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Manaktala M, Taneja S, Bhalla VK. Stress distribution in endodontically treated external cervical resorption lesions restored with MTA and biodentine - A finite element analysis. J Oral Biol Craniofac Res 2024; 14:415-422. [PMID: 38832294 PMCID: PMC11144738 DOI: 10.1016/j.jobcr.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Root 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 methods This 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. Results The 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. Conclusion Finite 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.
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Affiliation(s)
| | - Sonali Taneja
- Dept. Of Conservative Dentistry and Endodontics, I.T.S Dental College, Ghaziabad, India
| | - Vidhi Kiran Bhalla
- Dept. Of Conservative Dentistry and Endodontics, I.T.S Centre for Dental Studies and Research, Ghaziabad, India
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Pace R, Di Gianfilippo R, Franceschi D, Pini Prato G. A clinical dilemma: Performing or avoiding root instrumentation in the treatment of the acute phase of endodontic-periodontal lesions? A case report. Clin Adv Periodontics 2024. [PMID: 38853676 DOI: 10.1002/cap.10297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/04/2024] [Accepted: 05/05/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND This study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis. METHODS Clinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface. RESULTS At 6-month and 1-year follow-ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4-year follow-up period. CONCLUSIONS The spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL. KEY POINTS Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic-periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic-periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo-periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.
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Affiliation(s)
- Riccardo Pace
- Department of Endodontics, The University of Florence, Florence, Italy
| | - Riccardo Di Gianfilippo
- Pacific Academy of Periodontal and Implant Research (PAPIR), Bellevue, Washington, USA
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora Franceschi
- Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
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Spielman R, Ameh G, Brandes I, Berkowitz L, Elson N, Blum IR. Challenges in differential diagnosis and treatment of cervical root resorption vs. root caries. Prim Dent J 2024; 13:65-70. [PMID: 38888079 DOI: 10.1177/20501684241256468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
External cervical root resorption may be occasionally mistaken for root caries and vice versa. Radiographical and clinical differential diagnoses of cervical root resorption and root caries are essential for correct treatment planning and a successful treatment outcome. This article reviews the contemporary literature and summarises the prevailing professional consensus pertaining to external cervical root resorption. Clinical diagnostics which help distinguish cervical root resorption from root caries are outlined and treatment approaches of external cervical root resorption are discussed.
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Affiliation(s)
- Robert Spielman
- Robert Spielman Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Governor Ameh Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Irene Brandes DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Leonard Berkowitz DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Natalia Elson DDS, FWLI Clinical Assistant Professor & Group Practice Director, Department of General Dentistry & Comprehensive Care, New York University College of Dentistry, New York, USA; Senior Mentor, The Kells Society
- Igor R. Blum DDS, PhD, Dr Med Dent, MSc, MA (Educ), MFDS RCS (Eng), MFDS RCS (Edin), FDS (Rest Dent) RCS (Eng), FFDRCSI, FCGDent, PGCHE, FHEA, FICD, LLM (Medico-Legal Law)
- Professor/Consultant & Specialist in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Governor Ameh
- Robert Spielman Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Governor Ameh Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Irene Brandes DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Leonard Berkowitz DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Natalia Elson DDS, FWLI Clinical Assistant Professor & Group Practice Director, Department of General Dentistry & Comprehensive Care, New York University College of Dentistry, New York, USA; Senior Mentor, The Kells Society
- Igor R. Blum DDS, PhD, Dr Med Dent, MSc, MA (Educ), MFDS RCS (Eng), MFDS RCS (Edin), FDS (Rest Dent) RCS (Eng), FFDRCSI, FCGDent, PGCHE, FHEA, FICD, LLM (Medico-Legal Law)
- Professor/Consultant & Specialist in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Irene Brandes
- Robert Spielman Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Governor Ameh Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Irene Brandes DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Leonard Berkowitz DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Natalia Elson DDS, FWLI Clinical Assistant Professor & Group Practice Director, Department of General Dentistry & Comprehensive Care, New York University College of Dentistry, New York, USA; Senior Mentor, The Kells Society
- Igor R. Blum DDS, PhD, Dr Med Dent, MSc, MA (Educ), MFDS RCS (Eng), MFDS RCS (Edin), FDS (Rest Dent) RCS (Eng), FFDRCSI, FCGDent, PGCHE, FHEA, FICD, LLM (Medico-Legal Law)
- Professor/Consultant & Specialist in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Leonard Berkowitz
- Robert Spielman Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Governor Ameh Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Irene Brandes DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Leonard Berkowitz DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Natalia Elson DDS, FWLI Clinical Assistant Professor & Group Practice Director, Department of General Dentistry & Comprehensive Care, New York University College of Dentistry, New York, USA; Senior Mentor, The Kells Society
- Igor R. Blum DDS, PhD, Dr Med Dent, MSc, MA (Educ), MFDS RCS (Eng), MFDS RCS (Edin), FDS (Rest Dent) RCS (Eng), FFDRCSI, FCGDent, PGCHE, FHEA, FICD, LLM (Medico-Legal Law)
- Professor/Consultant & Specialist in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Natalia Elson
- Robert Spielman Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Governor Ameh Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Irene Brandes DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Leonard Berkowitz DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Natalia Elson DDS, FWLI Clinical Assistant Professor & Group Practice Director, Department of General Dentistry & Comprehensive Care, New York University College of Dentistry, New York, USA; Senior Mentor, The Kells Society
- Igor R. Blum DDS, PhD, Dr Med Dent, MSc, MA (Educ), MFDS RCS (Eng), MFDS RCS (Edin), FDS (Rest Dent) RCS (Eng), FFDRCSI, FCGDent, PGCHE, FHEA, FICD, LLM (Medico-Legal Law)
- Professor/Consultant & Specialist in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Igor R Blum
- Robert Spielman Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Governor Ameh Undergraduate dental student, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Irene Brandes DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Leonard Berkowitz DDS Clinical Assistant Professor & Assistant Clinical Director, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, USA
- Natalia Elson DDS, FWLI Clinical Assistant Professor & Group Practice Director, Department of General Dentistry & Comprehensive Care, New York University College of Dentistry, New York, USA; Senior Mentor, The Kells Society
- Igor R. Blum DDS, PhD, Dr Med Dent, MSc, MA (Educ), MFDS RCS (Eng), MFDS RCS (Edin), FDS (Rest Dent) RCS (Eng), FFDRCSI, FCGDent, PGCHE, FHEA, FICD, LLM (Medico-Legal Law)
- Professor/Consultant & Specialist in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Cagay Sevencan G, Erener H. Reliability of information in YouTube™ videos on types of root resorption and related stimulating factors. Dent Traumatol 2024. [PMID: 38794913 DOI: 10.1111/edt.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND/AIM Root resorption occurs for various reasons and can also be seen as a treatment complication in orthodontics. This study aimed to assess the reliability and quality of YouTube™ videos on root resorption and to assess whether the videos referred to orthodontic treatment and other stimulation factors. MATERIALS AND METHODS YouTube was searched using the keyword 'root resorption', which is the most searched term on Google Trends. The first 200 videos identified using the default filter 'sort by relevance' were used. Information such as the source, type, duration, and number of likes were recorded. Videos were analyzed using a 23-point content scale related to root resorption and divided into groups (poor, moderate, and excellent) based on the Global Quality Score. RESULTS A total of 95 videos were included in the study. Most were uploaded by dentists or dental clinics (n = 64, 67.4%). The mean number of days since upload was 1536 ± 1254, and the mean duration was 5 ± 4 min. The videos had a mean of 80 ± 515 likes and 7043 ± 35,382 views, and a mean viewing rate of 1131.71 ± 8736.83. The most discussed topic was radiographic signs of root resorption. While the highest content score for the videos was 21, the average score was only 4. The mean GQS was 2 ± 1. Grouping videos by GQS showed that 55 (57.9%) were poor, 38 (40%) were moderate, and 2 (2.1%) were excellent. There was a significant relationship between videos that mentioned orthodontics (n = 62; 65.3%) and higher GQS (p = .036), and a significant difference was between GQS groups for total content levels (p < .001). CONCLUSIONS YouTube videos related to root resorption lack sufficient information and clarity, and their quality needs to be improved. Oral health professionals should strive to produce higher-quality videos.
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Affiliation(s)
- Gülçin Cagay Sevencan
- Department of Endodontics, Faculty of Dentistry, Tekirdag Namık Kemal University, Tekirdag, Turkey
| | - Hande Erener
- Department of Orthodontics, Faculty of Dentistry, Tekirdag Namık Kemal University, Tekirdag, Turkey
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Merrick D, Duncan HF, Bolas A, Hughes A, O'Sullivan M. Multiple External Cervical Resorption Lesions in Patient with Graft versus Host Disease Treated with Systemic Bleomycin: A Case Report. J Endod 2024; 50:674-679. [PMID: 38311117 DOI: 10.1016/j.joen.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
The phenomenon of multiple external cervical root resorption (ECRR) lesions in a single patient is rare but may have a link with the chemotherapeutic agent bleomycin. This case details an adult male with multiple ECRR lesions that developed following chemotherapy. His treatment regimen for Hodgkin's lymphoma included the chemotherapeutic antibiotic bleomycin, which has previously been linked with development of multiple ECRR lesions. The patient developed graft versus host disease following an allogeneic stem cell transplant, which could have a significant role in the development and promotion of the ECRR lesions. In total, 8 teeth developed ECRR, and all the known causative factors were excluded when examined. To our knowledge, this is only the second reported case in the literature to link bleomycin to multiple ECRR lesions. This case report aims to bring the reader's attention to the fact that multiple cervical resorption lesions can develop simultaneously. These lesions can be difficult to diagnose and treat and are often misdiagnosed as caries. Finally, the reader should consider the possible role of bleomycin and graft versus host disease in development of multiple lesions of ECRR.
