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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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Li T, Meng X, Zhou S, Li S, Luo Q, Zhang T. Complete idiopathic resorption of distobuccal root of a maxillary first molar: A case report. Clin Case Rep 2024; 12:e8786. [PMID: 38645604 PMCID: PMC11031742 DOI: 10.1002/ccr3.8786] [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: 02/28/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Key Clinical Message This case report provides a rare case of idiopathic root resorption in maxillary first molar and suggests the importance of CBCT in the diagnosis and treatment outcome of complex endodontic diseases. Endodontic surgery is an effective method for treating teeth with persistent apical periodontitis. Abstract Idiopathic root resorption is an unexplained root resorption when the patient experiences root resorption without any local or systemic factors. Early diagnosis and appropriate treatment are crucial for long-term outcomes.
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Affiliation(s)
- Tianqi Li
- Medical School of Chinese PLABeijingChina
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
- Department of StomatologyFujian People's Armed Police Corps HospitalFuzhouChina
| | - Xiangbo Meng
- Medical School of Chinese PLABeijingChina
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Sunxin Zhou
- Medical School of Chinese PLABeijingChina
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Shuaichen Li
- Medical School of Chinese PLABeijingChina
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Qiang Luo
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Tong Zhang
- Department of Stomatology, The First Medical CentreChinese PLA General HospitalBeijingChina
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Shalish M, Abed J, Keinan D, Slutzky-Goldberg I. The consequences of orthodontic extrusion on previously intruded permanent incisors-A retrospective study. Dent Traumatol 2024; 40:54-60. [PMID: 37638617 DOI: 10.1111/edt.12880] [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: 02/12/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023]
Abstract
AIM The aim of this study is to compare the adverse effects that occur after orthodontic extrusion of teeth that have been traumatically intruded with those of similar teeth that have not experienced any trauma. BACKGROUND The outcome of incisors intrusion can be affected by the patient's age, extent of injury, root development, and malocclusion. Orthodontic extrusion is a potential solution, but it may also cause complications. MATERIALS AND METHODS A retrospective study of the effects of extrusion of traumatically intruded teeth was carried out. The study group included 21 teeth in 14 patients. The control group included 32 teeth in 10 patients that underwent orthodontic extrusion with no history of trauma. Patients' age, gender, and stage of root development were recorded. The severity of the intrusion was classified as mild (<3 mm), moderate (3-6 mm), and severe (≥7 mm). A comparison of signs of pulp necrosis and root resorptions between the groups was made. RESULTS The central incisor is the tooth that is most injured in 80.9% of cases. A majority of these incidents involve severe intrusion, which was found in 42.9% of cases. 90% of the traumatized teeth had already lost their vitality prior to orthodontic treatment. Various forms of root resorption were observed in the study group. In the control group, 31.2% of teeth showed signs of external root resorption, but no endodontic intervention was carried out during the follow-up period, as these teeth remained vital. CONCLUSIONS Following intrusion, there is a high risk for root resorption and pulp necrosis. Orthodontic repositioning should be carried out with caution and mild force to prevent complications. Long-term follow-ups are required to ensure the best possible outcome.
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Affiliation(s)
- Miriam Shalish
- Department of Orthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jawad Abed
- Department of Oral and Maxillofacial Surgery, Orthodontic Division, Baruch Padeh Medical Center Poriya, The Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
| | - David Keinan
- Department of Endodontology, The Maurice and Gabriella Golschlegger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Slutzky-Goldberg
- Department of Endodontics, Galilee College of Dental Sciences, The Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
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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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Jeng PY, Chang SH, Wang CY, Lin LD, Jeng JH, Tsai YL. Surgical repair of external cervical resorption - Prognosis and prognostic factors. J Dent Sci 2024; 19:377-386. [PMID: 38303835 PMCID: PMC10829651 DOI: 10.1016/j.jds.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/01/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose External cervical resorption (ECR) is an aggressive form of root resorption, which etiology is unclear and its prognosis remains unpredictable. The purpose of this study was to investigate the prognosis and potential prognostic factors of ECR-affected teeth after surgical intervention for external repair with/without root canal treatment. Materials and methods Treated ECR cases from 2009 to 2019 were collected retrospectively. The survival of the teeth and the status of root resorption were assessed during the follow-up period. Potential prognostic factors were analyzed with log-rank test and Kaplan-Meier statistics. Results A total of 42 treated ECR-affected teeth were enrolled. The two-year survival rate was 71.20% [54.16%, 93.59%]. Persistent root resorption was the main complication after treatment. Patients with multiple ECR-affected teeth had greater recurrent potential than patients with solitary ECR-affected teeth. Prolonged calcium hydroxide dressing may contribute to a more favorable clinical outcome. Gender, age, tooth position and the need for root canal treatment did not show statistically significant effect on the prognosis. Conclusion The current surgical method was able to arrest ECR in most cases. However, the case type (the number of ECR-affected teeth per patient) could highly affect the prognosis of the teeth. Clinicians should consider long-term calcium hydroxide dressing in case of pulp involvement to achieve better results.
