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Blum JS. The various forms of tooth resorption. AUST ENDOD J 2024. [PMID: 38798140 DOI: 10.1111/aej.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Şahin Mantı A, Ulusoy Öİ. An Evaluation of the Fracture Resistance of Teeth with Simulated External Cervical Resorption Cavities Categorized Using Three-Dimensional Classification. J Clin Med 2024; 13:2159. [PMID: 38673432 PMCID: PMC11050918 DOI: 10.3390/jcm13082159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/20/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: External cervical resorption causes dental hard tissue destruction that may reduce the fracture resistance of affected teeth. By using a compressive strength test, this study aimed to evaluate the fracture resistance of teeth with simulated external cervical resorption cavities that have different three-dimensional classifications. (2) Methods: In total, 170 teeth with simulated external cervical resorptions were divided into 16 experimental groups (n = 10) and 1 control group (n = 10) based on the three-dimensional classification: 1Ap, 1Bp, 1Cp, 1Dp, 2Ap, 2Bp, 2Cp, 2Dp, 3Ap, 3Bp, 3Cp, 3Dp, 4Ap, 4Bp, 4Cp, 4Dp and a control group. Defects were restored with mineral trioxide aggregate. The fracture resistances of the samples were statistically analyzed using two-way repeated ANOVA and the Bonferroni correction for multiple comparisons at a significance level of p < 0.05. (3) Results: The lowest resistance to fracture was observed in samples with vertical height level "4" and circumferential spread of "D" (p < 0.001). In the groups with circumferential spreads "B", "C" and "D", there were significant differences between the samples with vertical height levels "1", "2", "3" and "4" regarding fracture resistance (p < 0.001). (4) Conclusions: The circumferential spread and vertical height of the external cervical resorption influenced the fracture resistance of the affected teeth.
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Affiliation(s)
- Arzu Şahin Mantı
- Department of Endodontics, Faculty of Dentistry, Gazi University, Bişkek (8.) Street, 1. Road, No: 8, Emek, Ankara 06490, Turkey;
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Mohammad-Rahimi H, Dianat O, Abbasi R, Zahedrozegar S, Ashkan A, Motamedian SR, Rohban MH, Nosrat A. Artificial Intelligence for Detection of External Cervical Resorption Using Label-Efficient Self-Supervised Learning Method. J Endod 2024; 50:144-153.e2. [PMID: 37977219 DOI: 10.1016/j.joen.2023.11.004] [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: 07/17/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The aim of this study was to leverage label-efficient self-supervised learning (SSL) to train a model that can detect ECR and differentiate it from caries. METHODS Periapical (PA) radiographs of teeth with ECR defects were collected. Two board-certified endodontists reviewed PA radiographs and cone beam computed tomographic (CBCT) images independently to determine presence of ECR (ground truth). Radiographic data were divided into 3 regions of interest (ROIs): healthy teeth, teeth with ECR, and teeth with caries. Nine contrastive SSL models (SimCLR v2, MoCo v2, BYOL, DINO, NNCLR, SwAV, MSN, Barlow Twins, and SimSiam) were implemented in the assessment alongside 7 baseline deep learning models (ResNet-18, ResNet-50, VGG16, DenseNet, MobileNetV2, ResNeXt-50, and InceptionV3). A 10-fold cross-validation strategy and a hold-out test set were employed for model evaluation. Model performance was assessed via various metrics including classification accuracy, precision, recall, and F1-score. RESULTS Included were 190 PA radiographs, composed of 470 ROIs. Results from 10-fold cross-validation demonstrated that most SSL models outperformed the transfer learning baseline models, with DINO achieving the highest mean accuracy (85.64 ± 4.56), significantly outperforming 13 other models (P < .05). DINO reached the highest test set (ie, 3 ROIs) accuracy (84.09%) while MoCo v2 exhibited the highest recall and F1-score (77.37% and 82.93%, respectively). CONCLUSIONS This study showed that AI can assist clinicians in detecting ECR and differentiating it from caries. Additionally, it introduced the application of SSL in detecting ECR, emphasizing that SSL-based models can outperform transfer learning baselines and reduce reliance on large, labeled datasets.