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Affiliation(s)
- Daniel Merrick
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland.
| | - Henry F Duncan
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Andrew Bolas
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Annie Hughes
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Michael O'Sullivan
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
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Li T, Meng X, Zhou S, Li S, Luo Q, Zhang T. Complete idiopathic resorption of distobuccal root of a maxillary first molar: A case report. Clin Case Rep 2024; 12:e8786. [PMID: 38645604 PMCID: PMC11031742 DOI: 10.1002/ccr3.8786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Key Clinical Message This case report provides a rare case of idiopathic root resorption in maxillary first molar and suggests the importance of CBCT in the diagnosis and treatment outcome of complex endodontic diseases. Endodontic surgery is an effective method for treating teeth with persistent apical periodontitis. Abstract Idiopathic root resorption is an unexplained root resorption when the patient experiences root resorption without any local or systemic factors. Early diagnosis and appropriate treatment are crucial for long-term outcomes.
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Affiliation(s)
- Tianqi Li
- Medical School of Chinese PLABeijingChina
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
- Department of StomatologyFujian People's Armed Police Corps HospitalFuzhouChina
| | - Xiangbo Meng
- Medical School of Chinese PLABeijingChina
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Sunxin Zhou
- Medical School of Chinese PLABeijingChina
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Shuaichen Li
- Medical School of Chinese PLABeijingChina
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Qiang Luo
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Tong Zhang
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
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Machado ICP, Morais MO, Bicalho ALP, Ferrari PHP, Bueno JM, Junqueira JLC, Soares MQS. Prevalence and Characterization of External Cervical Resorption Using Cone Beam Computed Tomography. J Endod 2024; 50:164-172.e1. [PMID: 37977218 DOI: 10.1016/j.joen.2023.11.003] [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: 08/07/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The aim of this study was to assess the prevalence of external cervical resorption (ECR) and characterize the cases of ECR using cone beam computed tomography (CBCT). METHODS High-resolution CBCT scans of 6216 patients (2280 males and 3936 females), consecutively acquired during the period July 2021 to March 2022, were analyzed. Identified cases of ECR were characterized by 3 evaluators regarding lesion height, circumferential spread, portal of entry proximity to root canal, stage, location, and width. RESULTS In a total of 38 patients and 40 teeth, ECR cases demonstrated an incidence of 0.61%. The median age of the patients was 39 years. Prevalence of ERC was 0.78% among males and 0.50% among females. The most affected teeth were the maxillary incisors and canines. The most frequent characteristics of the lesion were: extension up to the cervical third (47.5%), more than 270° circumferential spread (42.55%), probable pulpal involvement (57.5%), progressive stage (65%), supracrestal (52.1%) and mesial (34.7%) localization of >1 mm in size (52.1%) portals of entry. Cases with greater longitudinal involvement also showed greater circumferential progression (P = .008). There was no association between portal of entry location and bone crest or ECR reparative phase (P = .42). Inter-rater agreement ranged from good to very good. No association between portal of entry and ECR progression was observed. CONCLUSIONS ECR showed low prevalence in the Brazilian population, affecting mostly anterior maxillary teeth of patients within a wide age range. CBCT allowed characterization of ECR lesions with good interobserver agreement.
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Affiliation(s)
| | - Marilia Oliveira Morais
- Department of Oral Radiology, Centro Integrado de Radiodontologia CIRO, Goiânia, Goiás, Brazil
| | | | | | - Juliano Martins Bueno
- Oral Radiology Division, São Leopoldo Mandic Research Institute, Campinas, São Paulo, Brazil; Department of Oral Radiology, Centro Integrado de Radiodontologia CIRO, Goiânia, Goiás, Brazil
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Mohammad-Rahimi H, Dianat O, Abbasi R, Zahedrozegar S, Ashkan A, Motamedian SR, Rohban MH, Nosrat A. Artificial Intelligence for Detection of External Cervical Resorption Using Label-Efficient Self-Supervised Learning Method. J Endod 2024; 50:144-153.e2. [PMID: 37977219 DOI: 10.1016/j.joen.2023.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The aim of this study was to leverage label-efficient self-supervised learning (SSL) to train a model that can detect ECR and differentiate it from caries. METHODS Periapical (PA) radiographs of teeth with ECR defects were collected. Two board-certified endodontists reviewed PA radiographs and cone beam computed tomographic (CBCT) images independently to determine presence of ECR (ground truth). Radiographic data were divided into 3 regions of interest (ROIs): healthy teeth, teeth with ECR, and teeth with caries. Nine contrastive SSL models (SimCLR v2, MoCo v2, BYOL, DINO, NNCLR, SwAV, MSN, Barlow Twins, and SimSiam) were implemented in the assessment alongside 7 baseline deep learning models (ResNet-18, ResNet-50, VGG16, DenseNet, MobileNetV2, ResNeXt-50, and InceptionV3). A 10-fold cross-validation strategy and a hold-out test set were employed for model evaluation. Model performance was assessed via various metrics including classification accuracy, precision, recall, and F1-score. RESULTS Included were 190 PA radiographs, composed of 470 ROIs. Results from 10-fold cross-validation demonstrated that most SSL models outperformed the transfer learning baseline models, with DINO achieving the highest mean accuracy (85.64 ± 4.56), significantly outperforming 13 other models (P < .05). DINO reached the highest test set (ie, 3 ROIs) accuracy (84.09%) while MoCo v2 exhibited the highest recall and F1-score (77.37% and 82.93%, respectively). CONCLUSIONS This study showed that AI can assist clinicians in detecting ECR and differentiating it from caries. Additionally, it introduced the application of SSL in detecting ECR, emphasizing that SSL-based models can outperform transfer learning baselines and reduce reliance on large, labeled datasets.
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Affiliation(s)
- Hossein Mohammad-Rahimi
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI on Health, Berlin, Germany; Department of Computer Engineering, Sharif University of Technology, Tehran, Iran
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia
| | - Reza Abbasi
- Department of Computer Engineering, Sharif University of Technology, Tehran, Iran
| | - Samira Zahedrozegar
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ashkan
- Department of Orthodontics, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeed Reza Motamedian
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI on Health, Berlin, Germany; Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia.
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Jeng PY, Chang SH, Wang CY, Lin LD, Jeng JH, Tsai YL. Surgical repair of external cervical resorption - Prognosis and prognostic factors. J Dent Sci 2024; 19:377-386. [PMID: 38303835 PMCID: PMC10829651 DOI: 10.1016/j.jds.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/01/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose External cervical resorption (ECR) is an aggressive form of root resorption, which etiology is unclear and its prognosis remains unpredictable. The purpose of this study was to investigate the prognosis and potential prognostic factors of ECR-affected teeth after surgical intervention for external repair with/without root canal treatment. Materials and methods Treated ECR cases from 2009 to 2019 were collected retrospectively. The survival of the teeth and the status of root resorption were assessed during the follow-up period. Potential prognostic factors were analyzed with log-rank test and Kaplan-Meier statistics. Results A total of 42 treated ECR-affected teeth were enrolled. The two-year survival rate was 71.20% [54.16%, 93.59%]. Persistent root resorption was the main complication after treatment. Patients with multiple ECR-affected teeth had greater recurrent potential than patients with solitary ECR-affected teeth. Prolonged calcium hydroxide dressing may contribute to a more favorable clinical outcome. Gender, age, tooth position and the need for root canal treatment did not show statistically significant effect on the prognosis. Conclusion The current surgical method was able to arrest ECR in most cases. However, the case type (the number of ECR-affected teeth per patient) could highly affect the prognosis of the teeth. Clinicians should consider long-term calcium hydroxide dressing in case of pulp involvement to achieve better results.
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Affiliation(s)
- Po-Yuan Jeng
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shu-Hui Chang
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chen-Ying Wang
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Deh Lin
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiiang-Huei Jeng
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Ling Tsai
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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Çoban Öksüzer M, Şanal Çıkman A. Evaluation of Fracture Strength after Repair of Cervical External Resorption Cavities with Different Materials. J Endod 2024; 50:85-95. [PMID: 37879603 DOI: 10.1016/j.joen.2023.10.007] [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: 08/07/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION The aim was to evaluate the stress distributions on dentin and repair materials caused by static force applied to teeth, with cervical external root resorption (CER) after repair with different materials using finite element analysis. METHODS This study was performed with the 3-dimensional finite element analysis method. Access cavity, root canal cavity dimensions, and supporting tissues other than cementum were modeled in the maxillary central tooth. The CER cavity was created on the labial side of the tooth model. The coronal side of the resorption cavity was restored with composite, and the radicular side with different materials (MTA, Biodentine, BioAggregate, calcium-enriched cement [CEM], glass ionomer cement [GIC], and resin-modified glass ionomer cement [RMGIC]). A static force of 300 N was applied to the palatal surface of the crown at an angle of 135° to the long axis of the tooth. The stress distributions in dentin and repair materials were analyzed. RESULTS The highest stress in dentin was seen in the fFigmodel with unrepaired CER. In the models repaired with MTA, GIC, and RMGIC, von Mises stress values in dentin were greater than for repairs with Biodentine, BioAggregate, and CEM materials. The von Mises stress on the repair materials applied to the root were highest for the BioAggregate material. This was followed by CEM, Biodentine, MTA, RMGIC, and GIC materials, respectively. CONCLUSION The repair of CER in the tooth significantly decreased the stress values in dentin. Biodentine, BioAggregate, and CEM absorbed more force and caused less stress to be transmitted to dentin compared to MTA, GIC, and RMGIC.