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Affiliation(s)
- Po-Yuan Jeng
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shu-Hui Chang
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chen-Ying Wang
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Deh Lin
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiiang-Huei Jeng
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Ling Tsai
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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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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Huang J, Walsh RM, Witherspoon DE, Khalighinejad N, Tam EC, Jalali P, He J. The prevalence, characteristics, and risk factors of external cervical resorption: a retrospective practice-based study. Clin Oral Investig 2023; 27:5595-5604. [PMID: 37493728 DOI: 10.1007/s00784-023-05180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES External cervical root resorption (ECR) is a poorly understood and aggressive form of resorption. The purpose of this study was to examine the prevalence, characteristics, and risk factors associated with the occurrence of ECR in patients seeking endodontic care from private practice settings. MATERIALS AND METHODS Records of 343 patients with 390 teeth diagnosed with ECR were identified from 3 private endodontic practices from 2008 to 2022. The patients' demographic information, systemic conditions, and dental history were recorded. The characteristics of the cases including Heithersay classification, pulpal and periapical status, and their management were documented. The association between case severity and potential predisposing factors was examined using chi-square analysis. RESULTS The overall prevalence of ECR among patients seeking endodontic care was low (< 1%). However, there was a greater than twofold increase in the pooled prevalence from 2016 to 2021 (0.99%) compared to the data from 2010 to 2015 (0.46%). The most commonly affected teeth were anterior teeth (48.7%). Class II (30.0%) and class III (45.4%) defects were the most often identified. Patients with a history of trauma or orthodontic treatment were significantly more likely to be diagnosed with severe cervical resorption (class III or IV) (p < 0.05). CONCLUSIONS There has been an increase in the prevalence of ECR in patients seeking endodontic care. A history of orthodontic treatment and traumatic dental mechanical injuries may predict the severity of resorption. CLINICAL RELEVANCE The upward trend in the occurrence of ECR warrants close monitoring of the patients at high risk of developing the condition to facilitate early detection and management.
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Affiliation(s)
- Jenny Huang
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | - Ryan M Walsh
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | | | | | - Esther C Tam
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | - Poorya Jalali
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA
| | - Jianing He
- Department of Endodontics, Texas A&M University College of Dentistry, 3302 Gaston Ave., Dallas, TX, 75246, USA.
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Rajawat A, Kaushik M. Stresses in teeth with External Cervical Resorption defects restored with different Biomimetic cements: A Finite Element Analysis. J Endod 2023:S0099-2399(23)00364-3. [PMID: 37355164 DOI: 10.1016/j.joen.2023.06.010] [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: 04/01/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION This study compared the stress distributions in teeth with simulated external cervical resorption defects restored with different restorative materials and identified areas of high stress concentration. METHODS A maxillary central incisor created in a scanned model using HyperWorks software served as control. External cervical resorption defects based on Shanon Patel's classification were created (1Bd/2Bd/3Bd) in the scanned model. The defects were restored using Mineral Trioxide Aggregate (MTA), Biodentine, Glass Ionomer Cement (GIC) and Bioaggregate. On all the models a force of 100 N was applied on palatal aspect, 2 mm incisal to cingulum directed at 45° along the long axis of the tooth. RESULTS The stresses generated in dentin and cementum is less, with a restorative material having high Young's modulus. For 1Bd defect, MTA and Bioaggregate showed least stresses in dentin and cementum respectively, whereas Biodentine had consistently lower stresses in dentin and cementum both. Larger defects like 2Bd and 3Bd restored with Bioaggregate exhibited minimum stresses in dentin and cementum. CONCLUSION Bioaggregate and Biodentine replace dentin with maximum stress and maximum strain. Elastic moduli similar to or higher than dentin are preferred for restoring cervical third resorptive lesions of the tooth.
