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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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Prathap MS, Prathap S. An Interdisciplinary Approach for Management of Trauma-induced External Root Resorption: A Case Report with a Two-Year Follow-up. JOURNAL OF ADVANCED ORAL RESEARCH 2020. [DOI: 10.1177/2320206820934634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Root resorption is largely pathologic and known to be initiated by several factors, including pulpal necrosis, trauma, periodontal treatment, orthodontic treatment, and bleaching agents. Incorrect diagnosis can lead to improper management and tooth loss. The treatment should involve the complete suppression of all the resorptive factors and the reconstruction of the defect using a suitable restorative material. The resorptive defect is often detected by the routine radiographic examination. A characteristic radiopaque line generally separates the image of the lesion from that of the root canal because the pulp remains protected by a thin layer of predentin until late in the process. Histopathologically, the lesions contain fibrovascular tissue with resorbing clastic cells adjacent to the dentin surface. Advanced lesions may also display fibro-osseous characteristics with deposition of ectopic bone-like calcifications. This case report presents extensive root resorption in the maxillary left lateral incisor and left canine in a 35-year-old patient. The defect was identified during the routine radiographic examination. The patient revealed a history of trauma 15 years back. Following the examination, the teeth were found to be vital and associated with the moderately deep periodontal pocket in the interdental region. The teeth were managed endodontically, and the resorption defect was restored with a biocompatible material after surgically elevating a flap. Periodontal management was also performed simultaneously by the surgical debridement of the area. Six-month postoperative radiograph revealed an arrest of the resorption and healing of the periodontal defect. Hence, an interdisciplinary management involving endodontic as well as periodontal treatment was performed that helped in saving the teeth with poor prognosis.
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Affiliation(s)
- M. S. Prathap
- Department of Conservative Dentistry and Endodontics, Yenepoya Dental College, Mangalore, Karnataka, India
| | - Sruthy Prathap
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
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Alqedairi A. Non-Invasive management of invasive cervical resorption associated with periodontal pocket: A case report. World J Clin Cases 2019; 7:863-871. [PMID: 31024958 PMCID: PMC6473127 DOI: 10.12998/wjcc.v7.i7.863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/29/2019] [Accepted: 02/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Invasive cervical resorption (ICR), a commonly misdiagnosed condition, is an aggressive form of external tooth resorption that contributes to periodontal tissue inflammation and deepening of the periodontal pockets. Herein we report the case of a patient, exhibiting ICR and elaborate the effects of a non-surgical approach in the amelioration of this condition.
CASE SUMMARY A 21-year-old female reporting intermittent pain at the upper left side, multiple restorations, no trauma history, and having received orthodontic treatment was studied. Localized erythematous swelling was noted at the buccal interdental papilla between the left maxillary first molar and second premolar. The diseased pulp and tissue in resorption were removed and the root canal system including the defect were sealed using gutta percha/AH Plus and mineral trioxide aggregate (MTA). At the one-year recall, the tooth showed no symptoms and responded normally to percussion and palpation. The surrounding periodontium exhibited a normal color and the probing depth was normal. Radiographic examination showed a restoration of crestal alveolar bone and good adaption to MTA.
CONCLUSION Non-surgical root canal treatment in conjunction with resorption defect orthograde repair with MTA was found to be an effective treatment option in the elimination of ICR. Early diagnoses are recommended in order to employ non-surgical approaches for management of ICR instead of surgical interventions.
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Affiliation(s)
- Abdullah Alqedairi
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
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Oliveira RR, Tavares WLF, Reis AL, Silva VA, Vieira LQ, Ribeiro Sobrinho AP. Cytokine expression in response to root repair agents. Int Endod J 2018; 51:1253-1260. [PMID: 29730894 DOI: 10.1111/iej.12944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 04/26/2018] [Indexed: 12/31/2022]
Abstract
AIM To evaluate the expression of TNF-α, IL-6, IFN-γ, TGF-β, IL-4, IL-10, RANKL, RANK and OPG on mouse calvarial bone treated with MTA, Geristore® and Emdogain® . METHODOLOGY Bone wounds were made on the heads of C57BL/6 mice, breaking the periosteum and the cortical surface of the calvaria. Each repair agent was inserted into sectioned Eppendorf microtubes and placed on the bone wound, and soft tissues were sutured. At 14 and 21 days, animals were sacrificed and the treated region was dissected. The calvaria bone was removed, and RNA was extracted. mRNA expression of the aforementioned cytokines was assessed using real-time PCR. Data were analysed by nonparametric methods, including the Mann-Whitney and Kruskal-Wallis tests (P < 0.05). RESULTS Following treatment with Emdogain® and MTA, mRNA expression of RANKL, RANK and OPG increased significantly (P < 0.05) between days 14 to 21. Geristore® did not alter the basal expression of these mediators during the same period of evaluation. Whilst treatment with Emdogain® did cause a significant increase in TNF-α mRNA expression between days 14 and 21 (P < 0.05), treatment with MTA did not alter the basal expression of this cytokine at either experimental time point. However, TNF-α mRNA expression was down-regulated significantly at day 21 (P < 0.05) when Geristore® was applied. A significant increase in the mRNA expression of IL-6, TGF-β, IL-10, IL-4 and IFN-γ was observed with Emdogain® and MTA treatment between days 14 to 21, whereas Geristore® reduced significantly the expression of IL-6, TGF-β and IL-4 (P < 0.05). CONCLUSION The clinical indication of these repair agents depends on the root resorption diagnosis. Whilst MTA and Emdogain® induce a pro- and anti-inflammatory response early and late, respectively, Geristore® was not associated with an inflammatory reaction when compared with both repair agents.