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Affiliation(s)
- Merve Çoban Öksüzer
- Department of Endodontics, Faculty of Dentistry, Recep Tayyip Erdoğan University, Rize, Türkiye.
| | - Ahter Şanal Çıkman
- Department of Endodontics, Faculty of Dentistry, Recep Tayyip Erdoğan University, Rize, Türkiye
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11
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Lin S, Marvidou AM, Novak R, Moreinos D, Abbott PV, Rotstein I. Pathogenesis of non-infection related inflammatory root resorption in permanent teeth: A narrative review. Int Endod J 2023; 56:1432-1445. [PMID: 37712904 DOI: 10.1111/iej.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The mechanism of action of root resorption in a permanent tooth can be classified as infection-related (e.g., microbial infection) or non-infection-related (e.g., sterile damage). Infection induced root resorption occurs due to bacterial invasion. Non-infection-related root resorption stimulates the immune system through a different mechanism. OBJECTIVES The aim of this narrative review is to describe the pathophysiologic process of non-infection-related inflammatory processes involved in root resorption of permanent teeth. METHODS A literature search on root resorption was conducted using Scopus (PubMed and Medline) and Google Scholar databases to highlight the pathophysiology of bone and root resorption in non-infection-related situations. The search included key words covering the relevant category. It included in vitro and in vivo studies, systematic reviews, case series, reviews, and textbooks in English. Conference proceedings, lectures and letters to the editor were excluded. RESULTS Three types of root resorption are related to the non-infection mechanism of action, which includes surface resorption due to either trauma or excessive orthodontic forces, external replacement resorption and external cervical resorption. The triggers are usually damage associated molecular patterns and hypoxia conditions. During this phase macrophages and clastic cells act to eliminate the damaged tissue and bone, eventually enabling root resorption and bone repair as part of wound healing. DISCUSSION The resorption of the root occurs during the inflammatory phase of wound healing. In this phase, damaged tissues are recognized by macrophages and neutrophiles that secrete interlaukines such as TNF-α, IL-1, IL-6, IL-8. Together with the hypoxia condition that accelarates the secretion of growth factors, the repair of the damaged perioduntiom, including damaged bone, is initiated. If the precementum and cementoblast are injured, root resorption can occur. CONCLUSIONS Wound healing exhibits different patterns of action that involves immune stimulation in a bio-physiological activity, that occurs in the proper sequence, with overlapping phases. Two pathologic conditions, DAMPs and hypoxia, can activate the immune cells including clastic cells, eliminating damaged tissue and bone. Under certain conditions, root resorption occurs as a side effect.
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Affiliation(s)
- Shaul Lin
- The Israeli National Center for Trauma & Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel
- Department of Endodontics, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Athina M Marvidou
- Department of Endodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - Rostislav Novak
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Orthopedic Department, Orthopedic Oncology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Daniel Moreinos
- Endodontic Department, Galilee Medical Center, Nahariya, Israel
| | - Paul Vincent Abbott
- UWA Dental School, The University of Western Australia, Western Australia, Nedlands, Australia
| | - Ilan Rotstein
- University of Southern California, California, Los Angeles, USA
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12
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Askerbeyli Örs S, Küçükkaya Eren S. Effects of different treatment modalities on biomechanical behavior of maxillary incisors with external invasive cervical resorption at different progression levels. Dent Traumatol 2023; 39:605-615. [PMID: 37424177 DOI: 10.1111/edt.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/12/2023] [Accepted: 06/18/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND/AIM This study aimed to evaluate the biomechanical behavior of maxillary incisors with external invasive cervical resorption (EICR) at different progression levels after receiving different modes of treatment under occlusal forces using finite element analysis (FEA). MATERIALS AND METHODS Three-dimensional (3D) models of intact maxillary central incisors were constructed and modified to include EICR cavities with different progression levels in the buccal cervical areas. The EICR cavities confined to dentin were repaired using Biodentine™ (Septodont Ltd., Saint Maur des Fausse ́s, France), resin composite, or glass ionomer cement (GIC) . Additionally, EICR cavities with pulp invasion requiring direct pulp capping were simulated as repaired using Biodentine only or 1 mm thick Biodentine and either resin composite or GIC for the rest of the cavity. Moreover, models with root canal treatment and EICR defects repaired using Biodentine, resin composites, or GIC were also generated. A force of 240 N was applied to the incisal edge. The principal stresses in the dentin were evaluated. RESULTS GIC showed more favorable results than the other materials in EICR cavities confined to the dentin. However, Biodentine alone resulted in more favorable minimum principal stresses (Pmin ) compared to other materials in EICR cavities with close pulp proximity. Exceptionally, the models localized in the coronal third of the root with a circumferential extension of the cavity >90° showed more favorable results for GIC. The presence of root canal treatment had no significant effect on stress values. CONCLUSIONS Based on this FEA study the use of GIC in EICR lesions confined to the dentin is recommended. However, Biodentine may be a better option for restoring EICR lesions close to the pulp with or without root canal treatment. Except when the circumferential extension of the cavity is >90°, the use of GIC may be more advantageous.
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Affiliation(s)
- Sevinc Askerbeyli Örs
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Selen Küçükkaya Eren
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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13
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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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14
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Patel S, Abella F, Patel K, Lambrechts P, Al-Nuaimi N. Clinical and radiographic features of external cervical resorption - An observational study. Int Endod J 2023; 56:1475-1487. [PMID: 37801348 DOI: 10.1111/iej.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/30/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023]
Abstract
AIM To determine the prevalence of symptoms, clinical signs and radiographic presentation of external cervical resorption (ECR). METHODOLOGY This study involved 215 ECR lesions in 194 patients referred to the Endodontic postgraduate Unit at King's College London or Specialist Endodontic practice (London, UK). The clinical and radiographic findings (periapical [PA] and cone beam computed tomography [CBCT]) were readily accessible for evaluation. A checklist was used for data collection. Inferential analysis was carried out to determine if there was any potential association between type and location of tooth in the jaw as well as sex, age of the patient and ECR presentation and radiographic feature. RESULTS Eighty-eight patients (94 teeth) were female and 106 patients were male (121 teeth), the mean age (±SD) was 41.5 (±17.7) years. Fifteen patients (7.7%) had more than one ECR lesion. The most affected teeth were maxillary central incisors (21.4% [46 teeth]) and mandibular first molars (10.2% [22 teeth]). ECR was most commonly detected as an incidental radiographic finding in 58.1% [125 teeth] of the cases. ECR presented with symptoms of pulpal/periapical disease in 23.3% [n = 50] and clinical signs (e.g. pink spot, cavitation) in 16.7% [36 teeth] of the cases. Clinical signs such as cavitation (14%), pink spot (5.1%) and discolouration (2.8%) were uncommon, but their incidence increased up to 24.7% when combined with other clinical findings. ECR was detected in the resorptive and reparative phases in 70.2% and 29.8% of the cases respectively. CONCLUSION ECR appears to be quiescent in nature, the majority being asymptomatic and diagnosed incidentally from PA or CBCT. When assessed with the Patel classification, most lesions were minimal to moderate in relation to their height (1 or 2) and circumferential spread (A or B). However, the majority of ECRs were in (close) proximity to the pulp. Symptoms and clinical signs were associated with (probable) pulp involvement rather than the height and circumferential spread of the lesion. Clinical signs were more frequently associated when ECR affected multiple surfaces.
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Affiliation(s)
- Shanon Patel
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Private Practice, London, UK
- Guy's & St. Thomas', NHS Trust, London, UK
| | | | - Kreena Patel
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Paul Lambrechts
- Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Nassr Al-Nuaimi
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Department of Restorative & Aesthetic Dentistry, College of Dentistry, University of Baghdad, Baghdad, Iraq
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15
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Musilli M, Iuorio MT, Vaia E, Vaia E, Ramaglia L, D’Antò V. Biomechanically and Periodontally-Based Orthodontic Treatment of a Patient with Upper Canine Affected by External Cervical Resorption (ECR): A Case Report. Dent J (Basel) 2023; 11:278. [PMID: 38132416 PMCID: PMC10743157 DOI: 10.3390/dj11120278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
(1) Background: Orthodontic treatment may be a potential predisposing factor for ECR. The affected tooth goes to ankylosis, which could lead to a malocclusion. Although teeth severely affected by ECR (class IV Heithersay) are usually extracted, this case report aims to present the use of an ECR class IV upper canine, both as ankylosed to solve the malocclusion and the occlusal plane canting, as well as not ankylosed to correct its ridge defect with orthodontic extrusion. (2) Methods: A 14-year-old male, complaining of an ugly smile and a failed orthodontic attempt to recover an impacted canine, was referred to the orthodontic clinic. He was diagnosed with class II right subdivision, midline deviation, both upper and lower occlusal plane canting, and an upper left canine, previously impacted, showing ECR class IV. The treatment first included canting resolution with a cantilever and a spring, exploiting the anchorage offered by the ankylosed ECR canine. Then, a coronectomy, endodontic treatment, and orthodontic extrusion of that canine were performed to obtain the implant site development. (3) Results: Clinical and radiographic outcomes showed normocclusion and better bony conditions for safer implant placement in the aesthetic zone. (4) Conclusions: The high aesthetics and the periodontal and bony conditions obtained are probably not achievable by other therapeutic alternatives.
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Affiliation(s)
| | - Morena Tina Iuorio
- Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, 80131 Naples, Italy; (M.T.I.); (E.V.); (E.V.); (L.R.)
| | - Emanuele Vaia
- Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, 80131 Naples, Italy; (M.T.I.); (E.V.); (E.V.); (L.R.)
| | - Enzo Vaia
- Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, 80131 Naples, Italy; (M.T.I.); (E.V.); (E.V.); (L.R.)
| | - Luca Ramaglia
- Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, 80131 Naples, Italy; (M.T.I.); (E.V.); (E.V.); (L.R.)
| | - Vincenzo D’Antò
- Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, 80131 Naples, Italy; (M.T.I.); (E.V.); (E.V.); (L.R.)
