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Wang Z, Zhang J, Sun X, Yu J, Liu B, Peng B, Wang L, Yang J, Zhu L. Nanoparticulate bioceramic putty suppresses osteoclastogenesis and inflammatory bone loss in mice via inhibition of TRAF6-mediated signalling pathways: A laboratory investigation. Int Endod J 2024; 57:682-699. [PMID: 38403990 DOI: 10.1111/iej.14051] [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: 08/10/2023] [Revised: 01/27/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
AIM This study aimed to determine the effects of iRoot BP Plus on receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclastogenesis in vitro and inflammation-mediated bone resorption in vivo and investigated the underlying molecular mechanisms. METHODOLOGY CCK-8 was performed to test cell viability in RANKL-induced RAW 264.7 cells and BMDMs in response to iRoot BP Plus. The effect of iRoot BP Plus on osteoclastogenesis was determined using TRAP staining and phalloidin staining, respectively. Pit formation assay was conducted to measure osteoclast resorptive capacity. Western blot and qPCR were performed to examine osteoclast-related proteins and gene expression, respectively. Western blot was also used to investigate the signalling pathways involved. For in vivo experiments, an LPS-induced mouse calvarial bone resorption model was established to analyse the effect of iRoot BP Plus on bone resorption (n = 6 per group). At 7 days, mouse calvaria were collected and prepared for histological analysis. RESULTS We identified that iRoot BP Plus extracts significantly attenuated RANKL-induced osteoclastogenesis, reduced sealing zone formation, restrained osteolytic capacity and decreased osteoclast-specific gene expression (p < .01). Mechanistically, iRoot BP Plus extracts reduced TRAF6 via proteasomal degradation, then suppressed the phosphorylation of mitogen-activated protein kinases (MAPKs), blocked the nuclear translocation of c-Fos and diminished nuclear factor-κB (NF-κB) p65 and NFATc1 accumulation. Consistent with the in vitro results, iRoot BP Plus extracts attenuated osteoclast activity thus protecting against inflammatory bone resorption in vivo (p < .05), which was accompanied by a suppression of TRAF6, c-Fos, NFATc1 and cathepsin K expression. CONCLUSION These findings provide valuable insights into the signalling mechanisms underlying nanoparticulate bioceramic putty-mediated bone homeostasis.
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Affiliation(s)
- Zijun Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jie Zhang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiaoyue Sun
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jingjing Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bingqian Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bin Peng
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Li Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jingwen Yang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lingxin Zhu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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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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Merrick D, Duncan HF, Bolas A, Hughes A, O'Sullivan M. Multiple External Cervical Resorption Lesions in Patient with Graft versus Host Disease Treated with Systemic Bleomycin: A Case Report. J Endod 2024; 50:674-679. [PMID: 38311117 DOI: 10.1016/j.joen.2024.01.019] [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: 11/06/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
The phenomenon of multiple external cervical root resorption (ECRR) lesions in a single patient is rare but may have a link with the chemotherapeutic agent bleomycin. This case details an adult male with multiple ECRR lesions that developed following chemotherapy. His treatment regimen for Hodgkin's lymphoma included the chemotherapeutic antibiotic bleomycin, which has previously been linked with development of multiple ECRR lesions. The patient developed graft versus host disease following an allogeneic stem cell transplant, which could have a significant role in the development and promotion of the ECRR lesions. In total, 8 teeth developed ECRR, and all the known causative factors were excluded when examined. To our knowledge, this is only the second reported case in the literature to link bleomycin to multiple ECRR lesions. This case report aims to bring the reader's attention to the fact that multiple cervical resorption lesions can develop simultaneously. These lesions can be difficult to diagnose and treat and are often misdiagnosed as caries. Finally, the reader should consider the possible role of bleomycin and graft versus host disease in development of multiple lesions of ECRR.
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Affiliation(s)
- Daniel Merrick
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland.
| | - Henry F Duncan
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Andrew Bolas
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Annie Hughes
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Michael O'Sullivan
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
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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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Swetha B, Malini DL, Mohan TM, Priya BD, Reddy OA, Haripriya G. Evaluation of rise in pH and oxygen release at the site of simulated external root resorption cavities using different oxygen-releasing biomaterials: An in vitro study. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:337-341. [PMID: 38634020 PMCID: PMC11019801 DOI: 10.4103/jcde.jcde_39_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 04/19/2024]
Abstract
Context External inflammatory root resorption has rapid onset and progresses aggressively. It leads to cementum loss, which allows communication between the infected pulp and the periodontium through the denuded dentinal tubules. Primary management strategy includes adequate chemomechanical debridement and lesion arrest for which maintaining alkaline pH and aerobic conditions is essential for healing and repair of the resorption defect. Aims The aim of this study is to evaluate rise in pH and oxygen release at the site of simulated external root resorption cavities using different oxygen-releasing biomaterials. Materials and Methods In 40 extracted single-rooted teeth access opening and chemomechanical debridement were done. Cavities simulating resorption defect are prepared on the roots. The samples are divided into four groups (n = 10) based on the biomaterial used. After placing the biomaterial, the root apices were sealed. Half of the samples from each group were tested for oxygen release using dissolved oxygen meter and the other half for rise in pH using pH meter at 7, 14, 21, and 28 days. Statistical Analysis The pH values were analyzed using Friedman 2-way analysis of variance (ANOVA) and Kruskal-Wallis test. Oxygen release was measured using the two-way and repeated-measures ANOVA. Results Calcium peroxide group showed the highest mean pH and oxygen release than other groups at any given point of time. Conclusions Incorporating oxygen-releasing biomaterials such as calcium peroxide and perfluorodecalin into intracanal medicaments, such as calcium hydroxide, creates an alkaline and oxygen-enriched milieu in the periapical tissues.
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Affiliation(s)
- Bollineni Swetha
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Duvvuri Lakshmi Malini
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - T. Murali Mohan
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - B. Devi Priya
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - O. Asha Reddy
- Department of Conservative Dentistry and Endodontics, Balaji Dental College, Telangana, India
| | - G. Haripriya
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
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Khosravifard N, Vadiati Saberi B, Khosravifard A, Hendi A, Shadi K, Mihandoust S, Yousefi Z, Mortezaei T, Ghaffari ME. Introducing a new auto edge detection technique capable of revealing cervical root resorption in CBCT scans with pronounced metallic artifacts. Sci Rep 2024; 14:4245. [PMID: 38379025 PMCID: PMC10879123 DOI: 10.1038/s41598-024-54974-1] [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: 11/27/2023] [Accepted: 02/19/2024] [Indexed: 02/22/2024] Open
Abstract
Cervical resorption is a serious threat to the longevity of the teeth. In this study, the Canny edge-detection algorithm was applied on CBCT images to compare the accuracy of original and Canny views for diagnosing cervical resorption in endodontically treated teeth. Intracanal metallic posts were inserted in 60 extracted teeth being randomly divided into three groups: control, 0.5 mm, and 1 mm cervical resorption. CBCT scans of the teeth were presented to three observers in both original and Canny formats with the accuracy being determined by receiver operating characteristic (ROC) analysis. The DeLong test was used for paired comparisons with the significance level set at 0.05. The highest accuracy belonged to Canny images in 1 mm resorption, followed by Canny images in 0.5 mm resorption, original images in 1 mm resorption, and original images in 0.5 mm resorption, respectively. The Canny images were significantly more accurate in the diagnosis of 0.5 mm (p < 0.001) and 1 mm (p = 0.009) resorption. Application of the Canny edge-detection algorithm could be suggested as a new technique for facilitating the diagnosis of cervical resorption in teeth that are negatively affected by metallic artifacts.
