External cervical resorption: Radiological diagnosis and literature (Review)

Idiopathic Intracoronal Resorption of Permanent Molars: A Report of Two Cases

Intracoronal resorption (IR) is a condition characterized by the presence of lesions in the dentin of unerupted or erupting teeth, usually located just below the enamel-dentin junction in the occlusal part of the crown. This article presents two cases of IR-one with and one without pulp involvement. In both cases, the teeth were asymptomatic, and the lesions were discovered during routine checkups. The first case presents pre-eruptive IR with pulp involvement in an immature mandibular molar. To preserve the vitality of the growth zone and complete root development, vital pulp therapy was performed through total coronal pulpotomy and application of Biodentine. The second case is also of a mandibular molar with incomplete root development, but although it initially resembled invasive cervical resorption, treatment revealed that the granulation tissue was surrounded by intact enamel and did not affect the pulp or root of the tooth. No carious lesion was found. The tooth was conventionally restored with a composite filling.

Long-term prognosis for teeth with external cervical resorption based on periapical images and cone beam CT: A clinical study

AIM

To evaluate whether supplemental information from CBCT changed long-term prognosis for teeth with external cervical resorption (ECR) compared to periapical (PA) images. Furthermore, to assess predictive findings in PA images and evaluate which findings in CBCT affected the long-term prognosis of teeth with ECR.

METHODOLOGY

One hundred and ninty-four patients, mean age 41.2, range 13-81, having 244 teeth with ECR were included. An initial long-term prognosis determined either good or poor was established based on intraoral images. Afterwards, the patients underwent CBCT, and final long-term prognosis was decided. From the PA images and CBCT, ECR using Heithersay's classification system, pulp involvement and extension of ECR was assessed. In CBCT, the number of surface lesion(s) was additionally assessed. Descriptive statistics evaluated changes in long-term prognosis after CBCT. Logistic regression analyses tested if findings in PA images and CBCT affected the long-term prognosis.

RESULTS

Based on CBCT, out of 244 teeth the long-term prognosis was assessed to be poor for 173 (70.9%) teeth and good for 71 (29.1%) teeth. The long-term prognosis changed in 76 (31.1%) teeth after CBCT; 5 (2.0%) changed from poor to good, and 71 (29%) changed from good to poor long-term prognosis. In 81 (33.2%) teeth the H-class increased, and in 10 (4.1%) teeth the H-class decreased after assessing CBCT. In 70 (28.7%) teeth, there was a change from no pulp involvement to involvement of the pulp after CBCT; eight (3.3%) teeth changed in the opposite direction. H-class 2 and 4 in PA images significantly increased the probability for a change in long-term prognosis compared to an H-class 3 (p < .05). H-class 4, pulp involvement, ECR in the oral 1/3 of the root, and more than two surface lesions seen in CBCT significantly influenced a poor long-term prognosis (p < .05).

CONCLUSIONS

Supplemental information from CBCT changed long-term prognosis in almost one third of teeth with ECR. In most cases, the long-term prognosis changed from good to poor. H-class 3 in PA images had a significant influence on change in long-term prognosis. Several findings in CBCT influenced a poor long-term prognosis.

A novel diode laser intervention in the management of external invasive cervical resorption

"Invasive cervical resorption (ICR)" is a rare category of "external root resorption." It is a progressive and destructive condition with an unclear cause. Managing external "ICR" presents a significant challenge, even to the most seasoned dental professionals. The removal of excessively vascularized granulation tissue is viewed as a pivotal step. This case report highlights the use of a diode laser to excise granulation tissue, by achieving optimal tissue ablation, promoting better healing, and subsequently restoring the severely damaged crown of the external ICR tooth with an intracanal fiber post.

Conservative management of an advanced external cervical resorption with internal approach using bio-ceramic materials: A case report

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.

Early detection of external cervical resorption in posterior teeth: a radiographic, cross-sectional study of an adolescent population

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.

Sub-clinical Cervical Root Resorption: A Case Report

External cervical resorption (ECR) is a dynamic pathological process characterized by its cervical position on the root and arises below the epithelial attachment and the coronal part of the bone. This report will highlight a case of ECR in an asymptomatic patient. A radiolucent area was noted during a routine dental follow-up examination on the bitewings at the mesial surface of the upper right second premolar. Persistently, the radiolucency had multiple radiographic views indicating a true form of a lesion that could be diagnosed as external cervical resorption. The patient did not report any complaints since dental treatment was completed in 2016. After a series of radiographs and conducting further diagnostic measures, a diagnosis of ECR was confirmed. The best treatment of choice for this case was extraction and restoring the missing tooth with an implant-supported crown. The size and the extent of such a defect could affect the strategy for implant placement. This paper aimed to report that ECR can be asymptomatic for a long time with advanced cervical root resorption in some cases.