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Affiliation(s)
- Akansha Rajawat
- Conservative Dentistry and Endodontics (Army College of Dental Sciences, Secunderabad), Practitioner, Ganga Singh Street, Dhauli Pyau, Mathura, Uttar Pradesh, India.
| | - Mamta Kaushik
- Conservative Dentistry and Endodontics, Professor and Head of Department, Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Secunderabad, Telangana, India
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Fonseca Tavares WL, Diniz Viana AC, Lucas Ferreira MV, da Costa Ferreira G, da Costa Ferreira I, Alves de Mesquita R, Amaral RR. Guided tissue regeneration in class IV external cervical resorption: A case report. J Endod 2023:S0099-2399(23)00284-4. [PMID: 37245653 DOI: 10.1016/j.joen.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/07/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Abstract
External cervical resorption (ECR) is a type of dental resorption that originates from the loss of the cementum's protective layer. The direct exposure of dentin to the periodontal ligament may lead to the invasion of clastic cells through an entry point on the external root surface into the dentinal tissue, causing resorption. Depending on the extension of ECR, different treatments are proposed. Although the literature presents distinct materials and methods for restoring ECR areas, an existing gap is related to care in the treatment of the supporting periodontal tissue. Guided tissue regeneration/guided bone regeneration (GTR/GBR) includes the stimulation of bone formation in bone defects using different types of membranes (resorbable and non-resorbable), regardless of its association with bone substitutes or grafts. Despite the benefits of guided bone regeneration, the application of this method in cases of ECR is still under-explored in the literature. Thus, the present case report uses GTR with xenogenic material and polydioxanone (PDO) membrane in a case of class IV ECR. The success of the present case is related to the correct diagnosis and treatment plan. Complete debridement of resorption areas and restoration with biodentine were effective in tooth repair. GTR contributed to the stabilization of supporting periodontal tissues. The association of the xenogeneic bone graft with the PDO membrane proved to be a viable option for restoring the health of the periodontium.
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Affiliation(s)
- Warley Luciano Fonseca Tavares
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Ana Cecília Diniz Viana
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Gabriela da Costa Ferreira
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Isabella da Costa Ferreira
- Department of Restorative Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves de Mesquita
- Department of Clinic, Pathology and Surgery, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rodrigo Rodrigues Amaral
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Australia
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13
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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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14
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EzEldeen M, Moroni L, Nejad ZM, Jacobs R, Mota C. Biofabrication of engineered dento-alveolar tissue. BIOMATERIALS ADVANCES 2023; 148:213371. [PMID: 36931083 DOI: 10.1016/j.bioadv.2023.213371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/19/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
Oral health is essential for a good overall health. Dento-alveolar conditions have a high prevalence, ranging from tooth decay periodontitis to alveolar bone resorption. However, oral tissues exhibit a limited regenerative capacity, and full recovery is challenging. Therefore, regenerative therapies for dento-alveolar tissue (e.g., alveolar bone, periodontal membrane, dentin-pulp complex) have gained much attention, and novel approaches have been proposed in recent decades. This review focuses on the cells, biomaterials and the biofabrication methods used to develop therapies for tooth root bioengineering. Examples of the techniques covered are the multitude of additive manufacturing techniques and bioprinting approaches used to create scaffolds or tissue constructs. Furthermore, biomaterials and stem cells utilized during biofabrication will also be described for different target tissues. As these new therapies gradually become a reality in the lab, the translation to the clinic is still minute, with a further need to overcome multiple challenges and broaden the clinical application of these alternatives.
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Affiliation(s)
- Mostafa EzEldeen
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Lorenzo Moroni
- Institute for Technology-inspired Regenerative Medicine, Department of Complex Tissue Regeneration, Maastricht University, Maastricht, the Netherlands
| | - Zohre Mousavi Nejad
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; Biomaterials Research Group, Department of Nanotechnology and Advance Materials, Materials and Energy Research Center, P.O. Box: 31787-316, Karaj, Alborz, Iran
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Carlos Mota
- Institute for Technology-inspired Regenerative Medicine, Department of Complex Tissue Regeneration, Maastricht University, Maastricht, the Netherlands.