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16
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Huang J, Walsh RM, Witherspoon DE, Khalighinejad N, Tam EC, Jalali P, He J. The prevalence, characteristics, and risk factors of external cervical resorption: a retrospective practice-based study. Clin Oral Investig 2023; 27:5595-5604. [PMID: 37493728 DOI: 10.1007/s00784-023-05180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES External cervical root resorption (ECR) is a poorly understood and aggressive form of resorption. The purpose of this study was to examine the prevalence, characteristics, and risk factors associated with the occurrence of ECR in patients seeking endodontic care from private practice settings. MATERIALS AND METHODS Records of 343 patients with 390 teeth diagnosed with ECR were identified from 3 private endodontic practices from 2008 to 2022. The patients' demographic information, systemic conditions, and dental history were recorded. The characteristics of the cases including Heithersay classification, pulpal and periapical status, and their management were documented. The association between case severity and potential predisposing factors was examined using chi-square analysis. RESULTS The overall prevalence of ECR among patients seeking endodontic care was low (< 1%). However, there was a greater than twofold increase in the pooled prevalence from 2016 to 2021 (0.99%) compared to the data from 2010 to 2015 (0.46%). The most commonly affected teeth were anterior teeth (48.7%). Class II (30.0%) and class III (45.4%) defects were the most often identified. Patients with a history of trauma or orthodontic treatment were significantly more likely to be diagnosed with severe cervical resorption (class III or IV) (p < 0.05). CONCLUSIONS There has been an increase in the prevalence of ECR in patients seeking endodontic care. A history of orthodontic treatment and traumatic dental mechanical injuries may predict the severity of resorption. CLINICAL RELEVANCE The upward trend in the occurrence of ECR warrants close monitoring of the patients at high risk of developing the condition to facilitate early detection and management.
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Affiliation(s)
- Jenny Huang
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | - Ryan M Walsh
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | | | | | - Esther C Tam
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | - Poorya Jalali
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | - Jianing He
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA.
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17
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Wang N, Zhang M, Zhu J, Zhu Y, Wu J. Multiple idiopathic cervical root resorption: A systematic review. Oral Dis 2023; 29:2409-2422. [PMID: 36251582 DOI: 10.1111/odi.14406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/28/2022]
Abstract
The current literature on multiple idiopathic cervical root resorption (MICRR), a rare and aggressive form of external root resorption, is limited to case reports and series. Therefore, we performed a systematic review of this condition. A comprehensive search of PubMed, Embase, Web of science, Cochrane Library, CNKI, and WANFANG was conducted using key terms relevant to MICRR, supplemented by a grey literature search. Risk of bias was assessed using Cochrane's and Joanna Briggs Institute's tools. A total of 36 studies with 47 cases were included. MICRR is more common among younger females and may be related to hormonal changes and denosumab use. Initially, the premolars are usually affected but all permanent teeth may eventually be involved. Cone-beam computed tomography is recommended for diagnosis and assessment of resorptive lesions. The management is focused on complete removal and restoration of the resorptive tissue to maintain the tooth's structural integrity. However, MICRR usually has a poor prognosis. Due to its invasive and aggressive behavior, MICRR requires greater attention.
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Affiliation(s)
- Ningxiang Wang
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
- Department of Stomatology, Nanjing Hospital of Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Mei Zhang
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jiaye Zhu
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yaoyao Zhu
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Juan Wu
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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18
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Okamoto M, Asahi Y, Duncan HF, Kuriki N, Takahashi Y, Hayashi M. Repair of an Extensive External Cervical Resorption Lesion Using Intentional Replantation with Crown Rotation. Case Rep Dent 2023; 2023:2103999. [PMID: 37441169 PMCID: PMC10335757 DOI: 10.1155/2023/2103999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/01/2023] [Accepted: 06/17/2023] [Indexed: 07/15/2023] Open
Abstract
Treatment of large external cervical resorption (ECR) lesions may be compromised, rendering the tooth unrestorable. Intentional replantation is a potential treatment option depending on the site and extent of ECR. We present a case of a large ECR successfully managed with intentional replantation with rotation of the tooth. The female patient consulted the hospital clinic, with an extensive palatal ECR on the maxillary lateral incisor. Routine planar radiographs and cone-beam computed tomography demonstrated a larger palatal than the ECR lesion (Heithersay Class III and Patel's Class 2Bp) not amenable to nonsurgical treatment. Intentional replantation after short-term extrusion was planned. The defect was restored, then a palatal ferrule was achieved by rotating the tooth by 180°. At the 18-month follow-up, the periradicular and periodontal tissues remained healthy, and no other symptoms were reported. In conclusion, this successful video-illustrated clinical case highlights the benefits of intentional replantation in saving teeth with advanced ECR.
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Affiliation(s)
- Motoki Okamoto
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Yoko Asahi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Henry Fergus Duncan
- Division of Restorative Dentistry and Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Nanako Kuriki
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yusuke Takahashi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Mikako Hayashi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
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19
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Rajawat A, Kaushik M. Stresses in teeth with External Cervical Resorption defects restored with different Biomimetic cements: A Finite Element Analysis. J Endod 2023:S0099-2399(23)00364-3. [PMID: 37355164 DOI: 10.1016/j.joen.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION This study compared the stress distributions in teeth with simulated external cervical resorption defects restored with different restorative materials and identified areas of high stress concentration. METHODS A maxillary central incisor created in a scanned model using HyperWorks software served as control. External cervical resorption defects based on Shanon Patel's classification were created (1Bd/2Bd/3Bd) in the scanned model. The defects were restored using Mineral Trioxide Aggregate (MTA), Biodentine, Glass Ionomer Cement (GIC) and Bioaggregate. On all the models a force of 100 N was applied on palatal aspect, 2 mm incisal to cingulum directed at 45° along the long axis of the tooth. RESULTS The stresses generated in dentin and cementum is less, with a restorative material having high Young's modulus. For 1Bd defect, MTA and Bioaggregate showed least stresses in dentin and cementum respectively, whereas Biodentine had consistently lower stresses in dentin and cementum both. Larger defects like 2Bd and 3Bd restored with Bioaggregate exhibited minimum stresses in dentin and cementum. CONCLUSION Bioaggregate and Biodentine replace dentin with maximum stress and maximum strain. Elastic moduli similar to or higher than dentin are preferred for restoring cervical third resorptive lesions of the tooth.
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Affiliation(s)
- Akansha Rajawat
- Conservative Dentistry and Endodontics (Army College of Dental Sciences, Secunderabad), Practitioner, Ganga Singh Street, Dhauli Pyau, Mathura, Uttar Pradesh, India.
| | - Mamta Kaushik
- Conservative Dentistry and Endodontics, Professor and Head of Department, Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Secunderabad, Telangana, India
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20
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Dao V, Mallya SM, Markovic D, Tetradis S, Chugal N. Reprint of: Prevalence and Characteristics of Root Resorption Identified in Cone-Beam Computed Tomography Scans. J Endod 2023; 49:692-702. [PMID: 37315998 DOI: 10.1016/j.joen.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Root resorption is a destructive process that compromises tooth structure and can result in tooth loss. Often it remains asymptomatic and is an incidental finding on radiographic examinations. The purpose of this study was to determine prevalence and characteristics of root resorption in patients referred for cone-beam computed tomography (CBCT) imaging for a variety of indications. METHODS The study included CBCT scans of 1086 consecutive patients referred for CBCT imaging over an 18-month period. A total of 1148 scans were acquired. Data were abstracted from radiology reports, and prevalence estimates of resorption were computed for the aggregate sample and also across specific indications. RESULTS Resorption was identified in 171 patients (15.7%, 95% CI: 13.6%-17.9%) and in 249 teeth with a prevalence range of 2.6%-92.3% across specific indications. An 18.7% of the patients had 2 resorption sites whereas 8.8% had 3 or more resorption sites. The majority of affected teeth were anteriors (43.8%), followed by molars (40.6%) and premolars (14.5%). The most prevalent resorption types were external (29.3%), cervical (22.5%), infection-induced apical resorption (13.7%), internal (9.6%), and impacted tooth induced (8.8%). The majority of teeth with resorption did not have prior endodontic treatment (73.9%) and had radiographically normal periapex (69.5%). Of 249 teeth with resorption, 31% presented as incidental finding. The prevalence of incidental findings of resorption increased with age, P < .05, and was significantly lower for anterior teeth (20.2%) as compared to premolars (41.7%) and molars (36.6%), (P < .05). CONCLUSION The high proportion of incidental findings of resorption detected by CBCT suggests that resorption is not recognized/detected by conventional radiography and therefore remains underdiagnosed.
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Affiliation(s)
- Vi Dao
- UCLA School of Dentistry, Section of Endodontics, Los Angeles, California
| | - Sanjay M Mallya
- UCLA School of Dentistry, Section of Oral and Maxillofacial Radiology, Los Angeles, California
| | - Daniela Markovic
- David Geffen School of Medicine, Division of General Internal Medicine and Health Sciences Research, Los Angeles, California
| | - Sotirios Tetradis
- UCLA School of Dentistry, Section of Oral and Maxillofacial Radiology, Los Angeles, California
| | - Nadia Chugal
- UCLA School of Dentistry, Section of Endodontics, Los Angeles, California.
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Elmatary A, Longridge N, Jarad F. IS EXTERNAL CERVICAL RESORPTION AN ESTABLISHED MANIFESTATION OF SYSTEMIC SCLEROSIS? A CASE REPORT. J Endod 2023:S0099-2399(23)00278-9. [PMID: 37211310 DOI: 10.1016/j.joen.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
AIM Scleroderma, or systemic sclerosis, is a multisystem autoimmune disorder characterized by hardening and fibrosis of the skin. To date, only a small number of case reports have established a relationship between scleroderma and external cervical resorption (ECR). The aim of this case report is to document the case of a patient with multiple external cervical resorption lesions, who was referred to our unit. SUMMARY A 54-year-old female patient, with a 10-year history of systemic sclerosis diagnosed by her rheumatologist, was referred to our unit regarding extensive ECR. A total of 14 maxillary and mandibular teeth with ECR were detected by clinical examination and cone-beam computed tomography (CBCT). The characteristic vascularity of resorptive defects with profuse bleeding upon probing was not evident. The patient declined any active treatment owing to the desire to avoid lengthy and unpredictable treatment, which may hasten the loss of her teeth. CONCLUSIONS General practitioners should be aware of the relationship between connective tissue disorders and ECR. Although not well established in the literature, the vascular changes implicated in scleroderma may stimulate the odontoclastic processes involved in ECR.
