Mineral trioxide aggregate in the treatment of external invasive resorption: a case report

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

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

An unusual case of invasive cervical resorption after piezosurgery-assisted en masse retraction

A 16-year-old patient sought orthodontic correction for profile improvement and labially inclined maxillary incisors. She had Class II malocclusion, protrusive maxillary and mandibular incisors, and increased overjet and overbite with an American Board of Orthodontics discrepancy index value of 25. She was treated with maxillary premolar extractions and miniscrew-supported en masse retraction assisted with piezoincisions. Extraction spaces (7.5 mm per side) were closed with maximum anchorage in 10 months. Total treatment time was 23 months. Twenty-seven months after debonding, a pink spot was noted at the buccocervial region of the left central incisor. Radiographic evaluation on cone-beam computed tomographic scans revealed a severe case of invasive cervical resorption on both central incisors, around which the piezosurgical cuts had been made. Treatment proceeded with a nonintervention approach and the affected teeth were reinforced with a lingual retainer.

Portland cement use in dental root perforations: a long term followup

Root canal and furcal perforations are causes of endodontic therapy failure and different materials that stimulate tissue mineralization have been proposed for perforation treatment. In the first case, a patient presented tooth 46 with unsatisfactory endodontic treatment and a periapical radiographic lesion. A radiolucent area compatible with a perforating internal resorption cavity was found in the mesial root. The granulation tissue was removed, and root canals were prepared. The intracanal medication was composed of calcium hydroxide and the perforation cavity was filled with Portland cement. The 11-year followup showed radiographic repair of the tissue adjacent to the perforation and absence of clinical signs and symptoms or periapical lesion. In the second case, a patient presented with edema on the buccal surface of tooth 46. The examination showed a radiolucent area in the furcation region compatible with an iatrogenic perforation cavity. The mesial root canals were calcified, and only the distal root canal was prepared. The cavity was filled with a calcium hydroxide-based paste and the distal root canal was obturated. In sequence, the perforation cavity was filled with Portland cement. The 9-year followup showed the tooth in masticatory function with radiographic and clinical aspects compatible with normality.

Invasive cervical resorption: etiology, diagnosis, classification and treatment

BACKGROUND

Invasive cervical resorption (ICR) is not well understood by the professional, being misdiagnosed, leading to inappropriate treatment and unnecessary loss of tooth.

INTRODUCTION

ICR is defined as a localized process of resorption, which begins in the cervical area of the tooth, just below the epithelial junction and above the ridge crest in the area of the connective tissue insertion. Possible predisposing factors include external trauma, orthodontic movement, surgical procedures, periodontal disease and its treatments, endogenous bleaching, pressure generated by wind instruments and herpes virus infection. Different approaches have been suggested for the treatment of ICR, depending on the extent of the lesion and its location. However, in some cases due to the severity of the injury, there is no alternative but to tooth extraction, followed by restoration of the edentulous area.

AIM AND OBJECTIVE

Discuss etiology, diagnosis and classification of the ICR, as well as different treatment options. Also is presented a case in which extraction was carried out, installation of the implant and ceramic crown, subsequent to a treatment approach that resulted in failure in the short-term period.

CONCLUSION

Early diagnosis of the ICR is critical to proper treatment and favorable prognosis. Interdisciplinary treatment should be instituted as soon as possible, avoiding the loss of the affected tooth. In advanced cases, treatment involving the installation of osseointegrated implants should be considered the first choice of treatment.

CLINICAL SIGNIFICANCE

Early diagnosis of the ICR is critical do prevent unnecessary tooth loss, once the prognosis for advanced cases is doubtful.

Internal and external resorption in a lower molar with an associated endodontic-periodontic lesion: a case report

This article describes a unique case in which both internal and external inflammatory resorption and endodontic-periodontic lesions were present at the same time in the patient's left mandibular first molar. Based on clinical and radiographic findings, it was determined that the nature of this case was a pulpal infection-induced inflammatory resorption and furcation lesion. After root canal therapy, the furcation lesion and external inflammatory resorption were completely resolved. This case indicates that the correct diagnosis of the stimulating factor for tooth resorption and determination of the primary origin of endodontic-periodontic lesions are critical for clinical management and success.

Treatment of invasive cervical resorption with sandwich technique using mineral trioxide aggregate: a case report

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

Treatment of open apex teeth using two types of white mineral trioxide aggregate after initial dressing with calcium hydroxide in children

BACKGROUND

The clinical and radiographic success of two types of white mineral trioxide aggregate (MTA) as apical barriers in non-vital immature permanent incisors in children was investigated.

MATERIALS AND METHODS

Following an initial dressing with calcium hydroxide, MTA apical barriers were placed in 22 non-vital traumatized, permanent incisors with open apices in 21 children (mean age 10years). Teeth were alternately assigned to either white MTA ProRoot(®) or white MTA Angelus groups and treated by two operators. Clinical and radiographic reviews took place at baseline, 3 months and every 6months thereafter. Two other calibrated, blinded examiners evaluated all radiographs. Examiner agreement was assessed using Kappa-Cohen tests. Results were analysed using Fisher's exact tests and repeated measures anova.

RESULTS

The mean follow-up time was 23.4months. There were no statistically significant differences in clinical or radiographic outcomes between the two groups. The overall clinical success and relative radiographic success rate was 95.5%. Statistically significant reduction in periapical pathosis was shown over time in both groups (P<0.05). A significant relationship was identified between non-divergent apical anatomy and ideal positioning of the MTA plug in all teeth (P=0.04). Interestingly, coronal discolouration was observed in 22.7% of teeth following white MTA placement.

CONCLUSIONS

Apical barrier placement using both white MTA ProRoot(®) and white MTA Angelus after an initial calcium hydroxide dressing showed similar favourable clinical and radiographic outcomes.

Surgical repair of external inflammatory root resorption with resin-modified glass ionomer cement

External inflammatory root resorption after luxation injury is a frequent complication. This article describes a case of extensive external root resorption in the middle third of the root of a maxillary right incisor. Root canal treatment was performed followed by surgical intervention. The resorptive defect was debrided and part of the root was repaired with resin-modified glass ionomer cement. Postoperative follow-up revealed complete healing.

Ex vivo assessment of genotoxicity and cytotoxicity in murine fibroblasts exposed to white MTA or white Portland cement with 15% bismuth oxide

AIMS

To evaluate whether white mineral trioxide aggregate (MTA) or white Portland cement with 15% bismuth oxide were able to induce genetic damage and cellular death ex vivo.

METHODOLOGY

Aliquots of 1 × 10(4) murine fibroblasts were incubated at 37 °C for 3 h with MTA (white) or white Portland cement with 15% bismuth oxide, at final concentrations ranging from 10 to 1000 μg mL(-1) individually. Data of three independent repeats from the comet assay and the trypan blue exclusion test were assessed by the one-way anova followed by Tukey's test.

RESULTS

Mineral trioxide aggregate or Portland cement containing bismuth oxide did not produce genotoxic effects with respect to the single-cell gel (comet) assay data for all concentrations evaluated. Furthermore, no cytotoxicity was observed for MTA or Portland cement.

CONCLUSION

White MTA or white Portland cement containing 15% bismuth oxide were not genotoxic and cytotoxic.