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15
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Aminoshariae A, Azarpazhooh A, Fouad AF, Glickman GN, He J, Kim SG, Kishen A, Letra AM, Levin L, Setzer FC, Tay FR, Hargreaves KM. Insights Into the May 2023 Issue of the JOE. J Endod 2023; 49:459-461. [PMID: 37120251 DOI: 10.1016/j.joen.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Ashraf F Fouad
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jianing He
- Texas A&M College of Dentistry, College Station, Texas
| | - Sahng G Kim
- Columbia University College of Dental Medicine, New York, New York
| | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Ariadne M Letra
- Department of Oral and Craniofacial Sciences, Center for Craniofacial and Dental Genetics, University of Pittsburgh, School of Dental Medicine, Pittsburgh, Pennsylvania
| | | | - Frank C Setzer
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, Georgia
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16
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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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17
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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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18
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Kotsanos IN, Tzika E, Economides N, Kotsanos N. Intentional replantation and management of avulsion related ankylosis and external cervical resorption. A 10-year follow up case report. Dent Traumatol 2023. [PMID: 36740825 DOI: 10.1111/edt.12828] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/22/2023] [Accepted: 01/22/2023] [Indexed: 02/07/2023]
Abstract
Replantation is the treatment of choice for avulsed permanent teeth; ankylosis and cervical root resorption are among survival complications. A 9.5-year-old boy presented with an avulsed maxillary permanent central incisor with an open root apex following a school accident. The tooth was kept in milk, after a dry time of 15-20 min. Its replantation was performed 60 min after the accident. At 8 months, apexification with apical plug was attempted upon radiographic evidence of apical periodontitis. Ankylosis sound with infraocclusion and radiographic evidence of external cervical root resorption (ECR) were evident at 3 years and 3 months. At the patient's return one year later with esthetic concerns (2 mm infraocclusion) there was a 5 mm diameter ECR cavity. After intentional atraumatic extraction the resorptive cavity was debrided and restored with Biodentine; subsequently the tooth was reimplanted and splinted at an extruded position. At the 10-year follow up since the first avulsion the tooth remains esthetically pleasing, asymptomatic, non-ankylotic and functional. The present case supports intentional replantation as an option in managing infraoccluded teeth with advanced ECR.
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Affiliation(s)
| | - Eleftheria Tzika
- Department of Pediatric Dentistry, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Economides
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Kotsanos
- Department of Pediatric Dentistry, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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19
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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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20
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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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21
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Alghofaily M, Fouad AF. Association of Chronic Systemic Medications with the Incidence, Prevalence, or Healing of Endodontic Disease: A Systematic Review. J Endod 2022; 48:1458-1467. [DOI: 10.1016/j.joen.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
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Kahler B. Present status and future directions - Managing discoloured teeth. Int Endod J 2022; 55 Suppl 4:922-950. [PMID: 35188275 PMCID: PMC9790475 DOI: 10.1111/iej.13711] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
Abstract
Managing tooth discolouration involves a range of different protocols for clinicians and patients in order to achieve an aesthetic result. There is an increasing public awareness in the appearance of their teeth and management of tooth discolouration may be inter-disciplinary and involve both vital and nonvital teeth. Vital teeth can be easily treated with low concentration hydrogen peroxide products safely and effectively using an external approach and trays. For endodontically treated teeth, the walking bleach technique with hydrogen releasing peroxide products is popular. However, there is an association with external cervical root resorption with higher concentrations of hydrogen peroxide of 30%-35%. There are also regulatory considerations for the use of hydrogen peroxide in certain jurisdictions internationally. Prosthodontic treatments are more invasive and involve loss of tooth structure as well as a life cycle of further treatment in the future. This narrative review is based on searches on PubMed and the Cochrane library. Bleaching endodontically treated teeth can be considered a safe and effective protocol in the management of discoloured teeth. However, the association between bleaching and resorption remains unclear although there is likely to be a relation to prior trauma. It is prudent to avoid thermocatalytic approaches and to use a base/sealer to cover the root filling. An awareness expectations of patients and multidisciplinary treatment considerations is important in achieving the aesthetic result for the patient. It is likely that there will be an increasing demand for aesthetic whitening treatments. Bleaching of teeth has also become increasingly regulated although there are international differences in the use and concentration of bleaching agents.