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Affiliation(s)
- R R Oliveira
- Departamento de Odontologia Restauradora, Faculdade de Odontologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - W L F Tavares
- Departamento de Odontologia Restauradora, Faculdade de Odontologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - A L Reis
- Departamento de Odontologia Restauradora, Faculdade de Odontologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - V A Silva
- Departamento de Odontologia Restauradora, Faculdade de Odontologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - L Q Vieira
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - A P Ribeiro Sobrinho
- Departamento de Odontologia Restauradora, Faculdade de Odontologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Tsaousoglou P, Markou E, Efthimiades N, Vouros I. Characteristics and treatment of invasive cervical resorption in vital teeth. A narrative review and a report of two cases. Br Dent J 2017; 222:423-428. [PMID: 28336998 DOI: 10.1038/sj.bdj.2017.263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 11/09/2022]
Abstract
Invasive cervical resorption (ICR) is a significant defect of the root surface where the hard dental tissues are undermined and become translucent due to the resorptive granulomatous tissue. It is mainly detected on radiographs. The radiographic appearance of ICR is asymmetrical radiolucency with irregular margins and an unchanged root canal. The purpose of this study is to present a comprehensive review together with the characteristics and the treatment of ICR through two cases which were followed-up for 36 months. In both cases the teeth were vital and the management consisted of raising a flap, granulomatous tissue removal, thorough debridement, restoration of the resorptive defect by placing a suitable filling material and follow-up examinations. Our results indicate that the specific treatment protocol has very positive outcomes. After 36 months pulpal vitality tests revealed a healthy pulp, and clinical and radiographic examination confirmed a stable periodontal condition.
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Affiliation(s)
- P Tsaousoglou
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | | | - N Efthimiades
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - I Vouros
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Reston EG, Bueno RPR, Closs LQ, Zettermann J. Fifteen-year Clinical Follow-up of Restoration of Extensive Cervical Resorption in a Maxillary Central Incisor. Oper Dent 2017; 42:E55-E58. [DOI: 10.2341/15-131-s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Internal bleaching in endodontically treated teeth requires care and protection to prevent harm to the periodontal ligament due to peroxide and may result in external root resorption. There is a myriad of treatment options when this occurs, such as monitoring, extraction, and subsequent rehabilitation with implants or fixed prosthodontics. In some cases, such as the one described here, a conservative attempt to maintain the tooth as a single structure can be made by sealing the resorptive defect. In the present case, we show a multidisciplinary approach where orthodontics, periodontics, and restorative dentistry were involved in treating the maxillary right central incisor (#8) of a 65-year-old patient with extensive cervical resorption, whose chief complaint was esthetics. The proposed treatment was extrusion of the tooth followed by curettage and restoration of the defect with glass ionomer cement. The patient has been followed for 15 years with no signs of recurrence, maintenance of periodontal health, and patient satisfaction with the esthetic outcome.