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Affiliation(s)
- Negar Khosravifard
- Department of Oral and Maxillofacial Radiology, Dental Sciences Research Center, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran.
| | - Bardia Vadiati Saberi
- Department of Periodontics, Dental Sciences Research Center, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Amir Khosravifard
- Department of Mechanical Engineering, Shiraz University, Shiraz, Iran
| | - Amirreza Hendi
- Department of Dental Prosthesis, Dental Sciences Research Center, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Kimia Shadi
- Department of Oral and Maxillofacial Radiology, Dental Sciences Research Center, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Sanaz Mihandoust
- Department of Oral and Maxillofacial Radiology, Dental Sciences Research Center, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Yousefi
- Department of Oral and Maxillofacial Radiology, Dental Caries Prevention Research Center, School of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Tahereh Mortezaei
- Department of Oral and Maxillofacial Radiology, Dental Sciences Research Center, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
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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: 0] [Impact Index Per Article: 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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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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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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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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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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Musilli M, Iuorio MT, Vaia E, Vaia E, Ramaglia L, D’Antò V. Biomechanically and Periodontally-Based Orthodontic Treatment of a Patient with Upper Canine Affected by External Cervical Resorption (ECR): A Case Report. Dent J (Basel) 2023; 11:278. [PMID: 38132416 PMCID: PMC10743157 DOI: 10.3390/dj11120278] [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: 10/09/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
(1) Background: Orthodontic treatment may be a potential predisposing factor for ECR. The affected tooth goes to ankylosis, which could lead to a malocclusion. Although teeth severely affected by ECR (class IV Heithersay) are usually extracted, this case report aims to present the use of an ECR class IV upper canine, both as ankylosed to solve the malocclusion and the occlusal plane canting, as well as not ankylosed to correct its ridge defect with orthodontic extrusion. (2) Methods: A 14-year-old male, complaining of an ugly smile and a failed orthodontic attempt to recover an impacted canine, was referred to the orthodontic clinic. He was diagnosed with class II right subdivision, midline deviation, both upper and lower occlusal plane canting, and an upper left canine, previously impacted, showing ECR class IV. The treatment first included canting resolution with a cantilever and a spring, exploiting the anchorage offered by the ankylosed ECR canine. Then, a coronectomy, endodontic treatment, and orthodontic extrusion of that canine were performed to obtain the implant site development. (3) Results: Clinical and radiographic outcomes showed normocclusion and better bony conditions for safer implant placement in the aesthetic zone. (4) Conclusions: The high aesthetics and the periodontal and bony conditions obtained are probably not achievable by other therapeutic alternatives.
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Affiliation(s)
| | - Morena Tina Iuorio
- Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, 80131 Naples, Italy; (M.T.I.); (E.V.); (E.V.); (L.R.)
| | - Emanuele Vaia
- Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, 80131 Naples, Italy; (M.T.I.); (E.V.); (E.V.); (L.R.)
| | - Enzo Vaia
- Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, 80131 Naples, Italy; (M.T.I.); (E.V.); (E.V.); (L.R.)
| | - Luca Ramaglia
- Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, 80131 Naples, Italy; (M.T.I.); (E.V.); (E.V.); (L.R.)
| | - Vincenzo D’Antò
- Department of Neuroscience, Reproductive Science and Oral Science, University of Naples Federico II, 80131 Naples, Italy; (M.T.I.); (E.V.); (E.V.); (L.R.)
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Muromachi K, Hosomichi K, Park H, Yamaguchi T, Tani-Ishii N. Identification of Candidate Genes of Familial Multiple Idiopathic Cervical Root Resorption. J Endod 2023; 49:1537-1547. [PMID: 37742719 DOI: 10.1016/j.joen.2023.09.008] [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: 03/30/2023] [Revised: 09/12/2023] [Accepted: 09/17/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Multiple idiopathic cervical root resorption (MICRR) is a disease with an unknown etiology that causes invasive cervical root resorption in multiple teeth. Although previous MICRR genomic studies have identified candidate gene variants, the etiology of the condition remains poorly understood. In the present study, we investigated the genetic causality of MICRR to explore candidate variants. METHODS Saliva samples from a family containing 2 affected and two unaffected subjects with the dominant transmission of MICRR were subjected to whole-exome sequencing. RESULTS As a result, we identified novel candidate variants of 10 genes. Each variant was confirmed by Sanger sequencing. Among them, the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) guidelines classified doublecortin domain containing 1 (c.1099 C > T) and β-defensin 114 (c.189 T > G) as "pathogenic," and solute carrier family 45 member 2 (c.152_153del) as "likely pathogenic." CONCLUSIONS These results provide new insight to help clarify the pathogenesis of MICRR, and the variants could be applied for further investigation to understand invasive cervical root resorption.
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Affiliation(s)
- Koichiro Muromachi
- Department of Endodontics, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan.
| | - Kazuyoshi Hosomichi
- Laboratory of Computational Genomics, School of Life Science, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Heetae Park
- Department of Orthodontics, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
| | - Tetsutaro Yamaguchi
- Department of Orthodontics, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan.
| | - Nobuyuki Tani-Ishii
- Department of Endodontics, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
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Rajeshwari HRS, Kishen A. Periodontal Fibroblasts-Macrophage Crosstalk in External Inflammatory Root Resorption. J Endod 2023; 49:1145-1153.e3. [PMID: 37268291 DOI: 10.1016/j.joen.2023.05.016] [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: 04/21/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
INTRODUCTION This study aimed to understand the influence of periodontal fibroblasts (PDLFs) on clastic differentiation of macrophages (Mφ) in different resorptive environments. METHODS PDLF-Mφ direct coculture (juxtacrine) was seeded on dentin, cementum, and polystyrene with/without lipopolysaccharide, macrophage colony-stimulating factor, and receptor activator of nuclear factor kappa beta ligand for 7 and 14 days and stained for tartrate-resistant acid phosphatase (TRAP) activity. PDLF-Mφ cocultured on polystyrene were immunostained for CD80, CD206, NFATc1, STAT6, and periostin, and cell culture supernatants were assessed for cytokines on days 2 and 7. Mφ grown in conditioned media of PDLFs (paracrine) and Mφ monoculture were used as controls. Data was analyzed using Student t test and one-way analysis of variance with the Tukey multiple comparisons test (P < .05). RESULTS PDLF-Mφ coculture showed a higher number of TRAP-positive multinucleated cells than Mφ monoculture on dentin and polystyrene. No TRAP-positive multinucleated cells were observed in paracrine and cementum. The expression of CD80 and CD206 in PDLF-Mφ was similar at day 2, whereas CD206 was greater than CD80 at day 7. The expression of STAT6 was greater than NFATc1 at both days 2 and 7 (P < .05). Periostin expression in the presence of the lipopolysaccharide, macrophage colony-stimulating factor, and receptor activator of nuclear factor kappa beta ligand combination was down-regulated in PDLF monoculture, whereas it was up-regulated in PDLF-Mφ coculture. The cytokine profile of PDLF-Mφ on day 2 was predominated by interleukin (IL)-1β, tumor necrosis factor alpha, and MMP9 and MMP2 on day 7. IL-6 and IL-8 showed steady expression at both days 2 and 7. CONCLUSIONS The study highlights the juxtacrine effect of PDLFs on the clastic differentiation of Mφ with a difference in clastic activity between dentin and cementum. The study also emphasizes the temporal effect of tumor necrosis factor alpha, MMP2, MMP9, and IL-1β on intercellular crosstalk in resorptive environments.
