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Zaccheo F, Petroni G, Fiorillo L, Heboyan A, Carnevale G, Calapaj M, Cervino G, Tallarico M. Exceptional bone remodeling over composite restoration in the management of external root resorption: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241269588. [PMID: 39140030 PMCID: PMC11320676 DOI: 10.1177/2050313x241269588] [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: 03/13/2024] [Accepted: 06/25/2024] [Indexed: 08/15/2024] Open
Abstract
A 65-year-old Caucasian male was referred to an endodontic specialist practice in a private clinic in December 2019 for the management of an asymptomatic, radiolucent lesion located at the cervical level of the distal root of his right lower first molar, noticed during a routine periapical radiograph. After an accurate evaluation with cone-beam computed tomography (CBCT), the subgingival lesion was diagnosed as a supracrestal external cervical resorption (ECR), with a circumferential spread ⩽90°, confined to dentine without pulp involvement. The lesion was treated with the following sequence: (1) a full flap accessed the ECR, (2) the granulomatous tissue was removed from the root area, (3) the cavity was refreshed and filled with a well-refined and polished resin composite, (4) the flap was sutured at the cemento-enamel junction. A mandibular CBCT scan was performed before treatment, right after treatment, and 3 years postoperatively. Compared to the 3-year posttreatment CBCT scan, the immediate posttreatment one, revealed the absence of bone loss and an unexpected coronal bone remodeling with new bone formation over the treated lesion.
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Affiliation(s)
- Fabrizio Zaccheo
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Petroni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Fiorillo
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, India
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | | | | | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Marco Tallarico
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, Rome, Italy
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Blum JS. The various forms of tooth resorption. AUST ENDOD J 2024; 50:191-201. [PMID: 38798140 DOI: 10.1111/aej.12857] [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: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
Tooth resorption refers to the loss of the organic and inorganic components of tooth structure by clastic cells. The complex and multifaceted nature of its aetiology, along with the several classification schemes published in the area, are likely to create confusion amongst researchers and clinicians, and may lead to compromised treatment decisions. Therefore, this paper will categorise and address tooth resorption based on aetiology in order to help clinicians diagnose and filter treatment options based on the pathophysiology of the resorption at hand. With recent advancements in the literature, the purpose of this paper is to provide clinicians with a current, clinically relevant summary of the various forms of tooth resorption, with a focus on aetiologically driven treatment strategies and suggestions that facilitate their recognition, diagnosis and management.
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Affiliation(s)
- Jordan Samuel Blum
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
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Gonzalez-Passos T, Barros-Costa M, Oliveira ML, Freitas DQ. Influence of tube current and metal artifact reduction on the diagnosis of external cervical resorption in teeth adjacent to a dental implant in CBCT: an ex-vivo study. Clin Oral Investig 2024; 28:356. [PMID: 38834721 DOI: 10.1007/s00784-024-05750-y] [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: 04/03/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES This ex-vivo study aimed to assess the influence of tube current (mA) and metal artifact reduction (MAR) on the diagnosis of early external cervical resorption (EECR) in cone-beam computed tomography (CBCT) in the presence of an adjacent dental implant. MATERIALS AND METHODS Twenty-three single-rooted teeth were sectioned longitudinally and EECR was induced using a spherical drill and 5% nitric acid in 10 teeth. Each tooth was positioned in the socket of the lower right canine of a dry human mandible and CBCT scans were acquired using 90 kVp, voxel of 0.085 mm, field of view of 5 x 5 cm, and varying tube current (4, 8 or 12 mA), MAR (enabled or disabled) and implant conditions (with a zirconia implant in the socket of the lower right first premolar or without). Five oral radiologists evaluated the presence of EECR in a 5-point scale and the diagnostic values (area under the receiver operating characteristic curve - AUC, sensitivity, and specificity) were compared using multi-way Analysis of Variance (α = 0.05). Kappa test assessed intra-/inter-evaluator agreement. RESULTS The tube current only influenced the AUC values in the presence of the implant and when MAR disabled; in this case, 8 mA showed lower values (p<0.007). MAR did not influence the diagnostic values (p>0.05). In general, the presence of an implant reduced the AUC values (p<0.0001); sensitivity values with 8 mA and MAR disabled, and specificity values with 4 mA and MAR enabled and 8 mA regardless MAR were also decreased (p<0.0001). CONCLUSIONS Variations in tube current and MAR were unable to improve EECR detection, which was impaired by the presence of an adjacent implant. CLINICAL RELEVANCE Increasing tube current or activating MAR tool does not improve EECR diagnosis, which is hampered by the artifacts generated by dental implants.