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Affiliation(s)
- Ahmed Elmatary
- Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS.
| | - Nicholas Longridge
- Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS
| | - Fadi Jarad
- Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS
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Pulp revascularization after autotransplantation of the mandibular canines with partially resected roots. Report of five cases with follow-ups between 26 and 80 months. J Endod 2023; 49:478-486. [PMID: 36934968 DOI: 10.1016/j.joen.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Transmigrated (migrated through the midline) mandibular canines constitute a treatment challenge. Advanced transmigration can be successfully treated by autotransplantation. In developing canines, pulp revascularisation is typical after transplantation. On the contrary, the pulp of teeth with completed apex formation does not undergo revascularization. In this case, root canal treatment becomes compulsory and decreases the success of autotransplantation. The aim of this observational retrospective study was to evaluate whether partial resection of the root (performed during the autotransplantation of mature canines) would enable revascularization of the pulp after the surgery. METHODS Five transmigrated mandibular canines with complete apex formation before the surgery were evaluated. During the autotransplantation surgery, the resection of 2-4 mm of the root apex was performed to open the path for revascularisation of the pulp after surgery. The transplanted teeth were observed during healing after the surgery for the presence of pulp obliteration. Clinical and radiographic examinations were performed. RESULTS All treated canines survived the minimum observation period of two years (ranging from 26 to 80 months, mean: 55 months) without pulp healing complications. The survival was 100 percent, and the success was 80 percent. In one canine, the external cervical root resorption was diagnosed and treated one year after the surgery. At the final examination, transplanted canines presented radiographic features of pulp obliteration, normal mobility, and healthy periodontal tissues. CONCLUSIONS The surgical protocol proved to be successful in promoting revascularization to maintain pulp vitality, in all cases. The outcomes confirm that autotransplantation, combined with the resection of the root, constitutes as a valid treatment for mature ectopic canines.
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External Cervical Resorption: Relationships Between Classification, Treatment, and One-Year Outcome with Evaluation of the Heithersay and Patel Classification Systems. J Endod 2023; 49:469-477. [PMID: 36931461 DOI: 10.1016/j.joen.2023.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/17/2023]
Abstract
INTRO The purpose of this study was to identify possible associations between classification, treatment, and one-year outcome of external cervical resorption (ECR) lesions using the Heithersay and Patel systems. Performance of the Patel 3-dimensional classification system was also evaluated. METHODS A chart review identified 142 cases of ECR over a twelve-year period. Information regarding demographics, predisposing factors, lesion classification, treatment, and outcomes were collected and analyzed. Inter- and intra-observer reliability analyses were conducted for both classification systems. RESULTS There were 72 cases with at least one year of follow up. 70% of these cases survived. Treatment recommendations were correlated with both Heithersay and Patel classification. There were no correlations found between one-year outcome and either classification or treatment done. The weighted reliability analysis showed substantial agreement in both classification systems for both inter- and intra-observer agreement. There was a significant association between the two systems, however the Heithersay system tended to underestimate the apical extent of the lesion. CONCLUSIONS Periodic review of ECR lesions presents as a viable treatment option, at least for one year after diagnosis. The Patel 3-D classification system is at least as effective as the Heithersay system and should be used in future ECR prognosis studies. Further long-term outcome assessments are still needed.
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Ricucci D, Milovidova I, Amantea M, Girone C, Rôças IN, Siqueira JF. Histologic features of external cervical resorption affecting impacted maxillary canines. Report of two cases. J Endod 2023:S0099-2399(23)00175-9. [PMID: 37001728 DOI: 10.1016/j.joen.2023.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
Reports on the histopathologic features of external cervical resorption (ECR) in unerupted teeth are scarce. This article reports on 2 maxillary impacted canines from different patients that showed ECR lesions and were surgically removed and histologically evaluated. Case 1 showed symptoms associated with oral communication of the dental follicle and pulpal exposure. Radiographs and cone-beam computed tomographic imaging showed that resorption affected a large part of the root and the crown. Case 2 was asymptomatic, and the resorption cavity was restricted to the tooth crown. Both teeth were extracted and subjected to histologic processing and analysis. In case number 1, the coronal pulp was necrotic and infected, showing areas of exposure to the resorption channels. The apical pulp was vital and uninflamed. The pulp space was surrounded by a continuous pericanalar resorption-resistant sheet. Part of the resorbed area of dentin was occupied by inflamed granulation tissue. More apically, a network of trabecular bone was present in the resorbed area. In case number 2, the pulp around the resorbed area was uninflamed and vital. A large fraction of the lost dentin was replaced by trabecular bone, closely adapted to the irregularly resorbed dentin surface, and no inflammatory cells. Our findings indicate that impacted teeth with ECR may remain asymptomatic until associated with infection. Histologic features of resorption in impacted teeth were similar to those in erupted teeth. In the case associated with infection, the resorbed area was occupied by inflamed tissue and newly formed bone. In the case with no infection, the resorption area was filled with bone undergoing a remodeling process.
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Prevalence and Characteristics of Root Resorption Identified in Cone-Beam Computed Tomography Scans. J Endod 2023; 49:144-154. [PMID: 36509167 DOI: 10.1016/j.joen.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Root resorption is a destructive process that compromises tooth structure and can result in tooth loss. Often it remains asymptomatic and is an incidental finding on radiographic examinations. The purpose of this study was to determine prevalence and characteristics of root resorption in patients referred for cone-beam computed tomography (CBCT) imaging for a variety of indications. METHODS The study included CBCT scans of 1086 consecutive patients referred for CBCT imaging over an 18-month period. A total of 1148 scans were acquired. Data were abstracted from radiology reports, and prevalence estimates of resorption were computed for the aggregate sample and also across specific indications. RESULTS Resorption was identified in 171 patients (15.7%, 95% CI: 13.6%-17.9%) and in 249 teeth with a prevalence range of 2.6%-92.3% across specific indications. An 18.7% of the patients had 2 resorption sites whereas 8.8% had 3 or more resorption sites. The majority of affected teeth were anteriors (43.8%), followed by molars (40.6%) and premolars (14.5%). The most prevalent resorption types were external (29.3%), cervical (22.5%), infection-induced apical resorption (13.7%), internal (9.6%), and impacted tooth induced (8.8%). The majority of teeth with resorption did not have prior endodontic treatment (73.9%) and had radiographically normal periapex (69.5%). Of 249 teeth with resorption, 31% presented as incidental finding. The prevalence of incidental findings of resorption increased with age, P < .05, and was significantly lower for anterior teeth (20.2%) as compared to premolars (41.7%) and molars (36.6%), (P < .05). CONCLUSION The high proportion of incidental findings of resorption detected by CBCT suggests that resorption is not recognized/detected by conventional radiography and therefore remains underdiagnosed.
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Suhr Villefrance J, Wenzel A, Kirkevang LL, Væth M, Christensen J, Matzen LH. Early detection of external cervical resorption in posterior teeth: a radiographic, cross-sectional study of an adolescent population. Dentomaxillofac Radiol 2023; 52:20220223. [PMID: 36331310 PMCID: PMC9974234 DOI: 10.1259/dmfr.20220223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To establish the prevalence and severity of external cervical resorption (ECR) in posterior teeth observed in bitewing (BW) radiographs in an epidemiological study of a 17-year-old patient population from community dentistry. Furthermore, to assess the potential predisposing factors for ECR. METHODS Posterior BWs from 5596 patients (2717 females, 2879 males; mean age 17.8 years) were assessed by three observers in order to detect ECR (using Heithersay's classification system, severity classes 1-4). When ECR was suspected, cone beam CT (CBCT) was offered to verify diagnosis. Prevalence was estimated based on ECR suspected in BWs and finally in CBCT. Possible predisposing factors (orthodontic treatment, trauma, and periodontal disease) were recorded and assessed for association with ECR. RESULTS In 41 patients, ECR was suspected in BWs (suspected prevalence 0.73%). 32 patients accepted CBCT examination, of which eight were verified to have ECR (final prevalence 0.18%). In 24 patients, other disease entities and abnormal tooth morphology, that had mimicked ECR in BWs, excluded ECR in CBCT. ECR severity ranged from class 1-3 in BW and 2-4 in CBCT. All but one case had not been diagnosed by the patient's community dentist. No statistically significant association between predisposing factors and ECR was identified. CONCLUSIONS ECR had low prevalence in this adolescent population, as observed in both BWs and CBCT. Still, early detection of ECR is important for treatment prognosis, and attention should be paid to this disease entity when assessing BWs obtained for other diagnostic purposes. CBCT may subsequently aid in verifying the disease.
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Affiliation(s)
- Julie Suhr Villefrance
- Section for Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Ann Wenzel
- Section for Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Lise-Lotte Kirkevang
- Section for Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Michael Væth
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Louise Hauge Matzen
- Section for Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Arıcan B, Sesen Uslu Y, Sarıalioğlu Güngör A. Resistance to fracture of simulated external cervical resorption cavities repaired with different materials. AUST ENDOD J 2022; 49:174-182. [PMID: 36354094 DOI: 10.1111/aej.12714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
The aim of the study was to evaluate the fracture resistance (FR) of teeth with simulated external cervical resorption (ECR) cavities repaired with different materials. Following the shaping of the 80 human permanent maxillary central incisors, standard ECR cavities were prepared and restored with a nanohybrid composite resin; a high viscosity GIC Equia Forte Fill; Biodentine; Biodentine + nanohybrid composite resin; MTA BIOREP; MTA BIOREP + nanohybrid composite resin. Then, the root canals were obturated with AH Plus and gutta-percha. The roots were embedded acrylic resin blocks and fracture strength test was applied. The highest FR was observed in the Biodentine group, while the lowest was in Equia group (p < 0.05). No significant results were observed among composite, Biodentine + composite, MTA BIOREP + composite and MTA BIOREP (p > 0.05). Biodentine may be a preferable material for repairing ECR cavities. Adding a composite layer on MTA BIOREP and Biodentine did not improve the FR of these materials.
