1
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Bardini G, Orrù C, Ideo F, Nagendrababu V, Dummer P, Cotti E. Clinical management of external cervical resorption: A systematic review. AUST ENDOD J 2023; 49:769-787. [PMID: 37702252 DOI: 10.1111/aej.12794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
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.
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Affiliation(s)
- Giulia Bardini
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Cristiano Orrù
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Francesca Ideo
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Paul Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
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2
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Mavridou AM, Rubbers E, Schryvers A, Maes A, Linssen M, Barendregt DS, Bergmans L, Lambrechts P. A clinical approach strategy for the diagnosis, treatment and evaluation of external cervical resorption. Int Endod J 2022; 55:347-373. [PMID: 35034370 DOI: 10.1111/iej.13680] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
AIM To propose a clinical approach strategy on the diagnosis, treatment, and evaluation of external cervical tooth resorption (ECR) cases. To investigate and discuss the outcome of this approach. METHODOLOGY A clinical approach strategy on ECR was developed based on a retrospective observation study of 542 teeth. 47 teeth were excluded due to lack of clinical/radiographical information, and 182 were immediately extracted. This approach had three steps: diagnosis, treatment planning, and evaluation. During diagnosis, the medical, dental history and clinical/radiographical characteristics were evaluated. Depending on the resorption extent, ECR cases were categorized into four classes according to Heithersay's classification. During treatment planning, a treatment decision flowchart was prepared based on four main decisive criteria: probing feasibility, pain, location and extent of resorption (class), and existence of bonelike tissue. Three treatment options were applied: a) extraction, b) monitoring, or c) conservative treatment by external, internal, or combination of internal-external treatments. During evaluation, assessment of ECR progression, tooth survival and other factors like esthetics and periodontal attachment were performed. Descriptive statistical analysis of the outcome for up to ten years (for the overall clinical approach and for each individual treatment decision), was carried out with OriginLabs OriginPro 9 and Microsoft Excel 365. RESULTS A three-step strategy was developed on how to deal with ECR cases. Indicative examples of each treatment decision were presented and discussed. The overall survival rate of this strategy was 84.6% (3 years), 70.3% (5 years), 42.7% (8 years) and 28.6% (10 years). Higher survival rate was observed for external treatment decision than for internal. The success of each treatment decision depended on the extent of the resorption (class). The success of a treatment decision should be based on the long-term outcome, as a different evolution can be observed with time. CONCLUSIONS A clinical approach strategy was introduced on ECR pathosis. This strategy was not solely based on ECR class, as other important decisive criteria were considered. This step-wise approach, has a 70.3% survival rate with a mean of 5 years. This work will hopefully provide an incentive for a broader collaboration, to potentially establish a universally accepted ECR treatment strategy.
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Affiliation(s)
- A M Mavridou
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium.,Private practice, Proclin Rotterdam, Rotterdam, The Netherlands
| | - E Rubbers
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium
| | - A Schryvers
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium
| | - A Maes
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium
| | - M Linssen
- Private practice, Proclin Rotterdam, Rotterdam, The Netherlands
| | - D S Barendregt
- Private practice, Proclin Rotterdam, Rotterdam, The Netherlands
| | - L Bergmans
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium
| | - P Lambrechts
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium
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3
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Brito GMD, Campos PSF, Mariz ACR, Simões D, Machado AW. Invasive cervical resorption of central incisor during orthodontic treatment. Dental Press J Orthod 2021; 25:49-58. [PMID: 33503125 PMCID: PMC7869801 DOI: 10.1590/2177-6709.25.6.049-058.oar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/30/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction: Invasive cervical resorption (ICR) is a relatively rare type of ERR (External
Root Resorption), in which a localized resorption begins in the cervical
area of the tooth, below the epithelial junction and above the ridge crest.