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Affiliation(s)
- Hossein Mohammad-Rahimi
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI on Health, Berlin, Germany; Department of Computer Engineering, Sharif University of Technology, Tehran, Iran
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia
| | - Reza Abbasi
- Department of Computer Engineering, Sharif University of Technology, Tehran, Iran
| | - Samira Zahedrozegar
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ashkan
- Department of Orthodontics, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeed Reza Motamedian
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI on Health, Berlin, Germany; Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, Maryland; Private Practice, Centreville Endodontics, Centreville, Virginia.
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Jeng PY, Chang SH, Wang CY, Lin LD, Jeng JH, Tsai YL. Surgical repair of external cervical resorption - Prognosis and prognostic factors. J Dent Sci 2024; 19:377-386. [PMID: 38303835 PMCID: PMC10829651 DOI: 10.1016/j.jds.2023.08.005] [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: 05/31/2023] [Revised: 08/01/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose External cervical resorption (ECR) is an aggressive form of root resorption, which etiology is unclear and its prognosis remains unpredictable. The purpose of this study was to investigate the prognosis and potential prognostic factors of ECR-affected teeth after surgical intervention for external repair with/without root canal treatment. Materials and methods Treated ECR cases from 2009 to 2019 were collected retrospectively. The survival of the teeth and the status of root resorption were assessed during the follow-up period. Potential prognostic factors were analyzed with log-rank test and Kaplan-Meier statistics. Results A total of 42 treated ECR-affected teeth were enrolled. The two-year survival rate was 71.20% [54.16%, 93.59%]. Persistent root resorption was the main complication after treatment. Patients with multiple ECR-affected teeth had greater recurrent potential than patients with solitary ECR-affected teeth. Prolonged calcium hydroxide dressing may contribute to a more favorable clinical outcome. Gender, age, tooth position and the need for root canal treatment did not show statistically significant effect on the prognosis. Conclusion The current surgical method was able to arrest ECR in most cases. However, the case type (the number of ECR-affected teeth per patient) could highly affect the prognosis of the teeth. Clinicians should consider long-term calcium hydroxide dressing in case of pulp involvement to achieve better results.
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Affiliation(s)
- Po-Yuan Jeng
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shu-Hui Chang
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chen-Ying Wang
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Deh Lin
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiiang-Huei Jeng
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Ling Tsai
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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Mazinis E, Thomaidis V. A Cone-beam Computed Tomography Evaluation of External Invasive Resorption of Unerupted Teeth. Report of Three Cases. J Endod 2023; 49:1747-1753. [PMID: 37758063 DOI: 10.1016/j.joen.2023.09.009] [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: 06/27/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
Tooth resorption can occur either physiologically or pathologically and can be classified as internal or external. The term "external invasive resorption" (EIR) has been used to describe lesions originating from any surface defect exposing dentin. The absence of bacterial contamination, an intact pulp space, and a lesion consisting mainly of fibrovascular tissue characterize EIR. This study presents three cases of invasive resorption in unerupted teeth, emphasizing the importance of cone-beam computed tomography (CBCT). In two cases, the primary defect localized on the enamel surface, while in the third case, the focal point of the defect was not clear. CBCT provided detailed visualization of the resorption lesion's size and its relationship with surrounding structures, enhancing the diagnosis of EIR. Histological analysis of the third case confirmed the initial diagnosis. Invasive resorption can occur due to any surface defect in the case of unerupted teeth. Further research and correlation between radiographic and histological analysis are essential for the detection and classification systems in unerupted teeth.