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Affiliation(s)
- Burçin Arıcan
- Department of Endodontics, School of Dental MedicineBahçeşehir UniversityIstanbulTurkey
| | - Yesim Sesen Uslu
- Department of Restorative Dentistry, School of Dental MedicineBahçeşehir UniversityIstanbulTurkey
| | - Ayça Sarıalioğlu Güngör
- Department of Restorative Dentistry, Faculty of DentistryBezmialem Vakif UniversityIstanbulTurkey
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Qin W, Gao J, Ma S, Wang Y, Li DM, Jiang WK, Chen F, Tay F, Niu LN. Multiple Cervical Root Resorption Involving 22 Teeth: A Case with Potential Genetic Predisposition. J Endod 2022; 48:1526-1532. [DOI: 10.1016/j.joen.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/25/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
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29
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External Cervical Resorption: A Volumetric Analysis on Evolution of Defects Over Time. J Endod 2022; 49:36-44. [DOI: 10.1016/j.joen.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
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Patel S, Saberi N, Pimental T, Teng P. Present status and future directions: Root resorption. Int Endod J 2022; 55 Suppl 4:892-921. [PMID: 35229320 PMCID: PMC9790676 DOI: 10.1111/iej.13715] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 12/30/2022]
Abstract
Root resorption is the loss of dental hard tissue because of odontoclastic action. In permanent teeth, it is undesirable and pathological in nature. Root resorption may occur on the inner aspect of the root canal (internal root resorption) or on the outer aspect of the root (external root resorption). Regardless of its location, root resorption is irreversible, and may result in discomfort for the patient, requires management and/or, in some cases, results in the premature loss of the affected tooth. Root resorption is often challenging to accurately diagnose and manage. The aim of this narrative review is to present the relevant literature on the aetiology, pathogenesis, diagnosis and management, as well as discuss the future directions of diagnosis and management of root resorption.
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Affiliation(s)
- Shanon Patel
- Faculty of Dentistry, Oral & Craniofacial SciencesKing’s College LondonLondonUK,Specialist PracticeLondonUK
| | - Navid Saberi
- Faculty of Dentistry, Oral & Craniofacial SciencesKing’s College LondonLondonUK
| | - Tiago Pimental
- Faculty of Dentistry, Oral & Craniofacial SciencesKing’s College LondonLondonUK
| | - Peng‐Hui Teng
- Faculty of Dentistry, Oral & Craniofacial SciencesKing’s College LondonLondonUK
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Nosrat A, Yu P, Verma P, Dianat O, Wu D, Fouad AF. Was the Coronavirus Disease 2019 Pandemic Associated with an Increased Rate of Cracked Teeth? J Endod 2022; 48:1241-1247. [PMID: 35835260 PMCID: PMC9273286 DOI: 10.1016/j.joen.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION There is lack of data on whether the coronavirus disease 2019 (COVID-19) pandemic was associated with changes in the etiology of pathosis in endodontic patients. The aim of this study was to determine the rate of cracks and other etiologic factors during the period of March 16th to May 31st in 2020 (COVID-19 initial outbreak) and 2021 (COVID-19 ongoing pandemic) compared with figures from the same period in 2019 (pre-COVID era) in 2 endodontists' practices. METHODS The etiologies of patients' chief complaints were determined from records of 2440 teeth (740 in 2019, 651 in 2020, and 1049 in 2021). Changes in the proportion of etiologic factors among all 3 periods were analyzed. The association between the rate of cracked teeth and patients' age and sex was determined using a logistic regression model. RESULTS The rates of all etiologies collectively during the studied periods showed a significant change (P < .0001). The rate of cracks significantly increased in 2020 (11.8%) (P = .0001) and 2021 (8%) (P = .0018) compared with 2019 (4.3%). The rate of persistent infections decreased in 2020 (22.3%) (P = .0013) and then increased in 2021 (27.5%) (P = .0153) compared with 2019 (30%). Cracked teeth were associated with the age group of 40-60 years (odds ratio [OR] = 1.882; 95% confidence interval [CI], 1.063-3.330) in 2020 and with age ranges of 40-60 years (OR = 2.051; 95% CI, 1.120-3.759) and >60 years (OR = 2.038; 95% CI, 1.050-3.956) and male sex (OR = 1.599; 95% CI, 1.019-2.510) in 2021. CONCLUSIONS The rate of cracked teeth increased during the initial outbreak of the COVID-19 pandemic and 1 year later. This study provided evidence on the association between the COVID-19 pandemic and changes in the rate and presentation of endodontic etiologic factors.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland,Private Practice, Centreville Endodontics, Centreville, Virginia
| | - Peter Yu
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland,Private Practice, Centreville Endodontics, Centreville, Virginia,Private Practice, Capitol Endodontics, Washington, DC
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland,Private Practice, Centreville Endodontics, Centreville, Virginia
| | - Di Wu
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina,Division of Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
| | - Ashraf F. Fouad
- Department of Endodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, Alabama,Address requests for reprints to Dr Ashraf F. Fouad, Department of Endodontics, School of Dentistry, The University of Alabama at Birmingham, 1919 Seventh Avenue South, Room 610, Birmingham, AL 35294
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A. Ghazi RF, Khalifa FA. Sub-clinical Cervical Root Resorption: A Case Report. Cureus 2022; 14:e27334. [PMID: 36043004 PMCID: PMC9414160 DOI: 10.7759/cureus.27334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
External cervical resorption (ECR) is a dynamic pathological process characterized by its cervical position on the root and arises below the epithelial attachment and the coronal part of the bone. This report will highlight a case of ECR in an asymptomatic patient. A radiolucent area was noted during a routine dental follow-up examination on the bitewings at the mesial surface of the upper right second premolar. Persistently, the radiolucency had multiple radiographic views indicating a true form of a lesion that could be diagnosed as external cervical resorption. The patient did not report any complaints since dental treatment was completed in 2016. After a series of radiographs and conducting further diagnostic measures, a diagnosis of ECR was confirmed. The best treatment of choice for this case was extraction and restoring the missing tooth with an implant-supported crown. The size and the extent of such a defect could affect the strategy for implant placement. This paper aimed to report that ECR can be asymptomatic for a long time with advanced cervical root resorption in some cases.
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Recent Progress on the Applications of Nanomaterials and Nano-Characterization Techniques in Endodontics: A Review. MATERIALS 2022; 15:ma15155109. [PMID: 35897542 PMCID: PMC9331596 DOI: 10.3390/ma15155109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 02/06/2023]
Abstract
The impact of nano-based technologies in endodontics for the identification and treatment of various dental infections is showing fast progress. Studies show that nanoparticles could serve as useful agents with many beneficial results and continue to be promising in the field of endodontics. To ensure progress and improvements on novel nanomaterials in relation to their physicochemical and biological properties, nano-identification methods for the detection and evaluation of diseases need to be further highlighted. This study aims to review the current technological progress and recent research outcomes as well as possible prospective applications of nano-based technologies in endodontics. A comprehensive literature survey has been carried out on the utilizations of nanomaterials and nano-characterization techniques in endodontics. The current status and recent applications in endodontics are discussed with illustrative examples. The results have shown that the progress and improved accuracy of nano-identification techniques enabled a better characterization, evaluation and selection of appropriate treatment plans for endodontics-related diseases. The results have been inspiring for further clinical investigations. Nano-endodontics is still a developing field with a strong potential for revolutions of novel materials and techniques in the diagnosis and treatment of dental diseases. Further improvements in nanoparticles properties will pave the way for the development of many beneficial endodontic therapeutic agents. The future looks encouraging for sustainable products and testing methods for clinical endodontic applications.
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Richert R, Santamaria J, Laforest L, Maurin JC. The Medical, Clinical, and Radiographic Aspects of Multiple Idiopathic Tooth Resorption: A Systematic Review. J Pers Med 2022; 12:jpm12071182. [PMID: 35887679 PMCID: PMC9318505 DOI: 10.3390/jpm12071182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Many causes of resorption remain unclear and are thus identified as idiopathic. In such cases, management is difficult, especially when multiple teeth are involved. The aim of the present study was to assess the literature regarding the medical, clinical, and radiographic aspects of multiple idiopathic resorptions (MIR) and to examine the factors associated with the risk of extraction. Methods: The title and protocol were registered a priori in PROSPERO (CRD42020191564), and the study followed the PRISMA methodology. Four electronic databases were searched to include reviews and case reports on MIR in permanent dentition. Results: Among the 1035 articles identified, 31 case reports were included. The mean age of the patients was 32 years (SD = 16.4). MIR were consistently diagnosed after radiographic evaluation and were undetected during intra-oral examination in 62% of cases. The treatment involved extraction in 77% of cases. The risk of extraction increased in the presence of periodontal inflammation. Conclusions: MIR are aggressive forms of resorption requiring routine visits. MIR mostly involve extraction and lead to a challenging prosthetic rehabilitation due to severely damaged abutment teeth. However, the current knowledge on MIR remains fragmental and based on a limited number of case reports.
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Affiliation(s)
- Raphaël Richert
- Hospices Civils de Lyon, PAM d’Odontologie, 69007 Lyon, France; (J.S.); (J.-C.M.)
- UFR d’Odontogie, Université Claude Bernard Lyon I, Université de Lyon, 69008 Lyon, France;
- Laboratoire de Mécanique des Contacts et Structures, UMR 5259 CNRS/INSA Lyon\Université de Lyon, 69100 Villeurbanne, France
- Correspondence:
| | - Julie Santamaria
- Hospices Civils de Lyon, PAM d’Odontologie, 69007 Lyon, France; (J.S.); (J.-C.M.)
| | - Laurent Laforest
- UFR d’Odontogie, Université Claude Bernard Lyon I, Université de Lyon, 69008 Lyon, France;
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615/UCBL, 69622 Villeurbanne, France
| | - Jean-Christophe Maurin
- Hospices Civils de Lyon, PAM d’Odontologie, 69007 Lyon, France; (J.S.); (J.-C.M.)