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Affiliation(s)
| | - Anil Kishen
- The Kishen Lab, Dental Research Institute, University of Toronto, Toronto, Ontario, Canada; Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; School of Graduate Studies, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Dao V, Mallya SM, Markovic D, Tetradis S, Chugal N. Reprint of: Prevalence and Characteristics of Root Resorption Identified in Cone-Beam Computed Tomography Scans. J Endod 2023; 49:692-702. [PMID: 37315998 DOI: 10.1016/j.joen.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Root resorption is a destructive process that compromises tooth structure and can result in tooth loss. Often it remains asymptomatic and is an incidental finding on radiographic examinations. The purpose of this study was to determine prevalence and characteristics of root resorption in patients referred for cone-beam computed tomography (CBCT) imaging for a variety of indications. METHODS The study included CBCT scans of 1086 consecutive patients referred for CBCT imaging over an 18-month period. A total of 1148 scans were acquired. Data were abstracted from radiology reports, and prevalence estimates of resorption were computed for the aggregate sample and also across specific indications. RESULTS Resorption was identified in 171 patients (15.7%, 95% CI: 13.6%-17.9%) and in 249 teeth with a prevalence range of 2.6%-92.3% across specific indications. An 18.7% of the patients had 2 resorption sites whereas 8.8% had 3 or more resorption sites. The majority of affected teeth were anteriors (43.8%), followed by molars (40.6%) and premolars (14.5%). The most prevalent resorption types were external (29.3%), cervical (22.5%), infection-induced apical resorption (13.7%), internal (9.6%), and impacted tooth induced (8.8%). The majority of teeth with resorption did not have prior endodontic treatment (73.9%) and had radiographically normal periapex (69.5%). Of 249 teeth with resorption, 31% presented as incidental finding. The prevalence of incidental findings of resorption increased with age, P < .05, and was significantly lower for anterior teeth (20.2%) as compared to premolars (41.7%) and molars (36.6%), (P < .05). CONCLUSION The high proportion of incidental findings of resorption detected by CBCT suggests that resorption is not recognized/detected by conventional radiography and therefore remains underdiagnosed.
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Affiliation(s)
- Vi Dao
- UCLA School of Dentistry, Section of Endodontics, Los Angeles, California
| | - Sanjay M Mallya
- UCLA School of Dentistry, Section of Oral and Maxillofacial Radiology, Los Angeles, California
| | - Daniela Markovic
- David Geffen School of Medicine, Division of General Internal Medicine and Health Sciences Research, Los Angeles, California
| | - Sotirios Tetradis
- UCLA School of Dentistry, Section of Oral and Maxillofacial Radiology, Los Angeles, California
| | - Nadia Chugal
- UCLA School of Dentistry, Section of Endodontics, Los Angeles, California.
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Elmatary A, Longridge N, Jarad F. IS EXTERNAL CERVICAL RESORPTION AN ESTABLISHED MANIFESTATION OF SYSTEMIC SCLEROSIS? A CASE REPORT. J Endod 2023:S0099-2399(23)00278-9. [PMID: 37211310 DOI: 10.1016/j.joen.2023.05.008] [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: 03/24/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
AIM Scleroderma, or systemic sclerosis, is a multisystem autoimmune disorder characterized by hardening and fibrosis of the skin. To date, only a small number of case reports have established a relationship between scleroderma and external cervical resorption (ECR). The aim of this case report is to document the case of a patient with multiple external cervical resorption lesions, who was referred to our unit. SUMMARY A 54-year-old female patient, with a 10-year history of systemic sclerosis diagnosed by her rheumatologist, was referred to our unit regarding extensive ECR. A total of 14 maxillary and mandibular teeth with ECR were detected by clinical examination and cone-beam computed tomography (CBCT). The characteristic vascularity of resorptive defects with profuse bleeding upon probing was not evident. The patient declined any active treatment owing to the desire to avoid lengthy and unpredictable treatment, which may hasten the loss of her teeth. CONCLUSIONS General practitioners should be aware of the relationship between connective tissue disorders and ECR. Although not well established in the literature, the vascular changes implicated in scleroderma may stimulate the odontoclastic processes involved in ECR.
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Affiliation(s)
- Ahmed Elmatary
- Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS.
| | - Nicholas Longridge
- Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS
| | - Fadi Jarad
- Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS
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18
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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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Ricucci D, Milovidova I, Amantea M, Girone C, Rôças IN, Siqueira JF. Histologic features of external cervical resorption affecting impacted maxillary canines. Report of two cases. J Endod 2023:S0099-2399(23)00175-9. [PMID: 37001728 DOI: 10.1016/j.joen.2023.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
Reports on the histopathologic features of external cervical resorption (ECR) in unerupted teeth are scarce. This article reports on 2 maxillary impacted canines from different patients that showed ECR lesions and were surgically removed and histologically evaluated. Case 1 showed symptoms associated with oral communication of the dental follicle and pulpal exposure. Radiographs and cone-beam computed tomographic imaging showed that resorption affected a large part of the root and the crown. Case 2 was asymptomatic, and the resorption cavity was restricted to the tooth crown. Both teeth were extracted and subjected to histologic processing and analysis. In case number 1, the coronal pulp was necrotic and infected, showing areas of exposure to the resorption channels. The apical pulp was vital and uninflamed. The pulp space was surrounded by a continuous pericanalar resorption-resistant sheet. Part of the resorbed area of dentin was occupied by inflamed granulation tissue. More apically, a network of trabecular bone was present in the resorbed area. In case number 2, the pulp around the resorbed area was uninflamed and vital. A large fraction of the lost dentin was replaced by trabecular bone, closely adapted to the irregularly resorbed dentin surface, and no inflammatory cells. Our findings indicate that impacted teeth with ECR may remain asymptomatic until associated with infection. Histologic features of resorption in impacted teeth were similar to those in erupted teeth. In the case associated with infection, the resorbed area was occupied by inflamed tissue and newly formed bone. In the case with no infection, the resorption area was filled with bone undergoing a remodeling process.