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Affiliation(s)
- Thamiles Gonzalez-Passos
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil. Av. Limeira, 901, Zip Code13414903, Piracicaba, São Paulo, Brazil.
| | - Matheus Barros-Costa
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil. Av. Limeira, 901, Zip Code13414903, Piracicaba, São Paulo, Brazil
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil. Av. Limeira, 901, Zip Code13414903, Piracicaba, São Paulo, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil. Av. Limeira, 901, Zip Code13414903, Piracicaba, São Paulo, Brazil
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Reduwan NH, Abdul Aziz AA, Mohd Razi R, Abdullah ERMF, Mazloom Nezhad SM, Gohain M, Ibrahim N. Application of deep learning and feature selection technique on external root resorption identification on CBCT images. BMC Oral Health 2024; 24:252. [PMID: 38373931 PMCID: PMC10875886 DOI: 10.1186/s12903-024-03910-w] [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: 09/22/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Artificial intelligence has been proven to improve the identification of various maxillofacial lesions. The aim of the current study is two-fold: to assess the performance of four deep learning models (DLM) in external root resorption (ERR) identification and to assess the effect of combining feature selection technique (FST) with DLM on their ability in ERR identification. METHODS External root resorption was simulated on 88 extracted premolar teeth using tungsten bur in different depths (0.5 mm, 1 mm, and 2 mm). All teeth were scanned using a Cone beam CT (Carestream Dental, Atlanta, GA). Afterward, a training (70%), validation (10%), and test (20%) dataset were established. The performance of four DLMs including Random Forest (RF) + Visual Geometry Group 16 (VGG), RF + EfficienNetB4 (EFNET), Support Vector Machine (SVM) + VGG, and SVM + EFNET) and four hybrid models (DLM + FST: (i) FS + RF + VGG, (ii) FS + RF + EFNET, (iii) FS + SVM + VGG and (iv) FS + SVM + EFNET) was compared. Five performance parameters were assessed: classification accuracy, F1-score, precision, specificity, and error rate. FST algorithms (Boruta and Recursive Feature Selection) were combined with the DLMs to assess their performance. RESULTS RF + VGG exhibited the highest performance in identifying ERR, followed by the other tested models. Similarly, FST combined with RF + VGG outperformed other models with classification accuracy, F1-score, precision, and specificity of 81.9%, weighted accuracy of 83%, and area under the curve (AUC) of 96%. Kruskal Wallis test revealed a significant difference (p = 0.008) in the prediction accuracy among the eight DLMs. CONCLUSION In general, all DLMs have similar performance on ERR identification. However, the performance can be improved by combining FST with DLMs.
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Affiliation(s)
- Nor Hidayah Reduwan
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
- Centre of Oral and Maxillofacial Diagnostic and Medicine Studies, Faculty of Dentistry, University Teknologi MARA, Sungai Buloh, 47000, Malaysia
| | - Azwatee Abdul Abdul Aziz
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Roziana Mohd Razi
- Department of Pediatric Dentistry and Orthodontic, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Erma Rahayu Mohd Faizal Abdullah
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, 50603, Malaysia.
| | - Seyed Matin Mazloom Nezhad
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Meghna Gohain
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Norliza Ibrahim
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia.
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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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Ghabraei S, Bolhari B, Hashemi N, Gharehchahi H. Conservative management of an advanced external cervical resorption with internal approach using bio-ceramic materials: A case report. Clin Case Rep 2024; 12:e8378. [PMID: 38161643 PMCID: PMC10753636 DOI: 10.1002/ccr3.8378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Key clinical message A successful management of an advanced external cervical resorption using a conservative approach with CBCT, dental operating microscope, and a new bio-ceramic material. Abstract External cervical resorption (ECR) is a pathologic condition that is initiated on the external aspect of the root, below the epithelial attachment in the cervical position. This article will report a case of external cervical resorption (ESR) in an advanced stage, which was asymptomatic and was incidentally detected in a follow-up radiograph after the end of orthodontic treatment. Cone-beam computed tomography (CBCT) was prescribed to accurately diagnose the resorptive lesion and differentiate it from internal root resorption (IRR), and the final diagnosis was Heithersay's class IV ECR. Considering the health of the periodontium and the absence of attachment loss, it was decided to use a conservative internal approach to the management of this case. After the treatment, the patient was asymptomatic and the radiographic examinations showed no signs of peri-radicular pathology during the follow-up period. With the correct case selection and the availability of the appropriate materials and equipment such as a dental operating microscope (DOM) and bio-ceramic materials, the internal approach can be a successful and minimally invasive treatment, even for the management of advanced ECR cases.