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Affiliation(s)
- EG Reston
- Eduardo G. Reston, DDS, MSD, PhD, Department of Restorative Dentistry, School of Dentistry, Universidade Luterana do Brasil (ULBRA), São José, Canoas, Brazil
| | - RPR Bueno
- Renata P. R. Bueno, DDS, MSD, PhD, Universidade Luterana do Brasil (ULBRA), Esteio, Brazil
| | - LQ Closs
- Luciane Q. Closs, DDS, MSD, PhD, Department of Orthodontics, School of Dentistry, Universidade Luterana do Brasil (ULBRA), São José, Canoas, Brazil
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Salem Milani A, Rahimi S, Froughreyhani M, Vahid Pakdel M. Effect of Blood Contamination on Marginal Adaptation and Surface Microstructure of Mineral Trioxide Aggregate: A SEM Study. J Dent Res Dent Clin Dent Prospects 2013; 7:157-63. [PMID: 24082987 PMCID: PMC3779375 DOI: 10.5681/joddd.2013.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 06/11/2013] [Indexed: 11/17/2022] Open
Abstract
Background and aims In various clinical situations, mineral trioxide aggregate (MTA) may come into direct contact or even be mixed with blood. The aim of the present study was to evaluate the effect of exposure to blood on marginal adaptation and surface microstructure of MTA.
Materials and methods Thirty extracted human single-rooted teeth were used. Standard root canal treatment was carried out. Root-ends were resected, and retrocavities were prepared. The teeth were randomly divided into two groups (n = 15): in group 1, the internal surface of the cavities was coated with fresh blood. Then, the cavities were filled with MTA. The roots were immersed in molds containing fresh blood. In group 2, the aforementioned procedures were performed except that synthetic tissue fluid (STF) was used instead of blood. To assess the marginal adaptation, “gap perimeter” and “maximum gap width” were measured under scanning electron microscope. The surface microstructure was also examined. Independent samples t-test and Mann-Whitney U test were used to analyze the data.
Results Maximum gap width and gap perimeter in the blood-exposed group were significantly larger than those in the STF-exposed group (p < 0.01). In the blood-exposed group, the crystals tended to be more rounded and less angular compared with the STF-exposed group, and there was a general lack of needle-like crystals.
Conclusion Exposure to blood during setting has a negative effect on marginal adaptation of MTA, and blood-exposed MTA has a different surface microstructure compared to STF-exposed MTA.
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Affiliation(s)
- Amin Salem Milani
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ; Assistant Professor, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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Froughreyhani M, Salem Milani A, Barakatein B, Shiezadeh V. Treatment of Strip Perforation Using Root MTA: A Case Report. IRANIAN ENDODONTIC JOURNAL 2013; 8:80-3. [PMID: 23717336 PMCID: PMC3662043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 10/07/2012] [Accepted: 10/22/2012] [Indexed: 11/03/2022]
Abstract
Root perforations are an undesired complication of endodontic treatment which result in loss of integrity of the root, and adversely affect the prognosis of the treatment. Recently, Iranian mineral trioxide aggregate [Root MTA] has been introduced as an ideal material for perforation repair. In this article a successful repair of strip root perforation of mandibular molar using Root MTA is presented with 15-month follow-up. This case suggests that Root MTA may be a substitute material for the treatment of strip perforation; however, more clinical studies with larger sample size and longer follow-ups are needed.
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Affiliation(s)
- Mohammad Froughreyhani
- Department of Endodontics, Dental School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Salem Milani
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding author: Amin Salem Milani, Dental and periodontal research center, Tabriz University of medical sciences, Daneshgah Ave., Tabriz, Iran. Tel: + 98-4113355965, Fax: +98-4113346977, E-mail:
| | - Behnaz Barakatein
- Department of Endodontics, Dental School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahhab Shiezadeh
- Dental School, Zanjan University of Medical Sciences, Zanjan, Iran
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Kim Y, Lee CY, Kim E, Roh BD. Invasive cervical resorption: treatment challenges. Restor Dent Endod 2012; 37:228-31. [PMID: 23430133 PMCID: PMC3568643 DOI: 10.5395/rde.2012.37.4.228] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/30/2012] [Accepted: 08/23/2012] [Indexed: 11/11/2022] Open
Abstract
Invasive cervical resorption is a relatively uncommon form of external root resorption. It is characterized by invasion of cervical region of the root by fibrovascular tissue derived from the periodontal ligament. This case presents an invasive cervical resorption occurring in maxillary lateral incisor, following damage in cervical cementum from avulsion and intracoronal bleaching procedure. Flap reflection, debridement and restoration with glass ionomer cement were performed in an attempt to repair the defect. But after 2 mon, more resorption extended apically. Considering root stability and recurrence potential, we decided to extract the tooth. Invasive cervical resorption in advanced stages may present great challenges for clinicians. Therefore, prevention and early detection must be stressed when dealing with patients presenting history of potential predisposing factors.
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Affiliation(s)
- Yookyung Kim
- Department of Conservative Dentistry, Yonsei University College of Dentistry, Seoul, Korea
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