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Affiliation(s)
- Bill Kahler
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia,The University of Queensland Oral Health CentreHerstonQueenslandAustralia
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23
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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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24
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Root Surface Changes in Endodontically Treated Teeth Following Orthodontic Movement. J Endod 2022; 48:1361-1366. [PMID: 35964706 DOI: 10.1016/j.joen.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Orthodontically induced external root resorption (OIERR) has been labeled an unavoidable consequence of orthodontic tooth movement (OTM). The objective of this study was to investigate the change in surface area (mm2) and volume (mm3) of endodontically treated teeth (ETT) compared to contralateral teeth with a vital pulp (VPT) following OTM. METHODS Seventy-six teeth were included in this retrospective analysis: ETT (n=38) and VPT (n=38). All teeth were evaluated using CBCT imaging at two time periods: before OTM (T1) and after OTM (T2). Study teeth were segmented to include all areas contained within the lamina dura and then were converted into a mesh model for data calculation. The surface area (mm2) and volume (mm3) of each tooth was calculated at T1 and T2 based on the number of cubic voxels present within the mesh model. Statistical analysis was performed using a linear mixed-effects model. RESULTS The average change in surface area following OTM in ETT was 13.01 mm2, and 19.95 mm2 in VPT (p<0.05). The average percent change in surface area following OTM in ETT was 2.09%, and 3.38% in VPT (p<0.05). The average change in volume following OTM in ETT was 22.48 mm3, and 32.44 mm3 in VPT (p<0.05). The average percent change in volume following OTM in ETT was 2.62%, and 4.10% in VPT (p<0.05). CONCLUSIONS The results from this study suggest that ETT are less susceptible to root resorption following OTM than their vital counterparts.
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A. Ghazi RF, Khalifa FA. Sub-clinical Cervical Root Resorption: A Case Report. Cureus 2022; 14:e27334. [PMID: 36043004 PMCID: PMC9414160 DOI: 10.7759/cureus.27334] [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] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
External cervical resorption (ECR) is a dynamic pathological process characterized by its cervical position on the root and arises below the epithelial attachment and the coronal part of the bone. This report will highlight a case of ECR in an asymptomatic patient. A radiolucent area was noted during a routine dental follow-up examination on the bitewings at the mesial surface of the upper right second premolar. Persistently, the radiolucency had multiple radiographic views indicating a true form of a lesion that could be diagnosed as external cervical resorption. The patient did not report any complaints since dental treatment was completed in 2016. After a series of radiographs and conducting further diagnostic measures, a diagnosis of ECR was confirmed. The best treatment of choice for this case was extraction and restoring the missing tooth with an implant-supported crown. The size and the extent of such a defect could affect the strategy for implant placement. This paper aimed to report that ECR can be asymptomatic for a long time with advanced cervical root resorption in some cases.