Objective: Describe the clinical case of an 11-year-old boy with no dental trauma
history, presenting moderate crowding and ectopic eruption of the maxillary
right central incisor. He had been undergoing orthodontic treatment
elsewhere, and his family was dissatisfied with the results. Description: A new treatment was indicated, which included rapid maxillary expansion
followed by extraction of four premolars. During routine panoramic
evaluation, a radiolucid image was detected and a periapical radiograph was
requested. At this point, an ICR of the maxillary right central incisor was
found. The treatment was cautiously finalized and despite the use of light
forces, central incisor was severally compromised by ICR and was therefore
extracted. Conclusion: This clinical example discusses the importance of routine radiographs for the
early diagnoses of ICR.
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Affiliation(s)
- Gabriela Meyge de Brito
- Universidade Federal da Bahia, Programa de Pós-graduação em Odontologia e Saúde (Salvador/BA, Brazil)
| | | | - Ana Carolina Ramos Mariz
- Universidade Federal da Bahia, Programa de Pós-graduação em Odontologia e Saúde (Salvador/BA, Brazil)
| | - Diana Simões
- Universidade Federal da Bahia, Programa de Pós-graduação em Odontologia e Saúde (Salvador/BA, Brazil)
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4
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Rotondi O, Waldon P, Kim SG. The Disease Process, Diagnosis and Treatment of Invasive Cervical Resorption: A Review. Dent J (Basel) 2020; 8:dj8030064. [PMID: 32630223 PMCID: PMC7557762 DOI: 10.3390/dj8030064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 12/29/2022] Open
Abstract
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.
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5
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Multiple External Root Resorption of Teeth as a New Manifestation of Systemic Sclerosis-A Cross-Sectional Study in Japan. J Clin Med 2019; 8:jcm8101628. [PMID: 31590327 PMCID: PMC6832113 DOI: 10.3390/jcm8101628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multiple external root resorption (MERR) has been reported in systemic sclerosis (SSc) patients in Japan and Spain. To establish whether MERR is a new manifestation, we investigated the prevalence of MERR and systemic and oral manifestations to be associated with MERR in patients with SSc. METHODS Root resorption was detected by dental X-rays, panoramagraphy or cone beam computed tomography (CBCT). The prevalence of systemic and oral manifestations was examined by rheumatologists and dentists, respectively. Autoantibodies were investigated using laboratory tests. RESULTS MERR was detected in four out of the 41 patients (9.8%) who participated in the present study. The prevalence of digital ulcers was significantly higher in patients with MERR (MERR vs non-MERR, 75% vs 16.2%, p < 0.05), whereas that of other systemic manifestations was not. The prevalence of face skin sclerosis (100% vs 10.8%, p < 0.01), calcinosis at the facial region (75% vs 0%, p < 0.01), limited mouth opening (75% vs 18.9% p < 0.05), temporomandibular disorder symptoms (50% vs 2.7%, p < 0.05), and tongue rigidity (75% vs 2.7%, p < 0.05) was significantly higher in patients with MERR. CONCLUSION SSc patients with MERR had highly homogenous maxillofacial manifestations. Further clinical and basic studies are needed to elucidate the mechanisms underlying MERR in SSc patients.