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Jensen ED, Ha W, Tan J, Oliver KJ, Ranjitkar S. Rapidly progressing generalised tooth resorption associated with primary immunodeficiency due to XIAP/BIRC4 mutation: A case report. Int J Paediatr Dent 2023; 33:196-202. [PMID: 36254405 DOI: 10.1111/ipd.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/31/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Emilija D Jensen
- Department of Paediatric Dentistry, Women's and Children's Hospital, North Adelaide, South Australia, Australia.,Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - William Ha
- Sydney Dental School, University of Sydney, Camperdown, New South Wales, Australia
| | - Jenny Tan
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kelly J Oliver
- Department of Paediatric Dentistry, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Sarbin Ranjitkar
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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Prevalence and Characteristics of Root Resorption Identified in Cone-Beam Computed Tomography Scans. J Endod 2023; 49:144-154. [PMID: 36509167 DOI: 10.1016/j.joen.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Root resorption is a destructive process that compromises tooth structure and can result in tooth loss. Often it remains asymptomatic and is an incidental finding on radiographic examinations. The purpose of this study was to determine prevalence and characteristics of root resorption in patients referred for cone-beam computed tomography (CBCT) imaging for a variety of indications. METHODS The study included CBCT scans of 1086 consecutive patients referred for CBCT imaging over an 18-month period. A total of 1148 scans were acquired. Data were abstracted from radiology reports, and prevalence estimates of resorption were computed for the aggregate sample and also across specific indications. RESULTS Resorption was identified in 171 patients (15.7%, 95% CI: 13.6%-17.9%) and in 249 teeth with a prevalence range of 2.6%-92.3% across specific indications. An 18.7% of the patients had 2 resorption sites whereas 8.8% had 3 or more resorption sites. The majority of affected teeth were anteriors (43.8%), followed by molars (40.6%) and premolars (14.5%). The most prevalent resorption types were external (29.3%), cervical (22.5%), infection-induced apical resorption (13.7%), internal (9.6%), and impacted tooth induced (8.8%). The majority of teeth with resorption did not have prior endodontic treatment (73.9%) and had radiographically normal periapex (69.5%). Of 249 teeth with resorption, 31% presented as incidental finding. The prevalence of incidental findings of resorption increased with age, P < .05, and was significantly lower for anterior teeth (20.2%) as compared to premolars (41.7%) and molars (36.6%), (P < .05). CONCLUSION The high proportion of incidental findings of resorption detected by CBCT suggests that resorption is not recognized/detected by conventional radiography and therefore remains underdiagnosed.
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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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Arıcan B, Sesen Uslu Y, Sarıalioğlu Güngör A. Resistance to fracture of simulated external cervical resorption cavities repaired with different materials. AUST ENDOD J 2022; 49:174-182. [PMID: 36354094 DOI: 10.1111/aej.12714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
The aim of the study was to evaluate the fracture resistance (FR) of teeth with simulated external cervical resorption (ECR) cavities repaired with different materials. Following the shaping of the 80 human permanent maxillary central incisors, standard ECR cavities were prepared and restored with a nanohybrid composite resin; a high viscosity GIC Equia Forte Fill; Biodentine; Biodentine + nanohybrid composite resin; MTA BIOREP; MTA BIOREP + nanohybrid composite resin. Then, the root canals were obturated with AH Plus and gutta-percha. The roots were embedded acrylic resin blocks and fracture strength test was applied. The highest FR was observed in the Biodentine group, while the lowest was in Equia group (p < 0.05). No significant results were observed among composite, Biodentine + composite, MTA BIOREP + composite and MTA BIOREP (p > 0.05). Biodentine may be a preferable material for repairing ECR cavities. Adding a composite layer on MTA BIOREP and Biodentine did not improve the FR of these materials.
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Affiliation(s)
- Burçin Arıcan
- Department of Endodontics, School of Dental MedicineBahçeşehir UniversityIstanbulTurkey
| | - Yesim Sesen Uslu
- Department of Restorative Dentistry, School of Dental MedicineBahçeşehir UniversityIstanbulTurkey
| | - Ayça Sarıalioğlu Güngör
- Department of Restorative Dentistry, Faculty of DentistryBezmialem Vakif UniversityIstanbulTurkey
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External Cervical Resorption: A Volumetric Analysis on Evolution of Defects Over Time. J Endod 2022; 49:36-44. [DOI: 10.1016/j.joen.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
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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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Richert R, Santamaria J, Laforest L, Maurin JC. The Medical, Clinical, and Radiographic Aspects of Multiple Idiopathic Tooth Resorption: A Systematic Review. J Pers Med 2022; 12:jpm12071182. [PMID: 35887679 PMCID: PMC9318505 DOI: 10.3390/jpm12071182] [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: 07/05/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Many causes of resorption remain unclear and are thus identified as idiopathic. In such cases, management is difficult, especially when multiple teeth are involved. The aim of the present study was to assess the literature regarding the medical, clinical, and radiographic aspects of multiple idiopathic resorptions (MIR) and to examine the factors associated with the risk of extraction. Methods: The title and protocol were registered a priori in PROSPERO (CRD42020191564), and the study followed the PRISMA methodology. Four electronic databases were searched to include reviews and case reports on MIR in permanent dentition. Results: Among the 1035 articles identified, 31 case reports were included. The mean age of the patients was 32 years (SD = 16.4). MIR were consistently diagnosed after radiographic evaluation and were undetected during intra-oral examination in 62% of cases. The treatment involved extraction in 77% of cases. The risk of extraction increased in the presence of periodontal inflammation. Conclusions: MIR are aggressive forms of resorption requiring routine visits. MIR mostly involve extraction and lead to a challenging prosthetic rehabilitation due to severely damaged abutment teeth. However, the current knowledge on MIR remains fragmental and based on a limited number of case reports.
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Affiliation(s)
- Raphaël Richert
- Hospices Civils de Lyon, PAM d’Odontologie, 69007 Lyon, France; (J.S.); (J.-C.M.)
- UFR d’Odontogie, Université Claude Bernard Lyon I, Université de Lyon, 69008 Lyon, France;
- Laboratoire de Mécanique des Contacts et Structures, UMR 5259 CNRS/INSA Lyon\Université de Lyon, 69100 Villeurbanne, France
- Correspondence:
| | - Julie Santamaria
- Hospices Civils de Lyon, PAM d’Odontologie, 69007 Lyon, France; (J.S.); (J.-C.M.)
| | - Laurent Laforest
- UFR d’Odontogie, Université Claude Bernard Lyon I, Université de Lyon, 69008 Lyon, France;
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615/UCBL, 69622 Villeurbanne, France
| | - Jean-Christophe Maurin
- Hospices Civils de Lyon, PAM d’Odontologie, 69007 Lyon, France; (J.S.); (J.-C.M.)