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Albers L, Bienert-Zeit A, Staszyk C. Equine Incisor Lesions: Histologic Confirmation of Radiographic, Macroscopic, and Micro-Computed Tomographic Findings. Vet Sci 2022; 9:vetsci9070348. [PMID: 35878366 PMCID: PMC9323279 DOI: 10.3390/vetsci9070348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Incisor diseases are a common problem in equine medicine. However, Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) and other lesions are often only diagnosed in advanced stages. In this study, the incisors of 20 horses were examined. The findings of X-rays, macroscopical inspection, and micro-computed tomography (µCT) were compared. Five categories from healthy to severely affected teeth were formed and selected teeth from each category were additionally examined by means of histology. Odontoclastic resorption of dental hard substances, infiltration of inflammatory cells, areas of irregular dental cementum, and formation of granulation tissue were observed. Resorptive lesions previously detected by µCT were confirmed by microscopical imaging, however, not all resorptive lesions were regarded as a pathological condition like EOTRH. Detailed microscopical inspection revealed the presence of so-called surface resorptions which represent repaired resorptive lesions without any pathological consequence for the horse. Nevertheless, some incisors which appeared healthy on the X-rays featured histological findings related to EOTRH. Therefore, the detection of early incisor lesions in equine medicine remains challenging. Abstract Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) and other incisor lesions are often diagnosed only in advanced stages. The incisors of 20 horses were examined radiographically, macroscopically, and via micro-computed tomography (µCT) to discriminate EORTH-affected teeth. Five categories from healthy to severely affected teeth were formed and teeth from each category were examined histologically to evaluate the opportunity of earlier radiographic diagnosis. Histologically, odontoclastic resorptive lesions, leukocytic infiltrations, and areas of irregular cementum and granulation tissue were observed. The extent and severity of histological findings were correlated to the µCT data. Micro-CT imaging was suitable to detect subtle irregularities in the dental substances which were referred to as resorptive lesions. Although histological examinations confirmed the presence of resorptive lesions, not all of them were classified as pathological conditions. Instead, repaired surface lesions were documented which were regarded as a physiological condition. Nevertheless, incisors which were radiographically regarded as healthy can also feature histological signs of EOTRH. Therefore, due to the possibility of misinterpreting radiographic findings combined with superimpositions on intraoral radiographs, the detection of early resorptive lesions remains challenging.
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Affiliation(s)
- Louisa Albers
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany;
- Correspondence:
| | - Astrid Bienert-Zeit
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany;
| | - Carsten Staszyk
- Faculty of Veterinary Medicine, Institute of Veterinary-Anatomy, -Histology and -Embryology, Justus-Liebig-University Gießen, 35392 Gießen, Germany;
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27
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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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Rodríguez Mazón M, Garcia-Font M, Doria G, Durán-Sindreu F, Abella F. Influence of Cone-beam Computed Tomography in clinical decision-making among different specialists in External Cervical Resorption lesions: a before-after study. J Endod 2022; 48:1121-1128. [PMID: 35690274 DOI: 10.1016/j.joen.2022.05.010] [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: 02/19/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Inadequate management of external cervical resorption (ECR) lesions may impact the treatment outcome. This study aimed to ascertain the influence of cone-beam computed tomography (CBCT) in clinical decision-making choices in cases of ECR among dentistry specialists (endodontics, prosthodontics, oral surgery, periodontics orthodontics, and general dentistry). A secondary objective was to evaluate the self-reported level of difficulty in choosing a treatment plan before and after viewing the CBCT images. METHODS Sixty examiners from different specialties were chosen to evaluate 12 cases of ECR lesions. Each case included clinical photographs, digital periapical (PA) radiographs, and a small-volume CBCT scan. In the first assessment, the examiners were given all the relevant information of each case, except the CBCT scan. Each examiner was asked to select 1 of the proposed treatment options and assess the difficulty of decision making. Four weeks later, the examiners randomly reviewed the same 12 cases with additional information from the CBCT data. RESULTS After the CBCT evaluation, the clinicians changed their treatment plan in 72.2% of the cases (P < .05). The self-reported level of difficulty in choosing a treatment changed in all groups after evaluating the CBCT scans (P< .05). After viewing the CBCT scan, the extraction option increased significantly in all groups (P < .05). CONCLUSIONS CBCT scan had a significant impact on clinical decision-making in cases of ECR evaluated by different specialists.
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Affiliation(s)
- Marta Rodríguez Mazón
- Departments of Endodontics. Universitat International de Catalunya, School of Dentistry, Sant Cugat del Valles, Barcelona, Spain
| | - Marc Garcia-Font
- Departments of Endodontics. Universitat International de Catalunya, School of Dentistry, Sant Cugat del Valles, Barcelona, Spain.
