Treatment Of Invasive Cervical Resorption Research Articles

External cervical tooth root resorption

External cervical tooth root resorption is one of the most aggressive types of pathological resorption. Due to the uncontrolled growth of resorptive tissue, irreversible loss of dentin and cement occurs. To date, there is no common position regarding the etiological factor and pathogenesis of invasive cervical resorption. The histological picture is similar to some fibro-bone lesions. The treatment outcome of the pathology is difficult to predict because elimination of the causative factor is often not sufficient for resorption arrest. Only the complete elimination of resorptive tissue helps to stop the process. The report describes a clinical case of a successful treatment of invasive cervical resorption of dental hard tissues.

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

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

Decision criteria influencing the therapeutic approach to invasive cervical resorption: a case series.

Invasive cervical resorption (ICR) is a dental lesion starting in the cervical region and involving the loss of dental hard tissue as a result of odontoclastic action. Due to its localization and invasive pattern, this process represents a challenging clinical situation. When feasible, the major aim of an ICR treatment is to completely remove the pathologic tissue (specifically at the entry point of the lesion) and to seal the resulting defect, without compromising tooth rehabilitation. In this context, choosing how to access the resorptive lacuna is essential. Two main options have been described in the literature: an external approach, requiring the surgical exposure of the resorptive lacuna, and an internal approach, taking advantage of the endodontic access cavity. However, there are no guidelines that indicate which approach to choose for the treatment of an ICR. This article is based on four clinical cases. It aims to provide specific clinical and radiologic features that should be considered in order to take the most appropriate decision, when choosing between the internal and the external approaches. It is proposed to base the therapeutic strategy on the accessibility and the size of the portal of entry of the lesion. When the entry point is wide, its extension along the root must also be taken into account. Other important parameters are the circumferential and vertical extents of the lesion in the radicular dentin. Although it is not a determining factor, the pulpal involvement of the lesion can also be considered.

Nonsurgical Management and 2-year Follow-up by means of Cone Beam Computed Tomography of an Invasive Cervical Resorption in a Molar

Invasive cervical resorption (ICR) is a relatively uncommon form of external tooth resorption, characterized by an invasive nature. It is usually painless and detection of lesions is often made incidentally. Three-dimensional imaging techniques, such as cone beam computed tomography (CBCT), are useful in the diagnosis and management of ICR as the true extent of the defect cannot always be estimated using conventional radiographs. The aim of this article is to report on the successful treatment of ICR in mandibular first molar by nonsurgical approach and follow-up by means of CBCT. An 18-year-old patient was referred with a complaint of unusual radiolucency in the mesial cervical area of tooth #19 with unknown etiology. Cone beam computed tomography was performed to assess the extent of the lesion in three spatial levels and diagnosis of Heithersay class III ICR was made. This case presented with ICR (Heithersay class III) on tooth #19. Nonsurgical root canal treatment and removal of the lesion from the coronal access was performed; the resorptive defect was filled with dual-cure, self-adhesive, resin-modified glass ionomer cement (RMGIC); 6-month follow-up X-ray film showed no changes at the lesion site and tooth was asymptomatic; 1-year follow-up X-ray film showed slight mesial bone loss and a probing depth of 3 mm; finally, 2-year follow-up CBCT images showed no recurrence and no further bone destruction at the lesion site. The intraoral radiographs revealed the resorptive changes in two dimensions; therefore, the actual extent and location of the lesions are not fully understood. On the contrary, CBCT is a very useful tool to achieve a proper diagnosis; it detects the extent of the defect more accurately and hence, improves the treatment outcomes of ICR. The ICR is usually seen as a late complication to traumatic injuries of the teeth; it is essential, therefore, that the patients who were exposed to situations that can damage the integrity of periodontal tissue need to have careful periodic recalls and X-ray examinations.

Minimally Invasive Treatment of Class 4 Invasive Cervical Resorption with Internal Approach: A Case Series

Invasive cervical resorption (ICR) is a type of external resorption that can involve the coronal, middle, and apical parts of the root in its advanced stages. The diagnosis and treatment of ICR depend on the extent of the resorption into the dentin. The treatment of advanced ICR is challenging, and these teeth have poor prognoses. This article describes 4 cases of class 4 ICR diagnosed by using cone-beam computed tomography and treated with a minimally invasive internal approach with sodium hypochlorite irrigation and calcium hydroxide dressing. All cases were followed for at least 3 years.

Treatment of Invasive Cervical Resorption-Case Report

Invasive cervical resorption is relatively uncommon, insidious and often aggressive form of external tooth resorption. Resorption of coronal dentin and enamel often creates a clinically obvious pinkish color in the tooth crown this is because high vascular resorptive tissue. Different approaches have been suggested for the treatment of invasive cervical resorption. This case report presents the surgical management of invasive cervical resorption.

Treatment of Invasive Cervical Resorption With Sandwich Technique Using Mineral Trioxide Aggregate: A Case Report

This article presents two cases of large invasive cervical resorption (ICR) with maintenance of pulp vitality after treatment with mineral trioxide aggregate (MTA) in a sandwich technique.Invasive cervical resorption is a relatively uncommon but aggressive form of external resorption, primarily caused by dental trauma or injury of the cervical periodontal attachment. The resorptive process does not penetrate into the root canal, and the pulp is not involved in the first phase of the resorption. This feature differentiates external resorption from internal resorption. In most cases, invasive cervical resorption is found during routine radiographic or clinical examination. Different materials have been proposed for the treatment of external cervical resorption. Therapy can be effective when it 1) removes the etiological factors and 2) interrupts the progressive resorption mechanism.The key learning points of this article are the following: treatment strategy to arrest the cervical resorption process and to prevent further resorption without changing pulpal vitality and successful seal of invasive cervical resorption defect using MTA with a sandwich technique.