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6
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Shemesh A, Levin A, Hadad A, Itzhak JB, Solomonov M. CBCT analyses of advanced cervical resorption aid in selection of treatment modalities: a retrospective analysis. Clin Oral Investig 2019; 23:1635-1640. [PMID: 30145663 DOI: 10.1007/s00784-018-2592-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 08/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The selection of treatment for advanced (classes 3 and 4) invasive cervical resorption (ICR) based on a two-dimensional periapical radiograph is challenging. The purpose of the present study is to describe different treatment approaches for advanced invasive cervical resorption based on cone-beam computed tomography evaluation. MATERIALS AND METHODS All cases of advanced ICR based on CBCT evaluation in our endodontic department between 2011 and 2016 were included in the study. The dimension, circumferential, and coronal-cervical locations of the entry point of the resorption tissue into the tooth were evaluated. The selected treatment approach for each case was documented, and all the data were summarized and analyzed. RESULTS Twenty-three cases of advanced ICR were included in the study. Approximately, 74% were diagnosed in stage 4, and 26% were diagnosed in stage 3. The narrow entry point was identified in 43% (10 cases), while in 57% (13) of cases, the entry point was wide. Circumferentially, 70% (16) were located on the proximal side. Coronal-cervically, 43% (10) were located more than 1.5 mm above the crestal bone. All narrow entry point cases were treated using a minimally invasive technique, while different treatment approaches were chosen for cases with a wide entry point. CONCLUSIONS The present study proposes different treatment approaches for advanced ICR based on CBCT. The CBCT evaluation of the entry point may facilitate choosing the appropriate treatment approach for advanced ICR cases. CLINICAL RELEVANCE The description of different treatment approaches for advanced invasive cervical resorption based on cone-beam computed tomography evaluation enables the clinician to choose the optimal treatment approach for each advanced ICR case.
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Affiliation(s)
- Avi Shemesh
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel.
| | - Avi Levin
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Avi Hadad
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Joe Ben Itzhak
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
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7
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Espona J, Roig E, Durán-Sindreu F, Abella F, Machado M, Roig M. Invasive Cervical Resorption: Clinical Management in the Anterior Zone. J Endod 2018; 44:1749-1754. [PMID: 30243659 DOI: 10.1016/j.joen.2018.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 01/04/2023]
Abstract
According to the high number of articles published on invasive cervical resorption (ICR), this pathology, as commonly believed, is a more frequent form of cervical resorption. ICR is often misdiagnosed as internal resorption or caries, which leads to inappropriate treatment and even unnecessary tooth loss. Despite a correct diagnosis, the treatment of this type of hyperplastic invasive external resorption poses a challenge for the clinician. The Heithersay classification and the use of cone-beam computed tomographic imaging have increased our knowledge of the pathology and helped improve its prognosis. Nevertheless, there is no standard protocol for the treatment of this type of lesion. This article proposes a treatment protocol for ICR based on the pattern and location of resorption. Three treatment approaches (internal access, external access, and intentional replantation) are presented through 3 clinical cases.
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Affiliation(s)
- José Espona
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Elena Roig
- Department of Restorative Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Francesc Abella
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Manoel Machado
- Department of Endodontics, Universidade de São Paulo, São Paulo, Brazil
| | - Miguel Roig
- Department of Restorative Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain.
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8
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Shemesh A, Levin A, Ben Itzhak J, Brosh Y, Braverman E, Batashvili G, Solomonov M. External invasive resorption: Possible coexisting factors and demographic and clinical characteristics. AUST ENDOD J 2018; 45:141-145. [PMID: 30129090 DOI: 10.1111/aej.12292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 11/27/2022]
Abstract
The purpose of this retrospective study was to identify the coexisting factors for EIR and to characterise EIR clinically and demographically. All cases of EIR that were referred to the endodontic department between 2011 to 2016 and diagnosed by an endodontist were evaluated. Demographic and clinical characteristics were collected and evaluated. Thirty-eight cases of EIR diagnosed between 2011 and 2016 were included in the study. Seventy-one percent of EIR cases were misdiagnosed by general practitioners. The most affected teeth were the maxillary central incisors (29% of cases) and mandibular molars (26%). Sixty-eight percent of EIR cases were diagnosed in teeth with clinically normal pulp. Pulp necrosis was observed mainly in the advanced stages (class 3 and class 4) of EIR (75%) and in teeth with a history of trauma (63%). Histories of previous trauma and orthodontic treatment were reported in 29% and 23% of cases, respectively.