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Affiliation(s)
- Emmanuel Mazinis
- Department of Endodontology, Dental School, Aristotle University of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Vasilios Thomaidis
- Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Lin S, Marvidou AM, Novak R, Moreinos D, Abbott PV, Rotstein I. Pathogenesis of non-infection related inflammatory root resorption in permanent teeth: A narrative review. Int Endod J 2023; 56:1432-1445. [PMID: 37712904 DOI: 10.1111/iej.13976] [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: 05/17/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The mechanism of action of root resorption in a permanent tooth can be classified as infection-related (e.g., microbial infection) or non-infection-related (e.g., sterile damage). Infection induced root resorption occurs due to bacterial invasion. Non-infection-related root resorption stimulates the immune system through a different mechanism. OBJECTIVES The aim of this narrative review is to describe the pathophysiologic process of non-infection-related inflammatory processes involved in root resorption of permanent teeth. METHODS A literature search on root resorption was conducted using Scopus (PubMed and Medline) and Google Scholar databases to highlight the pathophysiology of bone and root resorption in non-infection-related situations. The search included key words covering the relevant category. It included in vitro and in vivo studies, systematic reviews, case series, reviews, and textbooks in English. Conference proceedings, lectures and letters to the editor were excluded. RESULTS Three types of root resorption are related to the non-infection mechanism of action, which includes surface resorption due to either trauma or excessive orthodontic forces, external replacement resorption and external cervical resorption. The triggers are usually damage associated molecular patterns and hypoxia conditions. During this phase macrophages and clastic cells act to eliminate the damaged tissue and bone, eventually enabling root resorption and bone repair as part of wound healing. DISCUSSION The resorption of the root occurs during the inflammatory phase of wound healing. In this phase, damaged tissues are recognized by macrophages and neutrophiles that secrete interlaukines such as TNF-α, IL-1, IL-6, IL-8. Together with the hypoxia condition that accelarates the secretion of growth factors, the repair of the damaged perioduntiom, including damaged bone, is initiated. If the precementum and cementoblast are injured, root resorption can occur. CONCLUSIONS Wound healing exhibits different patterns of action that involves immune stimulation in a bio-physiological activity, that occurs in the proper sequence, with overlapping phases. Two pathologic conditions, DAMPs and hypoxia, can activate the immune cells including clastic cells, eliminating damaged tissue and bone. Under certain conditions, root resorption occurs as a side effect.
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Affiliation(s)
- Shaul Lin
- The Israeli National Center for Trauma & Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel
- Department of Endodontics, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Athina M Marvidou
- Department of Endodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - Rostislav Novak
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Orthopedic Department, Orthopedic Oncology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Daniel Moreinos
- Endodontic Department, Galilee Medical Center, Nahariya, Israel
| | - Paul Vincent Abbott
- UWA Dental School, The University of Western Australia, Western Australia, Nedlands, Australia
| | - Ilan Rotstein
- University of Southern California, California, Los Angeles, USA
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Askerbeyli Örs S, Küçükkaya Eren S. Effects of different treatment modalities on biomechanical behavior of maxillary incisors with external invasive cervical resorption at different progression levels. Dent Traumatol 2023; 39:605-615. [PMID: 37424177 DOI: 10.1111/edt.12868] [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: 01/16/2023] [Revised: 06/12/2023] [Accepted: 06/18/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND/AIM This study aimed to evaluate the biomechanical behavior of maxillary incisors with external invasive cervical resorption (EICR) at different progression levels after receiving different modes of treatment under occlusal forces using finite element analysis (FEA). MATERIALS AND METHODS Three-dimensional (3D) models of intact maxillary central incisors were constructed and modified to include EICR cavities with different progression levels in the buccal cervical areas. The EICR cavities confined to dentin were repaired using Biodentine™ (Septodont Ltd., Saint Maur des Fausse ́s, France), resin composite, or glass ionomer cement (GIC) . Additionally, EICR cavities with pulp invasion requiring direct pulp capping were simulated as repaired using Biodentine only or 1 mm thick Biodentine and either resin composite or GIC for the rest of the cavity. Moreover, models with root canal treatment and EICR defects repaired using Biodentine, resin composites, or GIC were also generated. A force of 240 N was applied to the incisal edge. The principal stresses in the dentin were evaluated. RESULTS GIC showed more favorable results than the other materials in EICR cavities confined to the dentin. However, Biodentine alone resulted in more favorable minimum principal stresses (Pmin ) compared to other materials in EICR cavities with close pulp proximity. Exceptionally, the models localized in the coronal third of the root with a circumferential extension of the cavity >90° showed more favorable results for GIC. The presence of root canal treatment had no significant effect on stress values. CONCLUSIONS Based on this FEA study the use of GIC in EICR lesions confined to the dentin is recommended. However, Biodentine may be a better option for restoring EICR lesions close to the pulp with or without root canal treatment. Except when the circumferential extension of the cavity is >90°, the use of GIC may be more advantageous.
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Affiliation(s)
- Sevinc Askerbeyli Örs
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Selen Küçükkaya Eren
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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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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Alani A, Tewari N, Calvert G. Contemporary issues in the management of dental trauma. Br Dent J 2023; 235:946-956. [PMID: 38102262 DOI: 10.1038/s41415-023-6564-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 12/17/2023]
Abstract
Contemporary diagnosis and management of traumatic dental injuries requires a multifaceted understanding of the pathological and psychological impact over a patient's lifetime. The legacy of dental trauma injuries can have repercussions for the dentition and supporting tissues, requiring complicated multidisciplinary clinical input. Foresight is required to ensure optimal aesthetic and functional outcomes. Mitigating risks and maximising benefits in patients presenting with polytrauma can be challenging, but if optimally managed at the acute presentation, the long-term burden to the patient and the clinician is reduced. This paper aims to discuss the contemporary clinical dilemmas, challenges and controversies related to the management of dental trauma.
