Treatment of aggressive external root resorption with calcium hydroxide medicaments: a case report

Tooth root resorption: A review

Tooth root resorption is multifactorial, leading to progressive destruction and eventual loss of tooth root dentin and cement. There are internal and external types of root resorption, each having its variety. The etiology and pathogenesis of tooth root resorption are poorly understood, and the most significant etiological factors are trauma, pulpal infection, tooth bleaching, and orthodontic treatment. Tooth root resorption is primarily asymptomatic; thus, it is revealed accidentally by radiographic examination. Progressive clinical manifestations are pain, tooth discoloration, tooth mobility, and other conditions. Awareness of the causes and risk factors allowing tooth root resorption, and regular radiographic examination, in case of necessity, make it possible to reveal resorption at an early stage and to prevent its further development. Thus, the aim of this study is to present etiopathogenesis, a clinical course, and diagnostic peculiarities of internal and external types of tooth root resorption, enabling practicing dentists to timely diagnose root resorption and take appropriate measures to avoid further complications. Within the limitation of this review, even though the etiopathogenesis of tooth root resorption is yet not fully understood, it is suggested that the etiological factors fall into two groups (endogenic and exogenic) to enhance further understanding of the possible causes and mechanisms of root resorption and allow practitioners to monitor high-risk patients and make timely diagnoses. Moreover, radiographic examination and CBCT are indispensable for the diagnosis of root resorption.

Apexification: A systematic review

Pulpal necrosis in permanent teeth that have not completed their root development leads to teeth with a very short root, roots with very thin walls, and an inadequate crown-root ratio, which overshadows their survival prognosis. Currently, there are various therapies to treat immature permanent teeth with pulpal pathology such as the case of apexification. An electronic search was performed in the PubMed database (www.ncbi.nlm.nih.gov), Scopus (www.scopus.com), Cochrane (www.cochrane.org) to identify the clinical investigations related to evolution of the cases. The search of the literature of clinical studies on permanent teeth with open apex that present pulpar pathology and that need treatment, have been found 11 clinical studies of treatments with apexification. The apexification by calcium hydroxide has been applied for many years back to the present as a valid therapy to perform the treatment of apexification.

Management of an Intruded Tooth and Adjacent Tooth Showing External Resorption as a Late Complication of Dental Injury: Three-Year Follow-Up

Treatment and prognosis of intrusive luxation can vary depending on the age of the patient, type of dentition, stage of root development, and time and severity of the trauma. Some studies have demonstrated that intrusions of up to 3.0 mm have an excellent prognosis, whereas teeth with severe intrusion or teeth that are intruded more than 6.0 mm present an unfavorable prognosis because of the occurrence of inflammatory resorption and pulp necrosis. The aim of this case report is to present an 11-year-old male patient with complete intrusion of the permanent maxillary left lateral incisor, associated with the adjacent central tooth presenting external resorption, treated by immediate surgical repositioning and root canal treatment with a favorable prognosis. After long-term (3-year) clinical and radiographic follow-up, the teeth appeared normal and the patient was pleased with the outcome.

Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth

The regeneration of immature permanent teeth following trauma could be beneficial to reduce the risk of fracture and loss of millions of teeth each year. Regenerative endodontic procedures include revascularization, partial pulpotomy, and apexogenesis. Several case reports give these procedures a good prognosis as an alternative to apexification. Care is needed to deliver regenerative endodontic procedures that maintain or restore the vitality of teeth, but which also disinfect and remove necrotic tissues. Regeneration can be accomplished through the activity of the cells from the pulp, periodontium, vascular, and immune system. Most therapies use the host's own pulp or vascular cells for regeneration, but other types of dental stem cell therapies are under development. There are no standardized treatment protocols for endodontic regeneration. The purpose of this article is to review the recent literature and suggest guidelines for using regenerative endodontic procedures for the treatment of permanent immature traumatized teeth. Recommendations for the selection of regenerative and conventional procedures based on the type of tooth injury, fracture type, presence of necrosis or infection, periodontal status, presence of periapical lesions, stage of tooth development, vitality status, patient age, and patient health status will be reviewed. Because of the lack of long-term evidence to support the use of regenerative endodontic procedures in traumatized teeth with open apices, revascularization regeneration procedures should only be attempted if the tooth is not suitable for root canal obturation, and after apexogenesis, apexification, or partial pulpotomy treatments have already been attempted and have a poor prognosis.