- UFR d’Odontogie, Université Claude Bernard Lyon I, Université de Lyon, 69008 Lyon, France;
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS\Université Claude Bernard Lyon 1, 69008 Lyon, France
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28
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Heboyan A, Avetisyan A, Karobari MI, Marya A, Khurshid Z, Rokaya D, Zafar MS, Fernandes GVDO. Tooth root resorption: A review. Sci Prog 2022; 105:368504221109217. [PMID: 35759366 PMCID: PMC10358711 DOI: 10.1177/00368504221109217] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Tooth root resorption is multifactorial, leading to progressive destruction and eventual loss of tooth root dentin and cement. There are internal and external types of root resorption, each having its variety. The etiology and pathogenesis of tooth root resorption are poorly understood, and the most significant etiological factors are trauma, pulpal infection, tooth bleaching, and orthodontic treatment. Tooth root resorption is primarily asymptomatic; thus, it is revealed accidentally by radiographic examination. Progressive clinical manifestations are pain, tooth discoloration, tooth mobility, and other conditions. Awareness of the causes and risk factors allowing tooth root resorption, and regular radiographic examination, in case of necessity, make it possible to reveal resorption at an early stage and to prevent its further development. Thus, the aim of this study is to present etiopathogenesis, a clinical course, and diagnostic peculiarities of internal and external types of tooth root resorption, enabling practicing dentists to timely diagnose root resorption and take appropriate measures to avoid further complications. Within the limitation of this review, even though the etiopathogenesis of tooth root resorption is yet not fully understood, it is suggested that the etiological factors fall into two groups (endogenic and exogenic) to enhance further understanding of the possible causes and mechanisms of root resorption and allow practitioners to monitor high-risk patients and make timely diagnoses. Moreover, radiographic examination and CBCT are indispensable for the diagnosis of root resorption.
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Affiliation(s)
- Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Anna Avetisyan
- Department of Therapeutic Stomatology, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Mohmed Isaqali Karobari
- Department of Conservative & Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
- Center for Transdisciplinary Research (CFTR), Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences University, Chennai, Tamil Nadu, India
| | - Anand Marya
- Department of Orthodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - Zohaib Khurshid
- Department of Prosthodontics and Implantology, College of Dentistry, King Faisal University, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Dinesh Rokaya
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah, Saudi Arabia
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad, Pakistan
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29
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Abbott PV, Lin S. Tooth resorption-Part 2: A clinical classification. Dent Traumatol 2022; 38:267-285. [PMID: 35605161 PMCID: PMC9543863 DOI: 10.1111/edt.12762] [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: 03/08/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
Tooth resorption is either a physiological or a pathological process resulting in loss of dentin and/or cementum. It may also be associated with bone loss. Currently there is no universal classification for the different types of tooth resorption. This lack of a universal classification leads to both confusion amongst practitioners and poor understanding of the resorptive processes occurring in teeth which can result in incorrect/inappropriate diagnoses and mis‐management. When developing a classification of diseases and/or conditions that occur within the body, several criteria should be followed to ensure a useful classification. The classification should not only include pathological conditions but also physiological conditions. Since tooth resorption can be either pathological or physiological, a classification of tooth resorption should include both of these categories. Any classification of diseases should be possible to use clinically, meaningful, useful, clear and universal. It should enable easy storage, retrieval and analysis of health information for evidenced‐based decision‐making. It should also be possible to share and compare data and information between different institutions, settings and countries. A classification of tooth resorption should be developed by combining anatomical, physiological and pathological approaches. For some types of resorption, the aetiological approach should also be incorporated. A classification of tooth resorption that uses simple, relevant and appropriate terminology based on the nature and location of the resorptive process occurring in teeth is proposed. There are two broad categories of internal and external tooth resorption which are sub‐divided into three types of internal tooth resorption (surface, inflammatory, replacement) and eight types of external tooth resorption (surface, inflammatory, replacement, invasive, pressure, orthodontic, physiological, idiopathic). The clinician's understanding, diagnosis and management of tooth resorption can be facilitated by using this simple classification which should ideally be used universally by the entire dental profession to ensure clarity and to avoid confusion.
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Affiliation(s)
- Paul V Abbott
- UWA Dental School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Shaul Lin
- Department of Endodontic and Dental Trauma, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,The Israeli National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Canter, Tel Hashomer, Israel
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30
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Lin S, Moreinos D, Kaufman AY, Abbott PV. Tooth Resorption - Part 1: The evolvement, rationales and controversies of tooth resorption. Dent Traumatol 2022; 38:253-266. [PMID: 35559593 PMCID: PMC9546147 DOI: 10.1111/edt.12757] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/27/2022]
Abstract
In 1966, Andreasen and Hjørting‐Hansen were the first to describe a relationship between tooth resorption and dental trauma. However, Andreasen's original classification did not include other resorptive processes which have since been identified. Numerous articles have been published suggesting new terminology and definitions for tooth resorption. A uniform language with universally accepted terminology is crucial to eliminate the multiplicity of terms and definitions which only cause confusion within the profession. An electronic literature search was carried out in the PubMed database using the following keywords for articles published in English: “root resorption,” “inflammatory root resorption,” “replacement resorption,” “cervical resorption,” “trauma,” “ankylosis,” “surface resorption,” and “internal resorption.” The search also included textbooks and glossaries that may not have surfaced in the online search. This was done to identify articles related to tooth resorption and its etiology in dentistry. The aim of this review was to present the history that has led to the variety of terms and definitions for resorption. This review emphasizes the need for a clearer, simpler, and more comprehensive nomenclature for the various types of tooth resorption which are presented in Part 2 of this series.
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Affiliation(s)
- Shaul Lin
- Department of Endodontic and Dental Trauma, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,The Gertner Institute Emergency Management and Disaster Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Moreinos
- Endodontics Department, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Arieh Y Kaufman
- Department of Endodontic and Dental Trauma, Rambam Health Care Campus, Haifa, Israel
| | - Paul V Abbott
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
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31
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Mikušková K, Vaňuga P, Adamicová K, Statelová D, Janíčková M, Malachovský I, Siebert T. Multiple idiopathic external cervical root resorption in patient treated continuously with denosumab: a case report. BMC Oral Health 2022; 22:129. [PMID: 35428235 PMCID: PMC9013172 DOI: 10.1186/s12903-022-02165-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/06/2022] [Indexed: 01/27/2023] Open
Abstract
Abstract
Background
External root resorption is an irreversible loss of dental hard tissue as a result of odontoclastic action. Multiple external cervical root resorptions in permanent teeth are rare. The exact cause of external cervical root resorption is unclear. It is currently well established that RANK/RANKL signaling is essential for osteoclastogenesis and osteoclast-mediated bone resorption. Denosumab is an anti-RANKL antibody used for the treatment of postmenopausal osteoporosis. RANK/RANKL pathway suppression by denosumab is expected to suppress the activity of clastic cells responsible for hard tissue resorption involving both osteoclasts and odontoclasts.
