Management Of Perforating External Cervical Root Resorption

Abstract

Introduction: External cervical resorption (ECR) is the loss of dental hard tissue as a result of odontoclastic action; it usually begins on the cervical region of the root surface of the teeth. The etiology and predisposing factors are not very clear. The aim of this case report is to show the management of maxillary right canine diagnosed with ECR. Case Report: A 54-year old female patient was referred to our clinic with the history of dentin hypersensitivity in maxillary right anterior area. Radiographic examination revealed a radiolucent lesion located on the cervical third of maxillary right canine. The tooth was clinically asymptomatic. The patient did not report any traumatic history. CBCT scans revealed the extent of the resorption cavity and confirmed the diagnosis of the lesion. Due to perforation of the resorption into the root canal space, the access cavity was opened and temporarily occluded with a gutta-percha point. Then the surgical repair of the resorptive defect was carried out without blocking the root canal with filling material. A mucoperiosteal flap was elevated to clean the granulamatous tissue. The lesion was apparent after complete degranulation of soft tissue. It was repaired with MTA-Angelus (Angelus, Londrina, PR, Brazil) , a glass ionomer and a composite resin. The flap was replaced and sutured. Once the ECR cavity was restored, then endodontic treatment was completed in the same appointment. The root canal was obturated with gutta percha and root canal sealer by cold lateral condensation. . Conclusion: In the 9-month follow-up examination, the tooth including ECR defect was completely asymptomatic and functional. Early detection is necessary for successful management and outcome of ECR. CBCT should be considered for the assessment and/or management of ECR.

Keywords

• external cervical resorption

References

1. Patel, S., S. Kanagasingam, and T.P. Ford, External cervical resorption: a review. Journal of endodontics, 2009. 35(5): p. 616-625.
2. Patel, S., et al., External cervical resorption‐part 1: histopathology, distribution and presentation. International endodontic journal, 2018. 51(11): p. 1205-1223.
3. Heithersay, G.S., Clinical, radiologic, and histopathologic features of invasive cervical resorption. Quintessence International, 1999. 30(1).
4. Heithersay, G.S., Invasive cervical resorption. Endodontic topics, 2004. 7(1): p. 73-92.
5. by:, E.S.o.E.d., et al., European Society of Endodontology position statement: External Cervical Resorption. International Endodontic Journal, 2018. 51(12): p. 1323-1326.
6. Iqbal, M.K., Clinical and scanning electron microscopic features of invasive cervical resorption in a maxillary molar. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2007. 103(6): p. e49-e54.
7. Patel, S., et al., External cervical resorption: a three‐dimensional classification. International endodontic journal, 2018. 51(2): p. 206-214.
8. Patel, S. and N. Saberi, External cervical resorption associated with the use of bisphosphonates: a case series. Journal of endodontics, 2015. 41(5): p. 742-748.

9. Solomon, C.S., M.O. Coffiner, and H.E. Chalfin, Herpes zoster revisited: implicated in root resorption. Journal of endodontics, 1986. 12(5): p. 210-213.
10. Von Arx, T., et al., Human and feline invasive cervical resorptions: the missing link?—Presentation of four cases. Journal of endodontics, 2009. 35(6): p. 904-913.
11. Vossoughi, R. and H.H. Takei, External cervical resorption associated with traumatic occlusion and pyogenic granuloma. Journal of the Canadian Dental Association, 2007. 73(7).
12. Mavridou, A.M., et al., Is Hypoxia Related to External Cervical Resorption? A Case Report. Journal of endodontics, 2019. 45(4): p. 459-470.
13. Mavridou, A.M., et al., Descriptive analysis of factors associated with external cervical resorption. Journal of endodontics, 2017. 43(10): p. 1602-1610.
14. Fuss, Z., I. Tsesis, and S. Lin, Root resorption–diagnosis, classification and treatment choices based on stimulation factors. Dental Traumatology, 2003. 19(4): p. 175-182.
15. Gunst, V., et al., Playing wind instruments as a potential aetiologic cofactor in external cervical resorption: two case reports. International endodontic journal, 2011. 44(3): p. 268-282.
16. Beertsen, W., et al., Generalized cervical root resorption associated with periodontal disease. Journal of clinical periodontology, 2001. 28(11): p. 1067-1073.
17. Patel, S. and N. Saberi, The ins and outs of root resorption. British dental journal, 2018. 224(9): p. 691.
18. Llavayol, M., et al., Multiple Cervical Root Resorption in a Young Adult Female Previously Treated with Chemotherapy: A Case Report. Journal of endodontics, 2019. 45(3): p. 349-353.
19. Patel, S., et al., External cervical resorption: part 2–management. International endodontic journal, 2018. 51(11): p. 1224-1238.
20. Schwartz, R.S., J.W. Robbins, and E. Rindler, Management of invasive cervical resorption: observations from three private practices and a report of three cases. Journal of endodontics, 2010. 36(10): p. 1721-1730.
21. Patel, K., F. Mannocci, and S. Patel, The assessment and management of external cervical resorption with periapical radiographs and cone-beam computed tomography: a clinical study. Journal of endodontics, 2016. 42(10): p. 1435-1440.
22. Hargreaves, K.M. and L.H. Berman, Cohen's pathways of the pulp expert consult. 2015: Elsevier Health Sciences.
23. Scarfe, W.C., et al., Use of cone beam computed tomography in endodontics. International journal of dentistry, 2009.
24. Vasconcelos, K.d.F., et al., Diagnosis of invasive cervical resorption by using cone beam computed tomography: report of two cases. Brazilian dental journal, 2012. 23(5): p. 602-607.
25. Patel, S., et al., The detection and management of root resorption lesions using intraoral radiography and cone beam computed tomography–an in vivo investigation. International endodontic journal, 2009. 42(9): p. 831-838.
26. Patel, S. and A. Dawood, The use of cone beam computed tomography in the management of external cervical resorption lesions. International endodontic journal, 2007. 40(9): p. 730-737.
27. Patel, S., et al., The potential applications of cone beam computed tomography in the management of endodontic problems. International endodontic journal, 2007. 40(10): p. 818-830.
28. Patel, S., New dimensions in endodontic imaging: Part 2. Cone beam computed tomography. International endodontic journal, 2009. 42(6): p. 463-475.