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Affiliation(s)
- Sholeh Ghabraei
- Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
| | - Behnam Bolhari
- Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
| | - Nasim Hashemi
- Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
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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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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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Ma Y, Mu D, Li X. Risk factors for root resorption of second molars with impacted third molars: a meta-analysis of CBCT studies. Acta Odontol Scand 2023; 81:18-28. [PMID: 35771794 DOI: 10.1080/00016357.2022.2077982] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis is to identify the risk factors of external root resorption (ERR) on second molar (M2) due to presence of impacted third (M3) molar based on cone- beam computerised tomography (CBCT) findings. MATERIAL AND METHODS Search of PubMed via MEDLINE, SCOPUS, and Experta Medical dataBASE (EMBASE) was performed to identify studies assessing the risk factors of ERR in M2 due to the presence of impacted M3. RESULTS M2 in close proximity to mesio-angular impacted M3 had 50% higher risk of root resorption than with vertical impacted M3 (RR 0.50 95% CI [0.35, 0.73], p = .0003). Presence of the impacted M3 in the lower arch with ERR in M2 was higher (38.3%) than in the upper arch (33.8%). With respect to the inclination of impacted M3, the incidence of ERR was higher with transverse, horizontal and mesio-angular impacted M3 with 54.5%, 47.5% and 44.5% of occurrence, respectively. CONCLUSION ERR in M2 was significantly affected by the contact with impacted M3 and most importantly, the inclination of M3. The presence of mesio-angular, horizontal or transverse impacted M3 in close proximity to apical or middle portion of M2 could possibly be a strong risk factor for ERR in M2.
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Affiliation(s)
- Yuecui Ma
- Department of stomatology, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Daogui Mu
- Department of imaging, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiangxin Li
- Department of stomatology, The First People's Hospital of Lianyungang, Lianyungang, China
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Conservative Therapy of External Invasive Cervical Resorption with Adhesive Systems: A 6-Year Follow-Up Case Report and Literature Review. Case Rep Dent 2022; 2022:9620629. [PMID: 36338011 PMCID: PMC9635965 DOI: 10.1155/2022/9620629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/07/2022] [Indexed: 01/24/2023] Open
Abstract
The diagnosis and treatment of external invasive cervical resorption (EICR) could be a challenging clinical situation even for the most experienced dentists. It is a fairly rare lesion and a poorly understood phenomenon, and its insidious and aggressive nature can lead to tooth loss. Even in the era of dental implants, trying to save a compromised tooth is imperative for any clinician. This report presents a case of an upper central incisor with a class II Heithersay EICR in which treatment was performed using a multidisciplinary approach and the defect was restored with resin composite. The surgery in which the defect was exposed and repaired was followed by an endodontic treatment and the placement of a fiber-reinforced post. In this case, the use of modern materials, such as resin composites, allowed not only the avoidance of tooth extraction but also the achievement of satisfactory aesthetic results. The 6-year follow-up demonstrated the success of therapy and the resolution of clinical symptoms. This case report highlights the importance of early detection of EICR and how composite resins could provide an effective and aesthetic restauration of the defect, which favors the health of the surrounding gingival tissue.