Case presentation
This case report demonstrates aggressive and generalized idiopathic external cervical root resorption that started and advanced during ongoing antiresorptive therapy with the human monoclonal RANKL-blocking antibody denosumab without discontinuation of therapy in a 74-year-old female patient treated for postmenopausal osteoporosis. The extent of resorptive defects was too large and progressively led to fractures of the teeth. The number of teeth involved and the extend of destruction excluded conservative treatment. The affected teeth had to be extracted for functional prosthetic reconstruction.
Conclusions
This finding suggests that treatment with denosumab may be associated with severe and aggressive odontoclastic resorption of multiple dental roots despite an adequate inhibitory effect on osteoclasts in the treatment of osteoporosis. The RANKL-independent pathways of clastic cell formation are likely to be involved in this pathological process.
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32
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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: 2] [Impact Index Per Article: 1.0] [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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33
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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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Mavridou AM, Rubbers E, Schryvers A, Maes A, Linssen M, Barendregt DS, Bergmans L, Lambrechts P. A clinical approach strategy for the diagnosis, treatment and evaluation of external cervical resorption. Int Endod J 2022; 55:347-373. [PMID: 35034370 DOI: 10.1111/iej.13680] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
AIM To propose a clinical approach strategy on the diagnosis, treatment, and evaluation of external cervical tooth resorption (ECR) cases. To investigate and discuss the outcome of this approach. METHODOLOGY A clinical approach strategy on ECR was developed based on a retrospective observation study of 542 teeth. 47 teeth were excluded due to lack of clinical/radiographical information, and 182 were immediately extracted. This approach had three steps: diagnosis, treatment planning, and evaluation. During diagnosis, the medical, dental history and clinical/radiographical characteristics were evaluated. Depending on the resorption extent, ECR cases were categorized into four classes according to Heithersay's classification. During treatment planning, a treatment decision flowchart was prepared based on four main decisive criteria: probing feasibility, pain, location and extent of resorption (class), and existence of bonelike tissue. Three treatment options were applied: a) extraction, b) monitoring, or c) conservative treatment by external, internal, or combination of internal-external treatments. During evaluation, assessment of ECR progression, tooth survival and other factors like esthetics and periodontal attachment were performed. Descriptive statistical analysis of the outcome for up to ten years (for the overall clinical approach and for each individual treatment decision), was carried out with OriginLabs OriginPro 9 and Microsoft Excel 365. RESULTS A three-step strategy was developed on how to deal with ECR cases. Indicative examples of each treatment decision were presented and discussed. The overall survival rate of this strategy was 84.6% (3 years), 70.3% (5 years), 42.7% (8 years) and 28.6% (10 years). Higher survival rate was observed for external treatment decision than for internal. The success of each treatment decision depended on the extent of the resorption (class). The success of a treatment decision should be based on the long-term outcome, as a different evolution can be observed with time. CONCLUSIONS A clinical approach strategy was introduced on ECR pathosis. This strategy was not solely based on ECR class, as other important decisive criteria were considered. This step-wise approach, has a 70.3% survival rate with a mean of 5 years. This work will hopefully provide an incentive for a broader collaboration, to potentially establish a universally accepted ECR treatment strategy.
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Affiliation(s)
- A M Mavridou
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium.,Private practice, Proclin Rotterdam, Rotterdam, The Netherlands
| | - E Rubbers
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium
| | - A Schryvers
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium
| | - A Maes
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium
| | - M Linssen
- Private practice, Proclin Rotterdam, Rotterdam, The Netherlands
| | - D S Barendregt
- Private practice, Proclin Rotterdam, Rotterdam, The Netherlands
| | - L Bergmans
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium
| | - P Lambrechts
- Department of Oral Health Sciences, BIOMAT Research Cluster, KU Leuven & University Hospitals Leuven, Leuven, Belgium
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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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Nagendrababu V, Murray PE, Ordinola-Zapata R, Peters OA, Rôças IN, Siqueira JF, Priya E, Jayaraman J, Pulikkotil SJ, Suresh N, Dummer PMH. PRILE 2021 guidelines for reporting laboratory studies in Endodontology: explanation and elaboration. Int Endod J 2021; 54:1491-1515. [PMID: 33982298 DOI: 10.1111/iej.13565] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022]
Abstract
Guidance to authors is needed to prevent their waste of talent, time and resources in writing manuscripts that will never be published in the highest-quality journals. Laboratory studies are probably the most common type of endodontic research projects because they make up the majority of manuscripts submitted for publication. Unfortunately, most of these manuscripts fail the peer-review process, primarily due to critical flaws in the reporting of the methods and results. Here, in order to guide authors, the Preferred Reporting Items for study Designs in Endodontology (PRIDE) team developed new reporting guidelines for laboratory-based studies: the Preferred Reporting Items for Laboratory studies in Endodontology (PRILE) 2021 guidelines. The PRILE 2021 guidelines were developed exclusively for the area of Endodontology by integrating and adapting the modified CONSORT checklist of items for reporting in vitro studies of dental materials and the Clinical and Laboratory Images in Publications (CLIP) principles. The process of developing the PRILE 2021 guidelines followed the recommendations of the Guidance for Developers of Health Research Reporting Guidelines. The aim of the current document is to provide authors with an explanation for each of the items in the PRILE 2021 checklist and flowchart with examples from the literature, and to provide advice from peer-reviewers and editors about how to solve each problem in manuscripts prior to their peer-review. The Preferred Reporting Items for study Designs in Endodontology (PRIDE) website (http://pride-endodonticguidelines.org/prile/) provides a link to the PRILE 2021 explanation and elaboration document as well as to the checklist and flowchart.
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Affiliation(s)
- Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | | | - Ronald Ordinola-Zapata
- Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Ove A Peters
- School of Dentistry, University of Queensland, Herston, Australia.,Department of Endodontics, Arthur A Dugoni School of Dentistry, University of Pacific, San Francisco, USA
| | - Isabela N Rôças
- Department of Endodontics, Faculty of Dentistry, Grande Rio University, Rio de Janeiro, Brazil.,Department of Endodontics and Dental Research, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil
| | - José F Siqueira
- Department of Endodontics, Faculty of Dentistry, Grande Rio University, Rio de Janeiro, Brazil.,Department of Endodontics and Dental Research, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil
| | - Ekta Priya
- Division of Children and Community Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Jayakumar Jayaraman
- Department of Developmental Dentistry, University of Texas Health School of Dentistry, San Antonio, TX, USA
| | - Shaju J Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Nandini Suresh
- Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Meenakshi Ammal Dental College, Chennai, India
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Munenaga S, Usuda M, Ouhara K, Maetani Y, Kajiya M, Matsuda S, Furusho H, Miyauchi M, Nakamori M, Maruyama H, Nishi H, Kawaguchi H. External cervical resorption detected via cone-beam computed tomography in a patient with myelin oligodendrocyte glycoprotein antibody-associated disease: A case report. Clin Case Rep 2021; 9:e04415. [PMID: 34257981 PMCID: PMC8259924 DOI: 10.1002/ccr3.4415] [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: 12/29/2020] [Revised: 04/01/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
External cervical resorption may occur in patients with MOG antibody-associated disease, which is clearly detected on cone-beam computed tomography. Therefore, dental screening is essential for these patients before initiating bisphosphonate therapy. Larger sample sizes are crucial to determine any possible association between external cervical resorption and MOG antibody-associated disease.