Use of Mineral Trioxide Aggregate in the Treatment of Invasive Cervical Resorption: A Case Report

Introduction Guided tissue regeneration (GTR) is a successful treatment procedure of periodontal reconstructive surgery. Adverse effects can be observed after GTR procedure, but external root resorption is rarely reported at clinical studies. Invasive cervical resorption is a clinical term used to describe a relatively uncommon, insidious, and often aggressive form of external root resorption. Methods The present case demonstrates an invasive cervical resorption that is a potential late complication of GTR in a maxillary canine of a 59-year-old male patient. After the surgical intervention and root canal treatment, the resorption was subsequently sealed with mineral trioxide aggregate. Results The 1-year follow-up demonstrates no pathologic changes on clinical and radiographic examination. Conclusions This case report presents a treatment strategy that might improve the healing outcomes for patients with invasive cervical resorption.

Iontophoresis Significantly Increases the Trans-dentinal Delivery of Osteoprotegerin, Alendronate, and Calcitonin

The purpose of this study was to evaluate the delivery of alendronate, calcitonin, and osteoprotegerin (OPG) through human dentin by both diffusion and iontophoresis for the potential treatment of invasive cervical resorption. Radiolabeled alendronate, calcitonin, and OPG were added to the top of a split chamber device that contained 1-mm thick dentin disks devoid of a smear layer. Transdentinal movement of medicaments by either random diffusion or application of an iontophoretic current was measured by analysis of gamma emission of effluent fractions. In addition, calcitonin delivery was evaluated at differing magnitudes of current (0-4 mA) by using the aforementioned chamber. Diffusion of all 3 medicaments was minimal. In contrast, the application of a 3-mA iontophoretic gradient significantly increased delivery for all 3 compounds at 10-, 20-, and 30-minute intervals. In addition, a linear increase in permeability was seen for calcitonin as milliamperes were increased from 0 to 4 (r = 0.947), with more than a 100-fold increase in delivery observed with iontophoresis. Delivery of the tested medicaments by using iontophoresis might prove to be a useful technique for treatment of invasive cervical resorption.

Invasive cervical resorption following trauma.

Invasive cervical resorption is an insidious and often aggressively destructive form of external root resorption which may occur as a late complication following dental trauma particularly where it involves damage to cementum and supporting tissues. While this resorption may be evident clinically as a pink coronal discolouration, later with cavitation of the enamel, often there are no obvious external signs and the condition is only detected radiographically. It is characterised by the invasion of the cervical region of the root by fibrovascular tissue which progressively resorbs dentine, enamel and cementum. The dental pulp remains protected by an intact layer of dentine and predentine until late in the process. Ectopic calcifications can be observed in advanced lesions both within the invading fibrous tissue and deposited directly onto the resorbed dentine surface. The aetiology of invasive cervical resorption is unknown but trauma has been documented as a potential predisposing factor. A recent study by the author of 222 patients with a total of 257 teeth which displayed varying degrees of invasive cervical resorption showed that trauma alone was a potential predisposing sole factor in 14% of patients and 15.1% of teeth. Trauma in combination with bleaching, orthodontics or delayed eruption was found in an additional 11.2% of patients or 10.6% of teeth and of these a combination of trauma and bleaching occurred in a relatively high proportion of 7.7% of patients or 7.4% of teeth. This study also revealed that of other potential predisposing factors orthodontics was the most common sole factor constituting 21.2% of patients and 24.1% of teeth examined. Successful treatment of invasive cervical resorption is dependent on the extent of the resorptive process. Teeth with invasive cervical resorption have been divided into four classes. Whilst several treatment modalities are possible, a clinical evaluation of the treatment of this condition by the topical application of a 90% aqueous solution of trichloracetic acid, curettage, endodontic therapy where necessary and restoration with a glass ionomer cement has been evaluated on 94 patients with a total of 101 teeth with a minimum follow-up period of three years. Results indicate a satisfactory treatment outcome can be anticipated in Class 1, 2 and 3 cases. In Class 4 resorption no treatment or alternative therapy is recommended. Diagnosis of lesions at an early stage of development is highly desirable and therefore the patients who have a potential for the development of this condition by virtue of a history such as trauma should be monitored radiographically at intervals throughout life.

Tissue responses in the rat to trichloracetic acid--an agent used in the treatment of invasive cervical resorption.

AbstractThe tissue responses in rats following topical application of 90 per cent trichloracetic acid to the palatal mucosa, and to a wound involving periodontal tissues, tooth root and bone were histologically evaluated. Coagulation necrosis of palatal and gingival mucosa was followed by oedema, splitting and separation of the eschar with rapid re‐epithelialization within two days. Of significance was an almost complete absence of underlying inflammation. There were no essential differences in the healing of the trichloracetic acid‐treated wounds into deeper dental tissues compared with control wounds. These results have significance with regard to the clinical use of trichloracetic acid in the treatment of invasive cervical resorption.