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11
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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: 28] [Impact Index Per Article: 14.0] [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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Mallya SM, Ahmad M, Cohen JR, Kaspo G, Ramesh A. Recommendations for imaging of the temporomandibular joint. Position statement from the American Academy of Oral and Maxillofacial Radiology (AAOMR) and the American Academy of Orofacial Pain (AAOP). Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:639-648. [DOI: 10.1016/j.oooo.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
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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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14
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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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15
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Huamán SD, Arnez MFM, Oliveira FMMPCD, Rossi AD, Silva LAB, Paula-Silva FWG. In Vivo Detection of External Apical Root Resorption Induced by Apical Periodontitis Using Periapical Radiography and Cone-Beam Computed Tomography. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.038] [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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16
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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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Martins CM, de Moraes AR, Cruz AJM, Barboza LCP, Batista VEDS, Mori GG, do Prado RL, Matos J, Herrera B, Lacerda PBG, Andrada AC. Survey based assessment of diagnosis through periapical radiograph and CBCT and treatment of root resorption with Brazilian and American dentists and endodontists. J Clin Exp Dent 2021; 13:e745-e754. [PMID: 34512912 PMCID: PMC8412804 DOI: 10.4317/jced.57774] [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: 05/28/2020] [Accepted: 12/20/2020] [Indexed: 11/05/2022] Open
Abstract
Background This study assesses and compares the knowledge level of endodontists (ENDs) and general dental practitioners (GPs) from Brazil and United States of America (USA) in the diagnosis and treatment of internal and external inflammatory root resorptions through periapical radiographic (PA) and cone beam computed tomography (CBCT) examinations. Material and Methods A cross-sectional online questionnaire-based survey was presented to the volunteers containing questions regarding personal and professional profile, as well as three clinical cases of internal and external inflammatory root resorption. A series of multiple-choice questions about the diagnosis and treatment options were surveyed. The data collected was analysed by the Chi-square test with Yates correction with a significance level of 5 %. Results Most answers were considered adequate when all three questions about the diagnosis and all two questions relating to the treatment were answered accurately. A total of 374 dentists answered the survey (n: 229 from Brazil vs. 145 from USA) being 41% END and 59% GP. END presented higher level of knowledge than GP regarding to diagnosis and treatment of inflammatory root resorptions both in Brazil and USA (p<0.05); USA presented higher level of adequate responses than Brazil (p<0.05). Conclusions END achieved a level of knowledge of the diagnosis and treatment of root resorption superior to the GP. Comparing the results obtained in both countries, it was observed that the USA had a higher correct response rate than Brazil. Key words:Internal root resorption, external root resorption, management, diagnosis, treatment.
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Affiliation(s)
- Christine-Men Martins
- DDS, MSc, PhD. Professor at Dental School of Presidente Prudente, University of Western São Paulo - UNOESTE, Presidente Prudente, Sao Paulo, Brazil
| | - Adrielly-Regina de Moraes
- Undergraduate at Dental School of Presidente Prudente, University of Western São Paulo - UNOESTE, Presidente Prudente, Sao Paulo, Brazil
| | - Ana-Julia-Menoti Cruz
- Undergraduate at Dental School of Presidente Prudente, University of Western São Paulo - UNOESTE, Presidente Prudente, Sao Paulo, Brazil
| | - Lalleska-Caroline-Pereira Barboza
- Undergraduate at Dental School of Presidente Prudente, University of Western São Paulo - UNOESTE, Presidente Prudente, Sao Paulo, Brazil
| | - Victor-Eduardo-de Souza Batista
- DDS, MSc, PhD. Professor at Dental School of Presidente Prudente, University of Western São Paulo - UNOESTE, Presidente Prudente, Sao Paulo, Brazil
| | - Graziela-Garrido Mori
- DDS, MSc, PhD. Professor at Dental School of Presidente Prudente, University of Western São Paulo - UNOESTE, Presidente Prudente, Sao Paulo, Brazil
| | - Rosana-Leal do Prado
- DDS, MSc, PhD. Professor at Dental School of Presidente Prudente, University of Western São Paulo - UNOESTE, Presidente Prudente, Sao Paulo, Brazil
| | - Janine Matos
- Graduate at University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Bruno Herrera
- Professor at University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Priscila-Bruna-Gonçalves Lacerda
- MsC candidate at Dental School of Presidente Prudente, University of Western São Paulo - UNOESTE, Presidente Prudente, Sao Paulo, Brazil
| | - Ana-Cristina Andrada
- Professor at University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
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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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Cunliffe J, Al-Hadidi A, Sawair FA, Mahasneh SA. Comparison of imaging modalities in the diagnosis of external cervical resorption (ECR): an in-vitro study. Odontology 2021; 110:157-163. [PMID: 34448951 DOI: 10.1007/s10266-021-00651-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/18/2021] [Indexed: 01/25/2023]
Abstract
External cervical resorption is a pathological condition affecting the cervical margins of teeth. Due to the increased prevalence and the area it affects, it can be easily misdiagnosed. The ability of clinicians to diagnose ECR and subcategorise the lesions using periapical radiographs and cone beam-CT scans has not been investigated in-depth. This study aims to assess if diagnostic ability to detect ECR lesions with the two modalities was different and if there was a change in the diagnosis when CBCT was used. A human skull, including the mandible was used for this study. The teeth were randomly allocated to the different subcategories, then pre and post-preparation radiographs with CBCT were taken. Statistical analysis was done using IBM SPSS version 16.0 (SPSS Inc., Chicago, IL, USA). The study sample was composed of 60 participants, the overall sensitivity of intraoral radiographs was significantly lower than CBCT. When the participants were told the radiograph and the CBCT were of the same tooth 60% said they would change their diagnosis. The use of intraoral radiographs alone might not be enough to identify and correctly diagnose ECR lesions. CBCT can give a better idea about the nature and the extent of the lesion.