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Affiliation(s)
- Syuichi Munenaga
- Department of General DentistryHiroshima University HospitalHiroshimaJapan
| | - Momoko Usuda
- Department of General DentistryHiroshima University HospitalHiroshimaJapan
| | - Kazuhisa Ouhara
- Department of Periodontal MedicineGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Yuta Maetani
- Department of Clinical Neuroscience and TherapeuticsGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Mikihito Kajiya
- Department of Periodontal MedicineGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Shinji Matsuda
- Department of Periodontal MedicineGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hisako Furusho
- Department of Oral and Maxillofacial PathobiologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial PathobiologyGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Masahiro Nakamori
- Department of Clinical Neuroscience and TherapeuticsGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and TherapeuticsGraduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hiromi Nishi
- Department of General DentistryHiroshima University HospitalHiroshimaJapan
| | - Hiroyuki Kawaguchi
- Department of General DentistryHiroshima University HospitalHiroshimaJapan
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Chen Y, Huang Y, Deng X. External cervical resorption-a review of pathogenesis and potential predisposing factors. Int J Oral Sci 2021; 13:19. [PMID: 34112752 PMCID: PMC8192751 DOI: 10.1038/s41368-021-00121-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/15/2021] [Accepted: 03/05/2021] [Indexed: 12/22/2022] Open
Abstract
External cervical resorption (ECR) refers to a pathological state in which resorption tissues penetrate into the dentin at the cervical aspect of the root. Despite being latent in its initial phase, ECR could cause severe damage to mineralized dental tissue and even involve the pulp if not given timely diagnosis and treatment. Nevertheless, the etiology of ECR is still poorly understood, which adds to the difficulty in early diagnosis. ECR has received growing attention in recent years due to the increasing number of clinical cases. Several potential predisposing factors have been recognized in cross-sectional studies as well as case reports. In the meantime, studies on histopathology and pathogenesis have shed light on possible mechanisms of ECR. This review aims to summarize the latest findings in the pathogenesis and potential predisposing factors of ECR, so as to provide pragmatic reference for clinical practice.
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Affiliation(s)
- Yiming Chen
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Ying Huang
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China.
| | - Xuliang Deng
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China.
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Widbiller M, Rothmaier C, Saliter D, Wölflick M, Rosendahl A, Buchalla W, Schmalz G, Spruss T, Galler KM. Histology of human teeth: Standard and specific staining methods revisited. Arch Oral Biol 2021; 127:105136. [PMID: 34044318 DOI: 10.1016/j.archoralbio.2021.105136] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Histological techniques have long been an integral part of dental research. Especially the processing of complex tissues poses specific challenges, however, literature offers only few technical references. Objectives of this study were therefore to optimize histological staining methods and compile detailed protocols for preparation and staining of dental tissues. METHODS Human teeth were collected and fixed with 4 % formaldehyde solution after extraction. Subsequently, teeth were decalcified in 17 % EDTA or Morse's solution over a period of 28 days. The extent of decalcification was determined by weight loss and radiography. After sectioning, histological staining methods were optimized for their use on teeth. These included hematoxylin-eosin, Masson trichrome, Masson-Goldner trichrome and May-Gruenwald-Giemsa staining. Nerve fibres were visualized by luxol fast blue staining and Bodian silver staining. In addition, specific methods like TRAP, modified Brown and Brenn as well as picrosirius red staining with light polarization or fluorescence were applied and optimized. RESULTS Preparation of an artificial access to the pulp chamber was essential to ensure prompt penetration of the chemicals. Decalcification with Morse's solution took at least two weeks but was more efficient than 17 % ETDA, where thorough demineralization was achieved only after three weeks. The staining methods exhibited differences not only regarding their ability to display specific structures of interest, but also in terms of reproducibility. CONCLUSION High-quality histology of teeth can only be achieved after optimal tissue preparation and accurate staining. A complementary use of staining techniques is necessary to answer specific research questions.
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Affiliation(s)
- M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany.
| | - C Rothmaier
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - D Saliter
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - M Wölflick
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - A Rosendahl
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - W Buchalla
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - G Schmalz
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - T Spruss
- Central Animal Facilities, University of Regensburg, Regensburg, Germany
| | - K M Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
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41
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KOŞAR T, GÜNAÇAR DN, KÖSE T. Three-Dimensional Volumetric/ Linear Analysis and Axial Classification of Root Resorptions Using Cone Beam Computed Tomography: A Retrospective Study. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.890067] [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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Galler KM, Grätz EM, Widbiller M, Buchalla W, Knüttel H. Pathophysiological mechanisms of root resorption after dental trauma: a systematic scoping review. BMC Oral Health 2021; 21:163. [PMID: 33771147 PMCID: PMC7995728 DOI: 10.1186/s12903-021-01510-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background The objective of this scoping review was to systematically explore the current knowledge of cellular and molecular processes that drive and control trauma-associated root resorption, to identify research gaps and to provide a basis for improved prevention and therapy. Methods Four major bibliographic databases were searched according to the research question up to February 2021 and supplemented manually. Reports on physiologic, histologic, anatomic and clinical aspects of root resorption following dental trauma were included. Duplicates were removed, the collected material was screened by title/abstract and assessed for eligibility based on the full text. Relevant aspects were extracted, organized and summarized. Results 846 papers were identified as relevant for a qualitative summary. Consideration of pathophysiological mechanisms concerning trauma-related root resorption in the literature is sparse. Whereas some forms of resorption have been explored thoroughly, the etiology of others, particularly invasive cervical resorption, is still under debate, resulting in inadequate diagnostics and heterogeneous clinical recommendations. Effective therapies for progressive replacement resorptions have not been established. Whereas the discovery of the RANKL/RANK/OPG system is essential to our understanding of resorptive processes, many questions regarding the functional regulation of osteo-/odontoclasts remain unanswered. Conclusions This scoping review provides an overview of existing evidence, but also identifies knowledge gaps that need to be addressed by continued laboratory and clinical research. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01510-6.