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Affiliation(s)
- Aws Alani
- King´s College Hospital, London, United Kingdom.
| | - Nitesh Tewari
- All India Institute of Medical Sciences, New Delhi, India
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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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Stefopoulos S, Kodonas K, Tzanetakis GN. Long-Term Clinical and Radiographic Observation of Previously Regenerated Treated Incisors Subjected to Orthodontic Movement. A Case Series. J Endod 2023; 49:1487-1494. [PMID: 37657730 DOI: 10.1016/j.joen.2023.08.015] [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: 05/28/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
INTRODUCTION With an increasing number of anterior traumatized teeth treated with regenerative endodontic procedures (REPs) nowadays, orthodontic movement of such teeth is expected to become a common scenario in everyday clinical practice. However, little is known about the clinical implications and the response capacity of regenerated tissues to orthodontic forces. METHODS The aim of this clinical article was to report on 4 cases of REP-treated immature anterior permanent teeth subjected to orthodontic forces, and to describe the long-term response of the regenerated apical and intracanal tissues. RESULTS Signs of orthodontic-induced external root resorption were observed in 2 of the 4 presented cases without, however, the presence of any associated adverse events. No other complications were observed, either clinically or radiographically, throughout the observation period. In the long-term, all 4 cases responded favorably to orthodontic forces, maintaining healthy apical tissues and structural integrity of both intracanal as well as apically regenerated tissues. CONCLUSIONS The orthodontic movement of REP-treated teeth seems feasible, nevertheless, special care should be implemented. Lightly acting orthodontic forces, short duration of active movement, and close monitoring of the patient seem to be prerequisites to limit complications to a minimum and achieve a favorable healing of REP-treated teeth in the long-term following orthodontic treatment completion.
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Affiliation(s)
| | - Kostas Kodonas
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giorgos N Tzanetakis
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
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Huang J, Walsh RM, Witherspoon DE, Khalighinejad N, Tam EC, Jalali P, He J. The prevalence, characteristics, and risk factors of external cervical resorption: a retrospective practice-based study. Clin Oral Investig 2023; 27:5595-5604. [PMID: 37493728 DOI: 10.1007/s00784-023-05180-2] [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: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES External cervical root resorption (ECR) is a poorly understood and aggressive form of resorption. The purpose of this study was to examine the prevalence, characteristics, and risk factors associated with the occurrence of ECR in patients seeking endodontic care from private practice settings. MATERIALS AND METHODS Records of 343 patients with 390 teeth diagnosed with ECR were identified from 3 private endodontic practices from 2008 to 2022. The patients' demographic information, systemic conditions, and dental history were recorded. The characteristics of the cases including Heithersay classification, pulpal and periapical status, and their management were documented. The association between case severity and potential predisposing factors was examined using chi-square analysis. RESULTS The overall prevalence of ECR among patients seeking endodontic care was low (< 1%). However, there was a greater than twofold increase in the pooled prevalence from 2016 to 2021 (0.99%) compared to the data from 2010 to 2015 (0.46%). The most commonly affected teeth were anterior teeth (48.7%). Class II (30.0%) and class III (45.4%) defects were the most often identified. Patients with a history of trauma or orthodontic treatment were significantly more likely to be diagnosed with severe cervical resorption (class III or IV) (p < 0.05). CONCLUSIONS There has been an increase in the prevalence of ECR in patients seeking endodontic care. A history of orthodontic treatment and traumatic dental mechanical injuries may predict the severity of resorption. CLINICAL RELEVANCE The upward trend in the occurrence of ECR warrants close monitoring of the patients at high risk of developing the condition to facilitate early detection and management.
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Affiliation(s)
- Jenny Huang
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | - Ryan M Walsh
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | | | | | - Esther C Tam
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | - Poorya Jalali
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | - Jianing He
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA.