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Affiliation(s)
- Avi Shemesh
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Avi Levin
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Joe Ben Itzhak
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Yair Brosh
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Evgeny Braverman
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Gabriel Batashvili
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
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9
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Matsuda S, Memida T, Mizuno N, Ogawa I, Ouhara K, Kajiya M, Fujita T, Sugiyama E, Kurihara H. Reparative bone-like tissue formation in the tooth of a systemic sclerosis patient. Int Endod J 2018; 51:1059-1066. [PMID: 29480950 DOI: 10.1111/iej.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
AIM To report a case of reparative bone-like tissue formation in the tooth of a patient with systemic sclerosis. SUMMARY A 58-year-old Japanese female patient with systemic sclerosis was referred because of tooth fracture. Cone beam computerized tomography (CBCT) revealed multiple root resorption and the unclear transition from alveolar bone to root profile. A sample from a fractured tooth was analysed histologically. Haematoxylin and eosin-stained sections revealed the irregular replacement of pulp and dentine by bone-like tissue. Calcinosis was noted in various parts of the body and a histological analysis identified it as dystrophic calcification on sclerosed fibrous connective tissue. Bite force and the occlusal area were markedly weaker than the means for female of the same age. KEY LEARNING POINTS CBCT may be more useful than dental radiography for diagnosing multiple root resorption in systemic sclerosis patients. When systemic sclerosis patients have calcinosis, their root status must be examined carefully. When root resorption is present in systemic sclerosis patients, reparative bone-like tissue formation in teeth needs to be taken into account prior to the initiation of dental treatment.
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Affiliation(s)
- S Matsuda
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - T Memida
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - N Mizuno
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - I Ogawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - K Ouhara
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - M Kajiya
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - T Fujita
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - E Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - H Kurihara
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan.,Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
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10
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Arroyo-Bote S, Bucchi C, Manzanares MC. External Cervical Resorption: A New Oral Manifestation of Systemic Sclerosis. J Endod 2017; 43:1740-1743. [PMID: 28606671 DOI: 10.1016/j.joen.2017.03.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/17/2017] [Accepted: 03/22/2017] [Indexed: 01/07/2023]
Abstract
Systemic sclerosis (SSc) is a complex, chronic, and progressive autoimmune disease. SSc causes bone resorption of mandible and distal phalanges of fingers through a known mechanism, and it has also been pointed out as a possible cause of apical root resorption of teeth, because tooth resorption is regulated by similar mechanisms to those controlling bone resorption. The objective of this article was to report the first case in the literature of external cervical resorption (ECR) as an oral manifestation of SSc. A 66-year-old female patient with a 35-year history of SSc was diagnosed with multiple ECRs through a computerized axial tomography and clinical examination. All known causes of ECR were discarded after a detailed anamnesis and clinical examination. This report details SSc as a possible cause of ECR and discusses the pathogenesis of ECR in relation with SSc. The systemic alterations provoked by SSc can be related to the etiopathogenesis of cervical root resorption. It is extremely relevant that dental care providers be aware that external cervical resorptions could be present in patients suffering from SSc, consciously look for these lesions, treat them early in case they are present, and advise the patient with SSc of the importance of continuous dental controls.
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Affiliation(s)
| | - Cristina Bucchi
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; CICO Research Centre, Faculty of Odontology, Universidad de La Frontera, Temuco, Chile
| | - Ma Cristina Manzanares
- Human Anatomy and Embryology Unit, Department of Experimental Pathology and Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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11
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Tsaousoglou P, Markou E, Efthimiades N, Vouros I. Characteristics and treatment of invasive cervical resorption in vital teeth. A narrative review and a report of two cases. Br Dent J 2017; 222:423-428. [PMID: 28336998 DOI: 10.1038/sj.bdj.2017.263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 11/09/2022]
Abstract
Invasive cervical resorption (ICR) is a significant defect of the root surface where the hard dental tissues are undermined and become translucent due to the resorptive granulomatous tissue. It is mainly detected on radiographs. The radiographic appearance of ICR is asymmetrical radiolucency with irregular margins and an unchanged root canal. The purpose of this study is to present a comprehensive review together with the characteristics and the treatment of ICR through two cases which were followed-up for 36 months. In both cases the teeth were vital and the management consisted of raising a flap, granulomatous tissue removal, thorough debridement, restoration of the resorptive defect by placing a suitable filling material and follow-up examinations. Our results indicate that the specific treatment protocol has very positive outcomes. After 36 months pulpal vitality tests revealed a healthy pulp, and clinical and radiographic examination confirmed a stable periodontal condition.
