Management of invasive cervical resorption in a maxillary central incisor

The Disease Process, Diagnosis and Treatment of Invasive Cervical Resorption: A Review

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.

Management of merged external/internal root resorption using CEM cement: a case report

Chronic pulpal inflammation and infection are the main predisposing factors for internal and external root resorption (IRR & ERR); however, merging of IRR and ERR is a rare lesion which rigorously alters the anatomy of root canals. This study reports a case of merged IRR and ERR in an asymptomatic maxillary left central incisor in a 33-year old Caucasian woman that was managed by one-visit root canal therapy (RCT) using calcium-enriched mixture (CEM) cement. Radiographic examination showed a short root with under-filled root canal obturation associated with ERR/IRR and an apical lesion. After thorough chemo-mechanical preparation, the root canal was obturated with CEM cement; one week later, the access cavity was permanently restored. Clinical/radiographic examinations at 1-year follow-up revealed uneventful healing, reestablishment of lamina dura and stabilization of the resorptive defects. The treatment outcome demonstrates that one-visit RCT using CEM cement may be a viable treatment option in cases with merged external/internal root resorption. Further clinical trials with a larger number of cases are suggested to document a higher level of evidence.

Prosthetically adverse implant position: an aesthetic surgical-prosthetic solution. Case report

Clinical case of a 43-year-old female patient treated at the clinic of Universidad Nacional Mayor de San Marcos, Peru, in 2015 for aesthetic problems in the activation of a unitary implant placed at a distal and vestibular direction from the ideal position. The clinical examination revealed the vestibularization of the implant at the level of the upper right central incisor with the healing abutment visible above the gingival line and high gingival smile. Connective tissue grafts and ovoid pontics were carried out in order to improve the characteristics of the peri-implant tissue. This clinical case evidenced an improvement of the soft tissue profile and patient satisfaction regarding her smile. The management of a vestibularized implant may be solved through the management of ovoid pontics and connective tissue grafts.

Characteristics and treatment of invasive cervical resorption in vital teeth. A narrative review and a report of two cases

Invasive cervical resorption (ICR) is a significant defect of the root surface where the hard dental tissues are undermined and become translucent due to the resorptive granulomatous tissue. It is mainly detected on radiographs. The radiographic appearance of ICR is asymmetrical radiolucency with irregular margins and an unchanged root canal. The purpose of this study is to present a comprehensive review together with the characteristics and the treatment of ICR through two cases which were followed-up for 36 months. In both cases the teeth were vital and the management consisted of raising a flap, granulomatous tissue removal, thorough debridement, restoration of the resorptive defect by placing a suitable filling material and follow-up examinations. Our results indicate that the specific treatment protocol has very positive outcomes. After 36 months pulpal vitality tests revealed a healthy pulp, and clinical and radiographic examination confirmed a stable periodontal condition.

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

Internal bleaching in endodontically treated teeth requires care and protection to prevent harm to the periodontal ligament due to peroxide and may result in external root resorption. There is a myriad of treatment options when this occurs, such as monitoring, extraction, and subsequent rehabilitation with implants or fixed prosthodontics. In some cases, such as the one described here, a conservative attempt to maintain the tooth as a single structure can be made by sealing the resorptive defect. In the present case, we show a multidisciplinary approach where orthodontics, periodontics, and restorative dentistry were involved in treating the maxillary right central incisor (#8) of a 65-year-old patient with extensive cervical resorption, whose chief complaint was esthetics. The proposed treatment was extrusion of the tooth followed by curettage and restoration of the defect with glass ionomer cement. The patient has been followed for 15 years with no signs of recurrence, maintenance of periodontal health, and patient satisfaction with the esthetic outcome.