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Affiliation(s)
- Kerstin M Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Germany.
| | - Eva-Maria Grätz
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Germany
| | - Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Germany
| | - Wolfgang Buchalla
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Franz-Josef-Strauß Allee 11, 93053, Regensburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, Regensburg, Germany
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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: 8] [Impact Index Per Article: 2.7] [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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Singh S, Kini S, Pai S, H. R. R, Purayil TP. Survival of human periodontal ligament fibroblast cells in Cornisol and HBSS for transportation of avulsed teeth: a comparative ex vivo study. Acta Odontol Scand 2021; 79:112-117. [PMID: 32730717 DOI: 10.1080/00016357.2020.1795248] [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] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Viability of periodontal ligament fibroblast cells (PDFC) is one of the key factors in determining the success of replantation of avulsed teeth. Extra-oral time and transport media are closely related to the same. The present study aims to evaluate and compare the efficiency of Cornisol, Hank's balanced salt solution (HBSS) and normal saline in preserving the viability of PDFC. MATERIALS AND METHODS The human PDFC were isolated from primary culture from freshly extracted human premolars. Effect of Cornisol, HBSS and normal saline on viability of isolated PDFC was assessed using standard MTT assay. The cells were exposed to the experimental solutions (Cornisol/HBSS/normal saline) for varying time points (30 min, 1 h, 24 h, 48 h and 96 h) and viability was determined by colorimetric MTT method by quantifying the amount of formazan crystal formed (optical density). Experiment was performed in triplicates and the data were subjected to statistical analysis. RESULTS Statistical analysis was performed using the Kruskal-Wallis ANOVA with post hoc Bonferroni's test with a significance level of p value ≤.05. Cornisol ≥ HBSS > saline. CONCLUSION Cornisol can be used as a storage media for avulsed teeth and is significantly more effective than HBSS in maintaining the periodontal ligament cell viability at tested time intervals.
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Affiliation(s)
- Shruti Singh
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Sandya Kini
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Swathi Pai
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Rajeshwari H. R.
- Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Tina Puthen Purayil
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
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Chu EY, Deeb JG, Foster BL, Hajishengallis E, Somerman MJ, Thumbigere-Math V. Multiple Idiopathic Cervical Root Resorption: A Challenge for a Transdisciplinary Medical-Dental Team. FRONTIERS IN DENTAL MEDICINE 2021; 2:652605. [PMID: 34368800 PMCID: PMC8340576 DOI: 10.3389/fdmed.2021.652605] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The goal of this perspective article is to use multiple idiopathic cervical root resorption (MICRR) as a model to demonstrate the need for transdisciplinary collaborations, from basic science to treatment planning, to improve the quality of health care for all. This is not a review of the literature on the current state of MICRR. Tooth root resorption is a normal physiological process required for resorption and exfoliation of primary teeth; however, root resorption of adult teeth is largely pathological. MICRR is an aggressive form of external root resorption, which occurs near the cemento-enamel junction (CEJ). The cause of MICRR remains elusive, however, it is mediated primarily by osteoclasts/odontoclasts. Accumulating case studies and experiments in animal models have provided insights into defining the etiologies and pathophysiological mechanisms for MICRR, which include: systemic conditions and syndromes, inherited genetic variants affecting osteoclast/odontoclast activity, altered periodontal structures, drug-induced root resorption and rebound effects after cessation of anti-resorptive treatment, chemotherapy, exposure to pets or viral infections, and other factors such as inflammatory conditions or trauma. To determine the causative factors for MICRR, as well as other oral-dental conditions, at minimum, a comprehensive health history should be collected for all patients by dental care providers, discussed with other health care providers and appropriate collaborations established. The examples highlighted in this perspective emphasize the need for transdisciplinary research collaborations coupled with integrated management strategies between medicine and dentistry in order to identify cause(s) early and improve clinical outcomes.
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Affiliation(s)
- Emily Y. Chu
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA, United States
| | - Brian L. Foster
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, United States
| | - Evlambia Hajishengallis
- Divisions of Pediatric Dentistry, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Martha J. Somerman
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Vivek Thumbigere-Math
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
- Division of Periodontics, University of Maryland School of Dentistry, Baltimore, MD, United States
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Tavares WLF, Oliveira RR, Ferreira MVL, Sobrinho APR, Braga T, Amaral RR. The use of antimicrobial photodynamic therapy in the successful management of an invasive cervical resorption class 4: A case report with five years follow-up. Photodiagnosis Photodyn Ther 2021; 33:102126. [PMID: 33444786 DOI: 10.1016/j.pdpdt.2020.102126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022]
Abstract
A 41-year-old male with a dental history of invasive cervical resorption (ICR) was initially treated with a surgical endodontics approach and secondly with antimicrobial photodynamic therapy (aPDT) along with endodontic retreatment. The use of aPDT was essential to promote bacterial reduction in the resorption defect. Combining these techniques allowed for clinical, radiographic, and tomographic success after five years of follow-up.
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Affiliation(s)
- Warley Luciano Fonseca Tavares
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Reis Oliveira
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus Vinícius Lucas Ferreira
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Antônio Paulino Ribeiro Sobrinho
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tiago Braga
- School of Dentistry and Oral Health Griffith University, Gold Coast, Queensland, Australia
| | - Rodrigo Rodrigues Amaral
- School of Dentistry and Oral Health Griffith University, Gold Coast, Queensland, Australia; Department of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Alyahya L, Myers GL. Denosumab Use as a Predictor Variable for External Cervical Resorption: A Case-Control Study. J Endod 2020; 47:366-373. [PMID: 33359534 DOI: 10.1016/j.joen.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The objective of this case-control study was to investigate the association between denosumab use and the risk of developing external cervical resorption (ECR). METHODS Thirty-three patients ≥45 years old who were diagnosed with ECR were selected. Controls were matched to the cases based on sex and age (±5 years) in a 1:1 ratio. Confounders were classified into systemic factors, including a history of systemic sclerosis, hepatitis B, denosumab use, and bisphosphonate use, or local factors, including a history of traumatic occlusion, periodontal procedures (scaling and root planing and periodontal surgeries), and tooth extraction (excluding third molar extraction). Additionally, the number of remaining teeth in each subject was recorded using panoramic radiographs. The baseline characteristics of the 2 groups, including age, sex, and the number of remaining teeth, were compared using the chi-square and Mann-Whitney U tests. Binary logistic regression was used to determine the possible association between denosumab use and the risk of developing ECR (α < 0.05). RESULTS No significant differences in baseline characteristics were observed between the case and control groups (P > .05). After adjusting for systemic and local cofounders, denosumab use was significantly associated with the occurrence of ECR (odds ratio = 7.317; 95% confidence interval, 1.410-37.966; P < .05). CONCLUSIONS Based on the binary logistic regression model, denosumab use could significantly predict the risk of developing ECR.
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Affiliation(s)
- Lolwa Alyahya
- Department of Endodontics, Virginia Commonwealth University, Richmond, Virginia
| | - Garry L Myers
- Department of Endodontics, Virginia Commonwealth University, Richmond, Virginia.
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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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Matny LE, Ruparel NB, Levin MD, Noujeim M, Diogenes A. A Volumetric Assessment of External Cervical Resorption Cases and Its Correlation to Classification, Treatment Planning, and Expected Prognosis. J Endod 2020; 46:1052-1058. [DOI: 10.1016/j.joen.2020.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/11/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022]
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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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