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Affiliation(s)
- P Tsaousoglou
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | | | - N Efthimiades
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - I Vouros
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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12
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Gijón VR, Martín CL, Encinas RMP, Navajas JM. Aetiological, histopathological, clinical, diagnostic and therapeutical features of idiopathic cervical resorption. ACTA ACUST UNITED AC 2016; 43:964-6, 968-70. [DOI: 10.12968/denu.2016.43.10.964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Virginia Robles Gijón
- Assistant Professor, Department of Conservative Dentistry, School of Dentistry, University of Granada, Spain
| | - Cristina Lucena Martín
- Associate Professor, Department of Conservative Dentistry, School of Dentistry, University of Granada, Spain
| | - Rosa M Pulgar Encinas
- Associate Professor, Department of Conservative Dentistry, School of Dentistry, University of Granada, Spain
| | - José Manuel Navajas
- Professor, Department of Conservative Dentistry, School of Dentistry, University of Granada, Spain
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13
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Mavridou AM, Hauben E, Wevers M, Schepers E, Bergmans L, Lambrechts P. Understanding External Cervical Resorption in Vital Teeth. J Endod 2016; 42:1737-1751. [DOI: 10.1016/j.joen.2016.06.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/04/2016] [Accepted: 06/09/2016] [Indexed: 12/31/2022]
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14
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Patel K, Foschi F, Pop I, Patel S, Mannocci F. The Use of Intentional Replantation to Repair an External Cervical Resorptive Lesion Not Amenable to Conventional Surgical Repair. Prim Dent J 2016; 5:78-83. [PMID: 28826436 DOI: 10.1308/205016816819304213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Intentional replantation consists of purposefully extracting a tooth, correcting the defect and replanting it into its original socket. This case report describes how this technique was used to successfully restore an external cervical resorptive (ECR) lesion. A 22-year-old man was diagnosed with ECR of the mandibular right canine following clinical and radiographic examination. CBCT showed the lesion had been initiated distally and extended circumferentially around the root canal. The nature of the resorptive lesion meant that it was inaccessible to repair conventionally in a predictable manner. This report describes how intentional replantation was used to access and restore the lesion with minimal patient cooperation and postoperative discomfort. At an 18-month recall the tooth was clinically sound with no radiographic evidence of inflammatory or replacement root resorption. Intentional replantation should be considered a viable treatment option when ECR is inaccessible and cannot be restored using conventional techniques.
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Affiliation(s)
- Kreena Patel
- Department of Endodontology, Kings College Dental Institute at Guy's King's and St Thomas' Hospital, London, UK
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15
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Krishnan U, Moule AJ, Alawadhi A. Cone beam CT assisted re-treatment of class 3 invasive cervical resorption. BMJ Case Rep 2015; 2015:bcr-2014-204615. [PMID: 25795743 DOI: 10.1136/bcr-2014-204615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Invasive cervical root resorption is an uncommon external root resorption which initiates at the cervical aspect of the tooth. This case report involves a case of cervical root resorption which was initially misdiagnosed and managed as cervical root caries. It was later diagnosed with cone beam CT and the lesion microsurgically removed and restored with resin modified glass ionomer cement. The importance of increasing awareness of this uncommon pathology and the role of cone beam CT in mapping the extent of the lesion is emphasised.