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Affiliation(s)
- Joanne Cunliffe
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Abeer Al-Hadidi
- School of Dentistry, The University of Jordan, Amman, 11942, Jordan
| | - Faleh A Sawair
- School of Dentistry, The University of Jordan, Amman, 11942, Jordan
| | - Sari A Mahasneh
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, M13 9PL, UK. .,School of Dentistry, The University of Jordan, Amman, 11942, Jordan.
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20
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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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21
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Langaliya A, Chaudhari E, Patel A, Shah J. Computer-aided design-CAM-guided endodontic microsurgical localization and retrieval of two separated instruments from the periapical area of a mandibular second molar. ENDODONTOLOGY 2021. [DOI: 10.4103/endo.endo_60_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Raabe C, Bornstein MM, Ducommun J, Sendi P, von Arx T, Janner SFM. A retrospective analysis of autotransplanted teeth including an evaluation of a novel surgical technique. Clin Oral Investig 2020; 25:3513-3525. [PMID: 33263141 PMCID: PMC8137630 DOI: 10.1007/s00784-020-03673-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To assess survival rates and frequency of complications for immature and mature autotransplanted teeth after at least 1 year in function. MATERIALS AND METHODS All consecutive patients who had undergone tooth autotransplantation between 2000 and 2018 were invited to a clinical and radiographic follow-up examination. First, survival rates were calculated on the basis of a phone inquiry. A clinical follow-up examination allowed for the calculation of the success rate, i.e., absence of any potentially adverse clinical and radiographic findings of the autotransplanted teeth. Moreover, the effect of demographic, dental, and surgical variables on survival/success was analyzed statistically. RESULTS Thirty-eight teeth in 35 patients were transplanted during the study period. Three teeth in 3 patients were excluded due to missing records. All other patients were successfully contacted and interviewed by phone. Out of these 35 transplants, 32 were still in function, and 3 had been extracted, yielding a 91.4% survival probability after a median follow-up of 3.4 years. Of the 32 teeth qualifying for the success analysis, 20 (62.5%) showed absence of potentially adverse findings, while 3 (9.4%) required root canal treatment (RCT). Out of the 9 mature, root-end resected transplants, 4 exhibited ongoing pulp canal obliteration, all with a single root canal. Postoperative and potentially adverse findings or failures were found more frequently in the group of mature transplants (55.6%) than immature transplants (30.4%) and for molars (72.7%) than premolars (17.6%) or canines (25%). None of the potential predictors had a statistically significant effect on survival or success. CONCLUSION Autotransplanted teeth yielded a satisfying midterm survival rate regardless of their stage of development. An additional, extraoral root-end resection of mature transplants may lead to rates of revascularization and postoperative pulp canal obliteration higher than the data reported on unmodified mature transplants. CLINICAL RELEVANCE Extraoral root-end resection of mature teeth shows promising outcomes for transplants especially with a single root canal and uncomplicated root morphology.