- UFR d’Odontogie, Université Claude Bernard Lyon I, Université de Lyon, 69008 Lyon, France;
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS\Université Claude Bernard Lyon 1, 69008 Lyon, France
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Management of External Inflammatory Root Resorption following Tooth Autotransplantation Using a Modified Combination of Triple Antibiotics. Case Rep Dent 2022; 2022:5178339. [PMID: 35754759 PMCID: PMC9217544 DOI: 10.1155/2022/5178339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/27/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022] Open
Abstract
External inflammatory root resorption (EIRR) is one of the most undesirable potential repercussions of various types of trauma and traumatic injuries to the tooth and its structure. This detrimental phenomenon may lead to severe complications, the consequent destruction of dental tissues, and eventual tooth loss. In the presented case, following the autogenous transplantation of tooth #17 as the host-tissue replacement for tooth #18, signs of EIRR were radiographically detected after 6 months. However, the thorough preparation of root canals, which involves complete cleaning and shaping, in addition to the application of a modified combination of triple antibiotics, consisting of penicillin G, metronidazole, and ciprofloxacin (PMC), managed to arrest EIRR. Moreover, the obturation of root canals using calcium-enriched mixture (CEM) cement as the endodontic biomaterial as well as the proper management of EIRR resulted in the healing of periradicular pathosis, abatement of clinical symptoms, and finally refunctionalisation of the tooth during a follow-up period of 2 years. It seems that the appropriate disinfection of the root canal system using PMC next to the prevention of microbial recontamination using CEM cement can perfectly manage EIRR.
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Abbott PV, Lin S. Tooth resorption-Part 2: A clinical classification. Dent Traumatol 2022; 38:267-285. [PMID: 35605161 PMCID: PMC9543863 DOI: 10.1111/edt.12762] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
Tooth resorption is either a physiological or a pathological process resulting in loss of dentin and/or cementum. It may also be associated with bone loss. Currently there is no universal classification for the different types of tooth resorption. This lack of a universal classification leads to both confusion amongst practitioners and poor understanding of the resorptive processes occurring in teeth which can result in incorrect/inappropriate diagnoses and mis‐management. When developing a classification of diseases and/or conditions that occur within the body, several criteria should be followed to ensure a useful classification. The classification should not only include pathological conditions but also physiological conditions. Since tooth resorption can be either pathological or physiological, a classification of tooth resorption should include both of these categories. Any classification of diseases should be possible to use clinically, meaningful, useful, clear and universal. It should enable easy storage, retrieval and analysis of health information for evidenced‐based decision‐making. It should also be possible to share and compare data and information between different institutions, settings and countries. A classification of tooth resorption should be developed by combining anatomical, physiological and pathological approaches. For some types of resorption, the aetiological approach should also be incorporated. A classification of tooth resorption that uses simple, relevant and appropriate terminology based on the nature and location of the resorptive process occurring in teeth is proposed. There are two broad categories of internal and external tooth resorption which are sub‐divided into three types of internal tooth resorption (surface, inflammatory, replacement) and eight types of external tooth resorption (surface, inflammatory, replacement, invasive, pressure, orthodontic, physiological, idiopathic). The clinician's understanding, diagnosis and management of tooth resorption can be facilitated by using this simple classification which should ideally be used universally by the entire dental profession to ensure clarity and to avoid confusion.
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Affiliation(s)
- Paul V Abbott
- UWA Dental School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Shaul Lin
- Department of Endodontic and Dental Trauma, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,The Israeli National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Canter, Tel Hashomer, Israel
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Mikušková K, Vaňuga P, Adamicová K, Statelová D, Janíčková M, Malachovský I, Siebert T. Multiple idiopathic external cervical root resorption in patient treated continuously with denosumab: a case report. BMC Oral Health 2022; 22:129. [PMID: 35428235 PMCID: PMC9013172 DOI: 10.1186/s12903-022-02165-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/06/2022] [Indexed: 01/27/2023] Open
Abstract
Abstract
Background
External root resorption is an irreversible loss of dental hard tissue as a result of odontoclastic action. Multiple external cervical root resorptions in permanent teeth are rare. The exact cause of external cervical root resorption is unclear. It is currently well established that RANK/RANKL signaling is essential for osteoclastogenesis and osteoclast-mediated bone resorption. Denosumab is an anti-RANKL antibody used for the treatment of postmenopausal osteoporosis. RANK/RANKL pathway suppression by denosumab is expected to suppress the activity of clastic cells responsible for hard tissue resorption involving both osteoclasts and odontoclasts.
Case presentation
This case report demonstrates aggressive and generalized idiopathic external cervical root resorption that started and advanced during ongoing antiresorptive therapy with the human monoclonal RANKL-blocking antibody denosumab without discontinuation of therapy in a 74-year-old female patient treated for postmenopausal osteoporosis. The extent of resorptive defects was too large and progressively led to fractures of the teeth. The number of teeth involved and the extend of destruction excluded conservative treatment. The affected teeth had to be extracted for functional prosthetic reconstruction.
Conclusions
This finding suggests that treatment with denosumab may be associated with severe and aggressive odontoclastic resorption of multiple dental roots despite an adequate inhibitory effect on osteoclasts in the treatment of osteoporosis. The RANKL-independent pathways of clastic cell formation are likely to be involved in this pathological process.
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Irinakis E, Haapasalo M, Shen Y, Aleksejuniene J. External cervical resorption - Treatment outcomes and determinants: a retrospective cohort study with up to 10 years of follow-up. Int Endod J 2022; 55:441-452. [PMID: 35243651 DOI: 10.1111/iej.13717] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
AIM To assess long-term external cervical resorption (ECR) treatment outcomes in relation to both local and treatment-related determinants. METHODOLOGY Information was available for 76 patients (98 teeth) who were diagnosed with ECR during the period from 2008 to 2018 at the University of British Columbia graduate endodontics clinic. The ECR patients were followed-up, and a clinical and radiographic examination was conducted. Chi-Square test compared failure rates among different subgroups. The survival analysis was used to evaluate the overall ECR survival/failure rates in relation to several local and treatment-related determinants. RESULTS Overall, 67 patients (89 teeth) were followed-up. The mean follow-up time was 3.9 years, and the minimum was 1 year. Twenty-four teeth failed (19 extracted, 5 not functional), and the overall probability of failure was 50.0% 8 years after the diagnosis. Significant (p < 0.05) local ECR determinants were tooth location and the Heithersay classification, and treatment-related determinants were root canal treatment (RCT) and the ECR repair combined with RCT. Treatment outcomes for Heithersay class 1 and 2 cases were better than for class 3 and 4 cases. CONCLUSIONS Higher failure rates were associated with posterior tooth location and higher Heithersay class, while RCT and ECR repair combined with RCT were associated with lower failure rates.
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Affiliation(s)
- E Irinakis
- Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, Canada
| | - M Haapasalo
- Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, Canada
| | - Y Shen
- Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, Canada
| | - J Aleksejuniene
- Department of Oral Health Sciences Faculty of Dentistry, The University of British Columbia, Vancouver, Canada
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Suhr Villefrance J, Kirkevang LL, Wenzel A, Væth M, Matzen LH. Impact of cone beam CT on diagnosis of external cervical resorption: the severity of resorption assessed in periapical radiographs and cone beam CT. A prospective clinical study. Dentomaxillofac Radiol 2022; 51:20210279. [PMID: 34520244 PMCID: PMC8802697 DOI: 10.1259/dmfr.20210279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To compare the severity of external cervical resorption (ECR) observed in periapical (PA) images and cone beam CT (CBCT) using the Heithersay classification system and pulp involvement; and to assess inter- and intraobserver reproducibility for three observers. METHODS CBCT examination was performed in 245 teeth (in 190 patients, mean age 40 years, range 12-82) with ECR diagnosed in PA images. Three observers scored the severity of ECR using the Heithersay classification system (severity class 1-4) and pulp involvement (yes/no) in both PA images and CBCT. Percentage concordance and κ-statistics described observer variation in PA images and CBCT for both inter- and intraobserver reproducibility. RESULTS For all three observers, the ECR score was the same in the two modalities in more than half of cases (average 59%; obs1: 54%, obs2: 63%, obs3: 61%). However, in 38% (obs1: 44%, obs2: 33%, obs3: 36%) of the cases, the observers scored more severe ECR in CBCT than in PA images (p < 0.001). The ECR score changed to a less severe score in CBCT only in 3% (obs1: 1%, obs2: 4%, obs3: 4%). For pulp involvement, 14% (obs1: 7%, obs2: 20%, obs3: 15%) of the cases changed from "no" in PA images to "yes" in CBCT. In general, κ values were higher for CBCT than for PA images for both the Heithersay classification score and pulp involvement. CONCLUSIONS ECR was generally scored as more severe in CBCT than PA images using the Heithersay classification and also more cases had pulp involvement in CBCT.
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Affiliation(s)
- Julie Suhr Villefrance
- Section for Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Lise-Lotte Kirkevang
- Section for Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Ann Wenzel
- Section for Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Michael Væth
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Louise Hauge Matzen
- Section for Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Ferreira MD, Barros-Costa M, Costa FF, Freitas DQ. The prevalence and characteristics of external cervical resorption based on cone-beam computed tomographic imaging: a cross-sectional study. Restor Dent Endod 2022; 47:e39. [DOI: 10.5395/rde.2022.47.e39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Matheus Diniz Ferreira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Matheus Barros-Costa
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Felipe Ferreira Costa
- Department of Oral Diagnosis, São Paulo Dental School, University of São Paulo (USP), São Paulo, Brazil
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
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Talpos-Niculescu RM, Nica LM, Popa M, Talpos-Niculescu S, Rusu LC. External cervical resorption: Radiological diagnosis and literature (Review). Exp Ther Med 2021; 22:1065. [PMID: 34434279 PMCID: PMC8353645 DOI: 10.3892/etm.2021.10499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/30/2021] [Indexed: 01/28/2023] Open
Abstract
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).