| | - Guillermo Doria
- Departments of Endodontics. Universitat International de Catalunya, School of Dentistry, Sant Cugat del Valles, Barcelona, Spain
| | - Fernando Durán-Sindreu
- Departments of Endodontics. Universitat International de Catalunya, School of Dentistry, Sant Cugat del Valles, Barcelona, Spain
| | - Francesc Abella
- Departments of Endodontics. Universitat International de Catalunya, School of Dentistry, Sant Cugat del Valles, Barcelona, Spain
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29
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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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30
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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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31
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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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Ferreira MD, Barros-Costa M, Costa FF, Freitas DQ. The prevalence and characteristics of external cervical resorption based on cone-beam computed tomographic imaging: a cross-sectional study. Restor Dent Endod 2022; 47:e39. [DOI: 10.5395/rde.2022.47.e39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Matheus Diniz Ferreira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Matheus Barros-Costa
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Felipe Ferreira Costa
- Department of Oral Diagnosis, São Paulo Dental School, University of São Paulo (USP), São Paulo, Brazil
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
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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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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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35
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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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36
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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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37
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Effect of Orthodontic Brackets on the Accuracy of Apex Locators: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6615560. [PMID: 33987442 PMCID: PMC8093058 DOI: 10.1155/2021/6615560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to evaluate the effect of metal orthodontic brackets on the accuracy of electronic apex locator (EAL). The actual canal lengths (ACL) of 40 mandibular incisor teeth were determined. Then, the teeth were randomly divided into two groups (n = 20). Orthodontic metal brackets were applied in the first group, and no brackets, in the second group. The working length of each tooth was measured with an EAL under 3 test conditions according to the distance between the lip clip and sample tooth. Data were analyzed using one-way repeated measures analysis of variance and Tukey's post hoc tests (p = 0.05). In the bracketed samples, when the lip clip was located at 1 cm and 2 cm from the samples. The mean differences between the EAL measurements and ACLs were statistically higher than those when the samples were located 3 cm from the lip clip (p < 0.05). There were also statistically significant differences between EAL measurements and ACLs in the bracketed samples located 1 and 2 cm from the lip clip (p < 0.05). In the nonbracketed group, the differences between EAL measurements and ACLs were not statistically significant in the samples located 1, 2, and 3 cm from the lip clip (p > 0.05). Use of orthodontic metal brackets can negatively influence the accuracy of the electronic apex locator when the distance between the lip clip and bracket was short. A minimum of 3 cm distance should be kept between the lip clip and tooth in order to make consistent electronic measurements.
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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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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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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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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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Jeng PY, Lin LD, Chang SH, Lee YL, Wang CY, Jeng JH, Tsai YL. Invasive Cervical Resorption—Distribution, Potential Predisposing Factors, and Clinical Characteristics. J Endod 2020; 46:475-482. [DOI: 10.1016/j.joen.2020.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/22/2022]
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Chen X, Yu X, Yan K, Liu S, Sun Z, Li S. Multiple idiopathic cervical root resorption involving all permanent teeth. AUST ENDOD J 2020; 46:263-271. [PMID: 32196855 DOI: 10.1111/aej.12398] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 12/26/2022]
Abstract
Multiple idiopathic external cervical root resorption is a rare condition with numerous predisposing factors that have not yet been clearly elucidated. In addition, its diagnosis and treatment pose challenges for clinicians, and thus, the extraction of the involved teeth is commonly performed. Here, we report a 29-year-old pregnant woman with no contributory medical or family/social history who experienced cervical root resorption that progressed aggressively and involved all permanent teeth. This case is unique owing to the involvement of all teeth. Reports of multiple idiopathic external cervical root resorption are rare in the literature, and the pathogenesis of the condition is poorly understood. This report aims to add an additional case to the existing literature, analyse the underlying mechanisms and provide clinicians with some guidance in diagnosing cervical root resorption.
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Affiliation(s)
- Xue Chen
- Department of Periodontology, School and Hospital of Stomatology, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China.,Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xijiao Yu
- Department of Endodontics, Jinan Stomatological Hospital, Jinan, China
| | - Kaixian Yan
- Department of Periodontology, School and Hospital of Stomatology, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Shuang Liu
- Department of Periodontology, School and Hospital of Stomatology, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Zhaoze Sun
- Department of Periodontology, School and Hospital of Stomatology, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Shu Li
- Department of Periodontology, School and Hospital of Stomatology, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
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Newton R, Hayes J. The association of external cervical resorption with modern internal bleaching protocols: what is the current evidence? Br Dent J 2020; 228:333-337. [PMID: 32170243 DOI: 10.1038/s41415-020-1317-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Internal bleaching is an effective and minimally invasive way of bleaching non-vital teeth. A commonly cited risk associated with it is external cervical resorption (ECR), which is a potentially significant complication that could result in loss of the tooth. This is an important point of discussion with a patient during the consent process. Legally, patients are required to be made aware of material risks to which they would be likely to attach significance, such as the loss of a tooth. The risk of ECR is therefore a key component in the patient's decision-making process as they weigh it against the perceived benefits. Over the last ten years, both clinical and legal reasons have resulted in a number of changes in the materials and protocols used for internal bleaching. This leads to the question of what the current quality of evidence is regarding the association of ECR following internal bleaching with modern protocols. Other restorative options for discoloured teeth, such as veneers or crowns, involve the irreversible removal of tooth tissue and these may be chosen by patients over internal bleaching based on out-of-date evidence.