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Affiliation(s)
- Clemens Raabe
- Department of Oral Surgery & Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Julien Ducommun
- Department of Oral Surgery & Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Pedram Sendi
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Thomas von Arx
- Department of Oral Surgery & Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Simone F M Janner
- Department of Oral Surgery & Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
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23
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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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24
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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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25
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Evaluation of Risk Factors for External Root Resorption and Dental Caries of Second Molars Associated With Impacted Third Molars. J Oral Maxillofac Surg 2020; 78:1467-1477. [PMID: 32504563 DOI: 10.1016/j.joms.2020.04.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Impacted third molars (M3s) may lead to external root resorption (ERR) and dental caries (DC) in the adjacent second molars (M2s). The aim of this study was to identify the risk factors for ERR and DC in M2s associated with impacted M3s. MATERIALS AND METHODS We implemented a cross-sectional study and enrolled a sample composed of patients with M3s and M2s present and cone-beam computed tomography (CBCT) scans available for review. If there was contact between the M2 and the adjacent M3 and the border of radiolucency was more distinct, the case was considered ERR. Apart from that, the case was considered DC. Potential predictor variables were defined as age, gender, tooth location, M2-M3 contact, root development in M3, M3 inclination, M3 impaction type, and M3 follicular diameter. Outcomes of the study were DC and ERR in M2s. CBCT was used to detect the presence of DC and ERR in M2s. RESULTS A total of 250 eligible images of M3s in the upper and lower jaws of 167 patients were included. The mean age of the patients with CBCT images available was 26.08 ± 4 years (range, 18 to 40), and 43.6% of the patients were men. Factors associated with a significantly increased frequency of ERR in M2s included maxillary location, presence of M2-M3 contact, and mesioangular inclination (P < .005). DC in M2s was significantly more likely to occur in those with absence of contact between M2 and M3 (P < .005). CONCLUSIONS The results of this study showed an increased risk of ERR to be associated with maxillary molars, mesioangular inclination, and presence of M2-M3 contact. The variable associated with an increased risk of DC was the absence of M2-M3 contact.
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26
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Jebril A, Aljamani S, Jarad F. The Surgical Management of External Cervical Resorption: A Retrospective Observational Study of Treatment Outcomes and Classifications. J Endod 2020; 46:778-785. [DOI: 10.1016/j.joen.2020.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/27/2020] [Accepted: 03/08/2020] [Indexed: 11/17/2022]
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27
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Abstract
Root resorption is a poorly understood phenomenon and is often misdiagnosed and, as a result, inappropriately treated. The aim of this paper is to provide a practical guide for diagnosis of root resorption lesions using a simple classification, and to describe the principles of management of these resorptive defects in everyday practice.
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28
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Goller Bulut D, Uğur Aydın Z. The impact of different voxels and exposure parameters of CBCT for the assessment of external root resorptions: A phantom study. AUST ENDOD J 2019; 45:146-153. [PMID: 31267607 DOI: 10.1111/aej.12354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 02/01/2023]
Abstract
This study aimed to compare the effectiveness of the different voxel sizes and imaging parameters of cone beam computed tomography (CBCT) on the determination of external root resorption (ERR). ERRs were created in coronal, middle and apical regions. Depths (0.62-0.73 mm) and diameters (0.68-0.81 mm) of ERRs were measured using a digital calliper. Images were obtained in 0.125, 0.2, 0.25, 0.3 and 0.4 mm3 voxel sizes and at different currents. Data were analysed using Friedman and Wilcoxon signed-rank tests at a level of P < 0.05. There was a difference between the parameters in determining the size of the ERR in coronal and middle regions (P < 0.05), but there was no difference in the apical region (P > 0.05). The change in current and exposure time did not make a difference in determining the dimensions of the ERRs (P > 0.05). Some voxel dimensions were more reliable in determining the depth and diameter of ERR in the coronal and middle region.
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Affiliation(s)
- Duygu Goller Bulut
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Abant İzzet Baysal University, Bolu, Turkey
| | - Zeliha Uğur Aydın
- Faculty of Dentistry, Department of Endodontics, Abant İzzet Baysal University, Bolu, Turkey
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29
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Patel S, Brown J, Pimentel T, Kelly RD, Abella F, Durack C. Cone beam computed tomography in Endodontics - a review of the literature. Int Endod J 2019; 52:1138-1152. [PMID: 30868610 DOI: 10.1111/iej.13115] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/11/2019] [Indexed: 12/14/2022]
Abstract
The use of cone beam computed tomography (CBCT) in the diagnosis and/or management of endodontic problems is increasing and is reflected in the exponential rise in publications on this topic in the last two decades. The aim of this paper is to: (i) Review current literature on the endodontic applications of CBCT; (ii) Based on current evidence make recommendations for the use of CBCT in Endodontics; (iii) Highlight the areas in which more research is required.