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Affiliation(s)
- Unni Krishnan
- Department of Dentistry, New Mowasat hospital, Salmiya, Kuwait
| | - Alex J Moule
- School of Dentistry, University of Queensland, Australia Faculty of Dentistry, Kuwait University, Salmiya, Kuwait
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Becker A, Abramovitz I, Chaushu S. Failure of treatment of impacted canines associated with invasive cervical root resorption. Angle Orthod 2013; 83:870-876. [PMID: 23343004 PMCID: PMC8744522 DOI: 10.2319/090812-716.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 12/01/2012] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVES 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Adrian Becker
- Associate Professor, Department of Orthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Itzhak Abramovitz
- Clinical Associate Professor Emeritus, Department of Endodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Stella Chaushu
- Associate Professor and Chair, Department of Orthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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Gandi P, Disha S. Treatment of maxillary central incisor with external root resorption using mineral trioxide aggregate: 18 months follow-up. BMJ Case Rep 2013; 2013:bcr-2013-200241. [PMID: 23843419 DOI: 10.1136/bcr-2013-200241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
External cervical resorption 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. This case report demonstrates an external cervical resorption in a maxillary central incisor of a 24-year-old male patient. After surgical intervention and root canal treatment, the resorption was subsequently sealed with mineral trioxide aggregate. The 18 months follow-up demonstrates no pathological changes on clinical and radiographic examination. This case report presents a treatment strategy that might improve the healing outcomes for patients with external cervical resorption.
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Affiliation(s)
- Padma Gandi
- Department of Conservative Dentistry & Endodontics, SVS Institute of Dental Sciences, Mahabubnagar, Andhra Pradesh, India.
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18
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Discacciati JAC, de Souza EL, Costa SC, Sander HH, Barros VDM, Vasconcellos WA. Invasive cervical resorption: etiology, diagnosis, classification and treatment. J Contemp Dent Pract 2012; 13:723-8. [PMID: 23250183 DOI: 10.5005/jp-journals-10024-1217] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Invasive cervical resorption (ICR) is not well understood by the professional, being misdiagnosed, leading to inappropriate treatment and unnecessary loss of tooth. INTRODUCTION ICR is defined as a localized process of resorption, which begins in the cervical area of the tooth, just below the epithelial junction and above the ridge crest in the area of the connective tissue insertion. Possible predisposing factors include external trauma, orthodontic movement, surgical procedures, periodontal disease and its treatments, endogenous bleaching, pressure generated by wind instruments and herpes virus infection. Different approaches have been suggested for the treatment of ICR, depending on the extent of the lesion and its location. However, in some cases due to the severity of the injury, there is no alternative but to tooth extraction, followed by restoration of the edentulous area. AIM AND OBJECTIVE Discuss etiology, diagnosis and classification of the ICR, as well as different treatment options. Also is presented a case in which extraction was carried out, installation of the implant and ceramic crown, subsequent to a treatment approach that resulted in failure in the short-term period. CONCLUSION Early diagnosis of the ICR is critical to proper treatment and favorable prognosis. Interdisciplinary treatment should be instituted as soon as possible, avoiding the loss of the affected tooth. In advanced cases, treatment involving the installation of osseointegrated implants should be considered the first choice of treatment. CLINICAL SIGNIFICANCE Early diagnosis of the ICR is critical do prevent unnecessary tooth loss, once the prognosis for advanced cases is doubtful.
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Affiliation(s)
- José Augusto Cesar Discacciati
- Department of Restorative Dentistry, Federal University of Minas Gerais, Avenida do Contorno, 7069/401 Santo Antonio-30110.043, Belo Horizonte, Minas Gerais, Brazil.