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Affiliation(s)
- Richard Newton
- Swansea Bay University Health Board, Restorative Dental Department, Morriston Hospital, Swansea, SA6 6NL, UK.
| | - Jeremy Hayes
- Swansea Bay University Health Board, Restorative Dental Department, Morriston Hospital, Swansea, SA6 6NL, UK
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Krug R, Soliman S, Krastl G. Intentional Replantation with an Atraumatic Extraction System in Teeth with Extensive Cervical Resorption. J Endod 2019; 45:1390-1396. [DOI: 10.1016/j.joen.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 02/04/2023]
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Abstract
Root resorption is a poorly understood phenomenon and is often misdiagnosed and, as a result, inappropriately treated. The aim of this paper is to provide a practical guide for diagnosis of root resorption lesions using a simple classification, and to describe the principles of management of these resorptive defects in everyday practice.
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Pettiette MT, Zhang S, Moretti AJ, Kim SJ, Naqvi AR, Nares S. MicroRNA Expression Profiles in External Cervical Resorption. J Endod 2019; 45:1106-1113.e2. [PMID: 31351582 DOI: 10.1016/j.joen.2019.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/06/2019] [Accepted: 06/05/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION External cervical resorption (ECR) has been challenging for its diagnosis, prevention, and treatment. Its etiology and pathogenesis are largely unknown. This study characterized microRNA (miRNA) expression patterns of human tissues from ECR lesions and identified potential messenger RNA targets and pathways. METHODS Granulomatous tissues from ECR (n = 5) and their adjacent nonaffected asymptomatic gingival connective tissues (n = 5) were collected. Similarly, chronic periodontitis (CP) and control samples were collected (n = 3). Quantitative reverse transcription polymerase chain reaction array analysis compared the expression profiles of 88 miRNAs between diseases. Differentially expressed miRNAs were identified using the Student t test. Bioinformatics for messenger RNA (miRWalk) and KEGG pathway analyses were performed to identify predicted target genes and biological/cellular functions and signaling pathways. RESULTS Three miRNAs (miR-20a-5p, miR-210-3p, and miR-99a-4p) were significantly down-regulated and 1 miRNA (miR-122-5p) was significantly up-regulated in ECR (P < .05). One up-regulated and 1 down-regulated miRNA reached the significance threshold in CP. A comparison of miRNA expression in ECR and CP identified 3 differentially expressed miRNAs, indicating differences in disease pathobiology. Inflammation-associated Wnt, PI3K-Akt, mitogen-activated protein kinases signaling, and bone formation-associated transforming growth factor beta pathways were identified and predicted to be modulated by differentially expressed miRNAs in both ECR and CP. Biological processes unique to each disease entity were identified, such as T- and B-cell receptor signaling pathways, osteoclast differentiation, and extracellular matrix-receptor interaction for CP. Glycosaminoglycan biosynthesis, mineral absorption, and insulin signaling pathways for ECR were identified. CONCLUSIONS This proof-of-principle in vivo study indicated that ECR has both common and unique miRNA expression profiles in comparison with CP, which are predicted to target genes regulating inflammation, immunity, and metabolism of mineralized tissues.
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Affiliation(s)
- Mary T Pettiette
- Department of Endodontics, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Shaoping Zhang
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, Iowa.
| | - Antonio J Moretti
- Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steven J Kim
- Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Afsar R Naqvi
- Mucosal Immunology Laboratory, Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois
| | - Salvador Nares
- Mucosal Immunology Laboratory, Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois
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