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Affiliation(s)
- S Patel
- Department of Conservative Dentistry, King's College London Dental Institute, London, UK.,Specialist Practice, London, UK
| | - J Brown
- Department of Maxillofacial & Dental Radiology, King's College London Dental Institute, London, UK
| | - T Pimentel
- Department of Conservative Dentistry, King's College London Dental Institute, London, UK
| | - R D Kelly
- Department of Conservative Dentistry, King's College London Dental Institute, London, UK
| | - F Abella
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - C Durack
- Speciailist Practice, Limerick, Ireland
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30
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Shemesh A, Levin A, Hadad A, Itzhak JB, Solomonov M. CBCT analyses of advanced cervical resorption aid in selection of treatment modalities: a retrospective analysis. Clin Oral Investig 2019; 23:1635-1640. [PMID: 30145663 DOI: 10.1007/s00784-018-2592-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 08/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The selection of treatment for advanced (classes 3 and 4) invasive cervical resorption (ICR) based on a two-dimensional periapical radiograph is challenging. The purpose of the present study is to describe different treatment approaches for advanced invasive cervical resorption based on cone-beam computed tomography evaluation. MATERIALS AND METHODS All cases of advanced ICR based on CBCT evaluation in our endodontic department between 2011 and 2016 were included in the study. The dimension, circumferential, and coronal-cervical locations of the entry point of the resorption tissue into the tooth were evaluated. The selected treatment approach for each case was documented, and all the data were summarized and analyzed. RESULTS Twenty-three cases of advanced ICR were included in the study. Approximately, 74% were diagnosed in stage 4, and 26% were diagnosed in stage 3. The narrow entry point was identified in 43% (10 cases), while in 57% (13) of cases, the entry point was wide. Circumferentially, 70% (16) were located on the proximal side. Coronal-cervically, 43% (10) were located more than 1.5 mm above the crestal bone. All narrow entry point cases were treated using a minimally invasive technique, while different treatment approaches were chosen for cases with a wide entry point. CONCLUSIONS The present study proposes different treatment approaches for advanced ICR based on CBCT. The CBCT evaluation of the entry point may facilitate choosing the appropriate treatment approach for advanced ICR cases. CLINICAL RELEVANCE The description of different treatment approaches for advanced invasive cervical resorption based on cone-beam computed tomography evaluation enables the clinician to choose the optimal treatment approach for each advanced ICR case.
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Affiliation(s)
- Avi Shemesh
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel.
| | - Avi Levin
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Avi Hadad
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Joe Ben Itzhak
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
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Krug R, Connert T, Beinicke A, Soliman S, Schubert A, Kiefner P, Sonntag D, Weiger R, Krastl G. When and how do endodontic specialists use cone‐beam computed tomography? AUST ENDOD J 2019; 45:365-372. [DOI: 10.1111/aej.12337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Ralf Krug
- Department of Operative Dentistry and Periodontology and Center of Dental TraumatologyUniversity Hospital of Würzburg Würzburg Germany
| | - Thomas Connert
- Department of Operative Dentistry and Periodontology and Center of Dental TraumatologyUniversity Hospital of Würzburg Würzburg Germany
- Department of Periodontology, Endodontology and CariologyUniversity Center for Dental MedicineUniversity of Basel Basel Switzerland
| | - Andrea Beinicke
- Department of Psychology, Work & Organizational PsychologyUniversity of Würzburg Würzburg Germany
| | - Sebastian Soliman
- Department of Operative Dentistry and Periodontology and Center of Dental TraumatologyUniversity Hospital of Würzburg Würzburg Germany
| | - Alexander Schubert
- Department of Operative Dentistry and Periodontology and Center of Dental TraumatologyUniversity Hospital of Würzburg Würzburg Germany
| | | | - David Sonntag
- Department of Operative Dentistry, Periodontology and EndodontologyUniversity Hospital of Düsseldorf Düsseldorf Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology and CariologyUniversity Center for Dental MedicineUniversity of Basel Basel Switzerland
| | - Gabriel Krastl
- Department of Operative Dentistry and Periodontology and Center of Dental TraumatologyUniversity Hospital of Würzburg Würzburg Germany
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Patel S, Lambrechts P, Shemesh H, Mavridou A. European Society of Endodontology position statement: External Cervical Resorption. Int Endod J 2018; 51:1323-1326. [DOI: 10.1111/iej.13008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 12/14/2022]
Affiliation(s)
| | - S. Patel
- Endodontic Postgraduate Unit; King's College London Dental Institute; London UK
- Private Practice; 45 Wimpole Street London UK
| | | | - H. Shemesh
- Academic Center for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - A. Mavridou
- Conservative Dentistry; KU Leuven; Leuven Belgium
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Patel S, Foschi F, Condon R, Pimentel T, Bhuva B. External cervical resorption: part 2 - management. Int Endod J 2018; 51:1224-1238. [PMID: 29737544 DOI: 10.1111/iej.12946] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/30/2018] [Indexed: 12/11/2022]
Abstract
Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2-week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues.