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Chan F, Brown LF, Parashos P. CBCT in contemporary endodontics. Aust Dent J 2023; 68 Suppl 1:S39-S55. [PMID: 37975281 DOI: 10.1111/adj.12995] [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] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
Cone-beam computed tomography (CBCT) is a three-dimensional imaging modality which can aid endodontic diagnosis and treatment planning. While there are guidelines available describing the indications, there are divergent philosophies on when this technology should be applied in clinical practice. This paper reviews the applications of CBCT including the clinical relevance of parameters which can be assessed, highlights the limitations of this technology, and provides guidance on how to maximise its clinical utility.
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Affiliation(s)
- F Chan
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - L F Brown
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - P Parashos
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
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Fonseca Tavares WL, Diniz Viana AC, Lucas Ferreira MV, da Costa Ferreira G, da Costa Ferreira I, Alves de Mesquita R, Amaral RR. Guided tissue regeneration in class IV external cervical resorption: A case report. J Endod 2023:S0099-2399(23)00284-4. [PMID: 37245653 DOI: 10.1016/j.joen.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/07/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Abstract
External cervical resorption (ECR) is a type of dental resorption that originates from the loss of the cementum's protective layer. The direct exposure of dentin to the periodontal ligament may lead to the invasion of clastic cells through an entry point on the external root surface into the dentinal tissue, causing resorption. Depending on the extension of ECR, different treatments are proposed. Although the literature presents distinct materials and methods for restoring ECR areas, an existing gap is related to care in the treatment of the supporting periodontal tissue. Guided tissue regeneration/guided bone regeneration (GTR/GBR) includes the stimulation of bone formation in bone defects using different types of membranes (resorbable and non-resorbable), regardless of its association with bone substitutes or grafts. Despite the benefits of guided bone regeneration, the application of this method in cases of ECR is still under-explored in the literature. Thus, the present case report uses GTR with xenogenic material and polydioxanone (PDO) membrane in a case of class IV ECR. The success of the present case is related to the correct diagnosis and treatment plan. Complete debridement of resorption areas and restoration with biodentine were effective in tooth repair. GTR contributed to the stabilization of supporting periodontal tissues. The association of the xenogeneic bone graft with the PDO membrane proved to be a viable option for restoring the health of the periodontium.
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Affiliation(s)
- Warley Luciano Fonseca Tavares
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Ana Cecília Diniz Viana
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Gabriela da Costa Ferreira
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Isabella da Costa Ferreira
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves de Mesquita
- Department of Clinic, Pathology and Surgery, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rodrigo Rodrigues Amaral
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Australia
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Nosrat A, Dianat O, Verma P, Levin MD, Price JB, Aminoshariae A, Rizzante FAP. Response to the letter by Jonathan A. Mason. J Endod 2023:S0099-2399(23)00212-1. [PMID: 37061163 DOI: 10.1016/j.joen.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
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External Cervical Resorption: Relationships Between Classification, Treatment, and One-Year Outcome with Evaluation of the Heithersay and Patel Classification Systems. J Endod 2023; 49:469-477. [PMID: 36931461 DOI: 10.1016/j.joen.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/17/2023]
Abstract
INTRO The purpose of this study was to identify possible associations between classification, treatment, and one-year outcome of external cervical resorption (ECR) lesions using the Heithersay and Patel systems. Performance of the Patel 3-dimensional classification system was also evaluated. METHODS A chart review identified 142 cases of ECR over a twelve-year period. Information regarding demographics, predisposing factors, lesion classification, treatment, and outcomes were collected and analyzed. Inter- and intra-observer reliability analyses were conducted for both classification systems. RESULTS There were 72 cases with at least one year of follow up. 70% of these cases survived. Treatment recommendations were correlated with both Heithersay and Patel classification. There were no correlations found between one-year outcome and either classification or treatment done. The weighted reliability analysis showed substantial agreement in both classification systems for both inter- and intra-observer agreement. There was a significant association between the two systems, however the Heithersay system tended to underestimate the apical extent of the lesion. CONCLUSIONS Periodic review of ECR lesions presents as a viable treatment option, at least for one year after diagnosis. The Patel 3-D classification system is at least as effective as the Heithersay system and should be used in future ECR prognosis studies. Further long-term outcome assessments are still needed.
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Mason JA. Interpretation of Results. J Endod 2023:S0099-2399(23)00174-7. [PMID: 36990314 DOI: 10.1016/j.joen.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/08/2023] [Indexed: 03/30/2023]
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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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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: 20] [Impact Index Per Article: 10.0] [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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