External cervical resorption case report and a brief review of literature

Evaluation of Fracture Strength after Repair of Cervical External Resorption Cavities with Different Materials

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.

Stresses in teeth with External Cervical Resorption defects restored with different Biomimetic cements: A Finite Element Analysis

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.

Combined endodontic and periodontal management of a class 3 invasive cervical resorption in a mandibular first molar

Dental radiography and cone-beam computed tomography revealed the left mandibular first molar in a 68-year-old female patient with Heithersay Class 3 invasive cervical resorption (ICR). The inhibition of ICR progression and environmental improvement in and around the affected tooth through combined endodontic and periodontal treatments led to a favorable clinical outcome.

External root resorption of second molars caused by impacted third molars: an observational study in panoramic radiographs

Abstract Objective This research investigate the presence of external root resorption (ERR) in second molars caused by impacted third molars in panoramic radiographs, relating to the position of third molars according to classification of Winter, Pell and Gregory. Material and method A cross-sectional, retrospective study using panoramic radiographs obtained from January 2014 to December 2015. The inclusion criterion was the presence of a second molar adjacent to an impacted third molar. Data were analyzed using descriptive and inferential statistics. Pearson's Chi-Square Test and Fisher's Exact Test (p≤0.05) were performed. Result The sample consisted of 584 panoramic radiographs, 356 (60.95%) of women, and 228 (39.05%) of men, the mean age was 25.31 years. The prevalence of ERR was 12.5%, and the group of 14-24 year olds was the most affected (p = 0.46). The presence of ERR was statistically higher in the mandible (42.1%) with p=0.01. The ERR located in the cervical (57.1%) and medium (58.8%) thirds was proportionally higher in the teeth with B2 (p=0.02) and mesio-angular positions (p=0.26). Conclusion The prevalence of ERR in second molars, caused by impacted third molars, was shown to be similar to results found in the literature, with no gender preference, this affects young patients, occurring frequently in mandible teeth, and presents greater severity in the cervical and middle thirds. The B2 and mesio-angular positions were more prone to ERR.

Mineral trioxide aggregate enriched with iron disulfide nanostructures: an evaluation of their physical and biological properties

The purpose of this study was to characterize mineral trioxide aggregates (MTA) enriched with iron disulfide (FeS₂ ) nanostructures at different concentrations, and to investigate their storage modulus, radiopacity, setting time, pH, cytotoxicity, and antimicrobial activity. Iron disulfide nanostructures [with particle size of 0.357 ± 0.156 μm (mean ± SD)] at weight ratios of 0.2, 0.4, 0.6, 0.8, and 1.0 wt% were added to white MTA (wMTA). The radiopacity, rheological properties, setting time, and pH, as well as the cytotoxicity (assessed using the MTT assay) and antibacterial activity (assessed using the broth microdilution test) were determined for MTA/FeS₂ nanostructures. The nanostructures did not modify the radiopacity values of wMTA (~6 mm of aluminium); however, they reduced the setting time from 18.2 ± 3.20 min to 13.7 ± 1.8 min, and the storage modulus was indicative of a good stiffness. Whereas the wMTA/FeS₂ nanostructures did not induce cytotoxicity when in contact with human pulp cells (HPCs) and human gingival fibroblasts (HGFs), they showed bacteriostatic activity against Staphylococcus aureus, Escherichia coli, and Enterococcus faecalis. Adding FeS₂ nanostructures to MTA might be an option for improving the root canal sealing and antibacterial effects of wMTA in endodontic treatments.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.

External Cervical Resorption: A New Oral Manifestation of Systemic Sclerosis

Systemic sclerosis (SSc) is a complex, chronic, and progressive autoimmune disease. SSc causes bone resorption of mandible and distal phalanges of fingers through a known mechanism, and it has also been pointed out as a possible cause of apical root resorption of teeth, because tooth resorption is regulated by similar mechanisms to those controlling bone resorption. The objective of this article was to report the first case in the literature of external cervical resorption (ECR) as an oral manifestation of SSc. A 66-year-old female patient with a 35-year history of SSc was diagnosed with multiple ECRs through a computerized axial tomography and clinical examination. All known causes of ECR were discarded after a detailed anamnesis and clinical examination. This report details SSc as a possible cause of ECR and discusses the pathogenesis of ECR in relation with SSc. The systemic alterations provoked by SSc can be related to the etiopathogenesis of cervical root resorption. It is extremely relevant that dental care providers be aware that external cervical resorptions could be present in patients suffering from SSc, consciously look for these lesions, treat them early in case they are present, and advise the patient with SSc of the importance of continuous dental controls.

Fifteen-year Clinical Follow-up of Restoration of Extensive Cervical Resorption in a Maxillary Central Incisor

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.