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Affiliation(s)
- Roxana-Maria Talpos-Niculescu
- Third Department, Discipline of Restorative Dentistry and Endodontics, Research Center TADERP, Faculty of Dental Medicine, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300070 Timisoara, Romania
| | - Luminita-Maria Nica
- Third Department, Discipline of Restorative Dentistry and Endodontics, Research Center TADERP, Faculty of Dental Medicine, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300070 Timisoara, Romania
| | - Malina Popa
- Second Department, Discipline of Pedodontics, Pediatric Dentistry Research Center, Faculty of Dental Medicine, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300070 Timisoara, Romania
| | - Serban Talpos-Niculescu
- Second Department, Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, 'Victor Babes' University of Medicine and Pharmacy, 300062 Timisoara, Romania
| | - Laura Cristina Rusu
- First Department, Discipline of Oral Pathology, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, Faculty of Dental Medicine, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300174 Timisoara, Romania
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Munenaga S, Usuda M, Ouhara K, Maetani Y, Kajiya M, Matsuda S, Furusho H, Miyauchi M, Nakamori M, Maruyama H, Nishi H, Kawaguchi H. External cervical resorption detected via cone-beam computed tomography in a patient with myelin oligodendrocyte glycoprotein antibody-associated disease: A case report. Clin Case Rep 2021; 9:e04415. [PMID: 34257981 PMCID: PMC8259924 DOI: 10.1002/ccr3.4415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/01/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
External cervical resorption may occur in patients with MOG antibody-associated disease, which is clearly detected on cone-beam computed tomography. Therefore, dental screening is essential for these patients before initiating bisphosphonate therapy. Larger sample sizes are crucial to determine any possible association between external cervical resorption and MOG antibody-associated disease.
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Affiliation(s)
- Syuichi Munenaga
- Department of General DentistryHiroshima University HospitalHiroshimaJapan
| | - Momoko Usuda
- Department of General DentistryHiroshima University HospitalHiroshimaJapan
| | - Kazuhisa Ouhara
- Department of Periodontal MedicineGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Yuta Maetani
- Department of Clinical Neuroscience and TherapeuticsGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Mikihito Kajiya
- Department of Periodontal MedicineGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Shinji Matsuda
- Department of Periodontal MedicineGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hisako Furusho
- Department of Oral and Maxillofacial PathobiologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial PathobiologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Masahiro Nakamori
- Department of Clinical Neuroscience and TherapeuticsGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and TherapeuticsGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hiromi Nishi
- Department of General DentistryHiroshima University HospitalHiroshimaJapan
| | - Hiroyuki Kawaguchi
- Department of General DentistryHiroshima University HospitalHiroshimaJapan
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Chen Y, Huang Y, Deng X. External cervical resorption-a review of pathogenesis and potential predisposing factors. Int J Oral Sci 2021; 13:19. [PMID: 34112752 PMCID: PMC8192751 DOI: 10.1038/s41368-021-00121-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/15/2021] [Accepted: 03/05/2021] [Indexed: 12/22/2022] Open
Abstract
External cervical resorption (ECR) refers to a pathological state in which resorption tissues penetrate into the dentin at the cervical aspect of the root. Despite being latent in its initial phase, ECR could cause severe damage to mineralized dental tissue and even involve the pulp if not given timely diagnosis and treatment. Nevertheless, the etiology of ECR is still poorly understood, which adds to the difficulty in early diagnosis. ECR has received growing attention in recent years due to the increasing number of clinical cases. Several potential predisposing factors have been recognized in cross-sectional studies as well as case reports. In the meantime, studies on histopathology and pathogenesis have shed light on possible mechanisms of ECR. This review aims to summarize the latest findings in the pathogenesis and potential predisposing factors of ECR, so as to provide pragmatic reference for clinical practice.
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Affiliation(s)
- Yiming Chen
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Ying Huang
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China.
| | - Xuliang Deng
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China.
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KOŞAR T, GÜNAÇAR DN, KÖSE T. Three-Dimensional Volumetric/ Linear Analysis and Axial Classification of Root Resorptions Using Cone Beam Computed Tomography: A Retrospective Study. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.890067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Galler KM, Grätz EM, Widbiller M, Buchalla W, Knüttel H. Pathophysiological mechanisms of root resorption after dental trauma: a systematic scoping review. BMC Oral Health 2021; 21:163. [PMID: 33771147 PMCID: PMC7995728 DOI: 10.1186/s12903-021-01510-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background The objective of this scoping review was to systematically explore the current knowledge of cellular and molecular processes that drive and control trauma-associated root resorption, to identify research gaps and to provide a basis for improved prevention and therapy. Methods Four major bibliographic databases were searched according to the research question up to February 2021 and supplemented manually. Reports on physiologic, histologic, anatomic and clinical aspects of root resorption following dental trauma were included. Duplicates were removed, the collected material was screened by title/abstract and assessed for eligibility based on the full text. Relevant aspects were extracted, organized and summarized. Results 846 papers were identified as relevant for a qualitative summary. Consideration of pathophysiological mechanisms concerning trauma-related root resorption in the literature is sparse. Whereas some forms of resorption have been explored thoroughly, the etiology of others, particularly invasive cervical resorption, is still under debate, resulting in inadequate diagnostics and heterogeneous clinical recommendations. Effective therapies for progressive replacement resorptions have not been established. Whereas the discovery of the RANKL/RANK/OPG system is essential to our understanding of resorptive processes, many questions regarding the functional regulation of osteo-/odontoclasts remain unanswered. Conclusions This scoping review provides an overview of existing evidence, but also identifies knowledge gaps that need to be addressed by continued laboratory and clinical research. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01510-6.
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Affiliation(s)
- Kerstin M Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Germany.
| | - Eva-Maria Grätz
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Germany
| | - Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Germany
| | - Wolfgang Buchalla
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, Regensburg, Germany
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Chen Y, Huang Y, Deng X. A Review of External Cervical Resorption. J Endod 2021; 47:883-894. [PMID: 33745945 DOI: 10.1016/j.joen.2021.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/21/2022]
Abstract
External cervical resorption (ECR) is a relatively uncommon yet aggressive form of dental hard tissue destruction. It is initiated at the cervical aspect of the root surface and extends apicocoronally and circumferentially inside the dentin. Despite the large number of case reports and clinical studies that have investigated ECR, its etiology remains unclear. Recent advancements in clinical assessment measures, such as the use of cone-beam computed tomographic imaging, have provided additional insights into the nature of this lesion. This has facilitated the continued development and improvement of treatment methods for this condition. In this article, we provide an overview of the latest research pertaining to the etiology, histopathology, predisposing factors, diagnosis, classification, and treatment of ECR. Furthermore, we provide a summary of the different classification schemes for ECR and highlight the relevant therapeutic principles.
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Affiliation(s)
- Yiming Chen
- Department of Geriatric Dentistry, National Medical Products Administration Key Laboratory for Dental Materials, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Laboratory of Biomedical Materials, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ying Huang
- Department of Geriatric Dentistry, National Medical Products Administration Key Laboratory for Dental Materials, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Laboratory of Biomedical Materials, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Xuliang Deng
- Department of Geriatric Dentistry, National Medical Products Administration Key Laboratory for Dental Materials, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Laboratory of Biomedical Materials, Peking University School and Hospital of Stomatology, Beijing, China.
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47
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Chu EY, Deeb JG, Foster BL, Hajishengallis E, Somerman MJ, Thumbigere-Math V. Multiple Idiopathic Cervical Root Resorption: A Challenge for a Transdisciplinary Medical-Dental Team. FRONTIERS IN DENTAL MEDICINE 2021; 2:652605. [PMID: 34368800 PMCID: PMC8340576 DOI: 10.3389/fdmed.2021.652605] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The goal of this perspective article is to use multiple idiopathic cervical root resorption (MICRR) as a model to demonstrate the need for transdisciplinary collaborations, from basic science to treatment planning, to improve the quality of health care for all. This is not a review of the literature on the current state of MICRR. Tooth root resorption is a normal physiological process required for resorption and exfoliation of primary teeth; however, root resorption of adult teeth is largely pathological. MICRR is an aggressive form of external root resorption, which occurs near the cemento-enamel junction (CEJ). The cause of MICRR remains elusive, however, it is mediated primarily by osteoclasts/odontoclasts. Accumulating case studies and experiments in animal models have provided insights into defining the etiologies and pathophysiological mechanisms for MICRR, which include: systemic conditions and syndromes, inherited genetic variants affecting osteoclast/odontoclast activity, altered periodontal structures, drug-induced root resorption and rebound effects after cessation of anti-resorptive treatment, chemotherapy, exposure to pets or viral infections, and other factors such as inflammatory conditions or trauma. To determine the causative factors for MICRR, as well as other oral-dental conditions, at minimum, a comprehensive health history should be collected for all patients by dental care providers, discussed with other health care providers and appropriate collaborations established. The examples highlighted in this perspective emphasize the need for transdisciplinary research collaborations coupled with integrated management strategies between medicine and dentistry in order to identify cause(s) early and improve clinical outcomes.
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Affiliation(s)
- Emily Y. Chu
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA, United States
| | - Brian L. Foster
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, United States
| | - Evlambia Hajishengallis
- Divisions of Pediatric Dentistry, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Martha J. Somerman
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Vivek Thumbigere-Math
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
- Division of Periodontics, University of Maryland School of Dentistry, Baltimore, MD, United States
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Irinakis E, Aleksejuniene J, Shen Y, Haapasalo M. External Cervical Resorption: A Retrospective Case-Control Study. J Endod 2020; 46:1420-1427. [DOI: 10.1016/j.joen.2020.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/14/2020] [Accepted: 05/30/2020] [Indexed: 02/07/2023]
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49
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Matny LE, Ruparel NB, Levin MD, Noujeim M, Diogenes A. A Volumetric Assessment of External Cervical Resorption Cases and Its Correlation to Classification, Treatment Planning, and Expected Prognosis. J Endod 2020; 46:1052-1058. [DOI: 10.1016/j.joen.2020.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/11/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022]
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50
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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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