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Affiliation(s)
- S Patel
- Department of Endodontology, King's College London Dental Institute, London, UK.,Specialist Practice, London, UK
| | - F Foschi
- Department of Endodontology, King's College London Dental Institute, London, UK
| | - R Condon
- Department of Endodontology, King's College London Dental Institute, London, UK
| | - T Pimentel
- Department of Endodontology, King's College London Dental Institute, London, UK
| | - B Bhuva
- Department of Endodontology, King's College London Dental Institute, London, UK
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Patel S, Mavridou AM, Lambrechts P, Saberi N. External cervical resorption-part 1: histopathology, distribution and presentation. Int Endod J 2018; 51:1205-1223. [PMID: 29704466 DOI: 10.1111/iej.12942] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/22/2018] [Indexed: 12/13/2022]
Abstract
External cervical resorption (ECR) is the loss of dental hard tissue as a result of odontoclastic action. It is a dynamic process that involves periodontal, dental and in later stages pulpal tissues. Over the last two decades, ECR has attracted increased interest; this is in part due to novel micro-CT and histopathological techniques for its assessment and also improved radiographic detection using CBCT. This literature review will cover the aetiology, potential predisposing factors, histopathology and diagnosis of ECR. Part 2 will cover the management of ECR.
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Affiliation(s)
- S Patel
- Department of Endodontology, King's College London Dental Institute, London, UK.,Specialist Practice, London, UK
| | - A M Mavridou
- Department of Oral Health Services, University of Leuven, Leuven, Belgium
| | - P Lambrechts
- Department of Oral Health Services, University of Leuven, Leuven, Belgium
| | - N Saberi
- Department of Endodontology, King's College London Dental Institute, London, UK
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Matsuda S, Memida T, Mizuno N, Ogawa I, Ouhara K, Kajiya M, Fujita T, Sugiyama E, Kurihara H. Reparative bone-like tissue formation in the tooth of a systemic sclerosis patient. Int Endod J 2018; 51:1059-1066. [PMID: 29480950 DOI: 10.1111/iej.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
AIM To report a case of reparative bone-like tissue formation in the tooth of a patient with systemic sclerosis. SUMMARY A 58-year-old Japanese female patient with systemic sclerosis was referred because of tooth fracture. Cone beam computerized tomography (CBCT) revealed multiple root resorption and the unclear transition from alveolar bone to root profile. A sample from a fractured tooth was analysed histologically. Haematoxylin and eosin-stained sections revealed the irregular replacement of pulp and dentine by bone-like tissue. Calcinosis was noted in various parts of the body and a histological analysis identified it as dystrophic calcification on sclerosed fibrous connective tissue. Bite force and the occlusal area were markedly weaker than the means for female of the same age. KEY LEARNING POINTS CBCT may be more useful than dental radiography for diagnosing multiple root resorption in systemic sclerosis patients. When systemic sclerosis patients have calcinosis, their root status must be examined carefully. When root resorption is present in systemic sclerosis patients, reparative bone-like tissue formation in teeth needs to be taken into account prior to the initiation of dental treatment.
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Affiliation(s)
- S Matsuda
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - T Memida
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - N Mizuno
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - I Ogawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - K Ouhara
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - M Kajiya
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - T Fujita
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - E Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - H Kurihara
- Department of Periodontal Medicine, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University Hospital, Hiroshima, Japan.,Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
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Patel S, Foschi F, Mannocci F, Patel K. External cervical resorption: a three-dimensional classification. Int Endod J 2017; 51:206-214. [DOI: 10.1111/iej.12824] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 07/23/2017] [Indexed: 12/01/2022]
Affiliation(s)
- S. Patel
- Postgraduate Endodontic Unit; King's College Dental Institute; London UK
| | - F. Foschi
- Postgraduate Endodontic Unit; King's College Dental Institute; London UK
| | - F. Mannocci
- Postgraduate Endodontic Unit; King's College Dental Institute; London UK
| | - K. Patel
- Postgraduate Endodontic Unit; King's College Dental Institute; London UK
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