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19
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Zainal Ariffin SH, Yamamoto Z, Zainol Abidin IZ, Megat Abdul Wahab R, Zainal Ariffin Z. Cellular and molecular changes in orthodontic tooth movement. ScientificWorldJournal 2011; 11:1788-803. [PMID: 22125437 PMCID: PMC3201678 DOI: 10.1100/2011/761768] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 10/10/2011] [Indexed: 02/06/2023] Open
Abstract
Tooth movement induced by orthodontic treatment can cause sequential reactions involving the periodontal tissue and alveolar bone, resulting in the release of numerous substances from the dental tissues and surrounding structures. To better understand the biological processes involved in orthodontic treatment, improve treatment, and reduce adverse side effects, several of these substances have been proposed as biomarkers. Potential biological markers can be collected from different tissue samples, and suitable sampling is important to accurately reflect biological processes. This paper covers the tissue changes that are involved during orthodontic tooth movement such as at compression region (involving osteoblasts), tension region (involving osteoclasts), dental root, and pulp tissues. Besides, the involvement of stem cells and their development towards osteoblasts and osteoclasts during orthodontic treatment have also been explained. Several possible biomarkers representing these biological changes during specific phenomenon, that is, bone remodelling (formation and resorption), inflammation, and root resorption have also been proposed. The knowledge of these biomarkers could be used in accelerating orthodontic treatment.
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Affiliation(s)
- Shahrul Hisham Zainal Ariffin
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia.
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Silveira LFM, Silveira CF, Martos J, Piovesan EM, César Neto JB. Clinical technique for invasive cervical root resorption. J Conserv Dent 2011; 14:440-4. [PMID: 22144822 PMCID: PMC3227300 DOI: 10.4103/0972-0707.87225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 06/12/2011] [Accepted: 06/21/2011] [Indexed: 11/29/2022] Open
Abstract
This clinical case report describes the diagnosis and treatment of an external invasive cervical resorption. A 17-year-old female patient had a confirmed diagnosis of invasive cervical resorption class 4 by cone beam computerized tomography. Although, there was no communication with the root canal, the invasive resorption process was extending into the cervical and middle third of the root. The treatment of the cervical resorption of the lateral incisor interrupted the resorptive process and restored the damaged root surface and the dental functions without any esthetic sequelae. Both the radiographic examination and computed tomography are imperative to reveal the extent of the defect in the differential diagnosis.
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Affiliation(s)
| | - Carina Folgearini Silveira
- Department of Semiology and Clinics , Faculty of Dentistry, Federal University of Pelotas, Pelotas, Brazil
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Danesh F, Karamifar K, Abbott PV. Management of an extensive invasive root resorptive lesion with mineral trioxide aggregate: a case report. J Oral Sci 2011; 53:397-401. [DOI: 10.2334/josnusd.53.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Roig M, Morelló S, Mercadé M, Durán-Sindreu F. Invasive cervical resorption: report on two cases. ACTA ACUST UNITED AC 2010; 110:e64-9. [DOI: 10.1016/j.tripleo.2010.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 03/09/2010] [Indexed: 11/16/2022]
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Plotino G, Buono L, Grande NM, Pameijer CH, Somma F. Nonvital tooth bleaching: a review of the literature and clinical procedures. J Endod 2008; 34:394-407. [PMID: 18358884 DOI: 10.1016/j.joen.2007.12.020] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 12/23/2007] [Accepted: 12/26/2007] [Indexed: 11/18/2022]
Abstract
Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth structure. It can be defined as being extrinsic or intrinsic on the basis of localization and etiology. In this review of the literature, various causes of tooth discoloration, different bleaching materials, and their applications to endodontically treated teeth have been described. In the walking bleach technique the root filling should be completed first, and a cervical seal must be established. The bleaching agent should be changed every 3-7 days. The thermocatalytic technique involves placement of a bleaching agent in the pulp chamber followed by heat application. At the end of each visit the bleaching agent is left in the tooth so that it can function as a walking bleach until the next visit. External bleaching of endodontically treated teeth with an in-office technique requires a high concentration gel. It might be a supplement to the walking bleach technique, if the results are not satisfactory after 3-4 visits. These treatments require a bonded temporary filling or a bonded resin composite to seal the access cavity. There is a deficiency of evidence-based science in the literature that addresses the prognosis of bleached nonvital teeth. Therefore, it is important to always be aware of the possible complications and risks that are associated with the different bleaching techniques.
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Affiliation(s)
- Gianluca Plotino
- Department of Endodontics, Catholic University of Sacred Heart, Rome, Italy.
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