cone-beam Computed Tomography: A Clinical Study

IntroductionThis in vivo study assessed whether there was a difference between periapical radiographs (PRs) and cone-beam computed tomographic (CBCT) imaging in the detection, assessment, and management of external cervical resorption (ECR). The secondary aim was to determine if parallax radiographs were of any further benefit compared with a single PR. MethodsPR and CBCT data were gathered for 115 teeth (98 patients) consecutively diagnosed with ECR. The diagnosis and treatment plan of each tooth were determined with PRs and CBCT imaging. Sensitivity, specificity, positive predictive values, negative predictive values, and receiver operator characteristic values were determined. ResultsThe overall sensitivity (0.86) and specificity (0.89) of PRs was significantly lower than CBCT imaging (P < .001). PRs had a limited ability to accurately detect the size (0.75), circumferential spread (0.60), and location of ECR compared with CBCT imaging (P < .001). PRs also underestimated the size of the ECR lesion. Significant differences (P < .001) were apparent in the treatment plans formed when PRs were assessed versus CBCT imaging. Parallax radiographs were shown to be of no additional benefit compared with a single radiograph. ConclusionsPRs have significant limitations in the detection, assessment, and treatment planning of ECR when compared with CBCT imaging. A CBCT scan should be considered before the management of a potentially restorable ECR lesion.

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.

Management of external cervical resorption using mineral trioxide aggregate

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