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      Management of invasive cervical resorption using a surgical approach followed by an internal approach after 2 months due to pulpal involvement

      case-report

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          Abstract

          Invasive cervical resorption (ICR) is an aggressive and invasive form of external tooth resorption that commences in the cervical region which can be managed using either a nonsurgical, surgical or a combination of nonsurgical and surgical approach. The restoration of resorptive defects having a coronal and radicular extent can be challenging as a single material cannot be used to restore the entire defect. This case presented with Heithersay's Class 3 ICR lesion in tooth #12, which was managed initially using a surgical approach and restoration of ICR defect with a combination of resin modified glass ionomer cement, composite resin and mineral trioxide aggregate (MTA). However, the patient presented with pulpal symptoms 2 months later which warranted a root canal therapy. An internal approach was then used to debride and remove remnant fibro-osseous tissue. The defect was then repaired with MTA. A 1 year follow-up demonstrated adequate periapical healing and no pathologic changes around the restored resorptive defect.

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          Internal root resorption: a review.

          Shanon Patel, Domenico Ricucci, Conor Durak … (2010)
          Internal root resorption is the progressive destruction of intraradicular dentin and dentinal tubules along the middle and apical thirds of the canal walls as a result of clastic activities. The prevalence, etiology, pathogenesis, histologic manifestations, differential diagnosis with cone beam computed tomography, and treatment perspectives involved in internal root resorption are reviewed. The majority of the documentation that exists in the literature is in the form of case reports, and there are only a limited number of studies that attempted to examine the histologic manifestations and biologic aspects of the disease. This might be due, in part, to the relatively rare occurrence of this type of resorption and the lack of an in vivo model, apart from the previous attempt on the use of diathermy, to predictably reproduce the condition for study. From a histologic perspective, internal root resorption is manifested in one form that is purely destructive, internal (root canal) inflammatory resorption, and another that is accompanied by repair, internal (root canal) replacement resorption that is featured by the deposition of metaplastic bone/cementum-like tissues adjacent to the sites of resorption. From a differential diagnosis perspective, the advent of cone beam computed tomography has considerably enhanced the clinician's capability of diagnosing internal root resorption. Nevertheless, root canal treatment remains the treatment of choice for this pathologic condition to date. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
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            Invasive cervical resorption: an analysis of potential predisposing factors.

            G Heithersay (1999)
            An investigation was undertaken to assess potential predisposing factors to invasive cervical resorption. A group of 222 patients with a total of 257 teeth displaying varying degrees of invasive cervical resorption were analyzed. Potential predisposing factors, including trauma, intracoronal bleaching, surgery, orthodontics, periodontal root scaling or planing, bruxism, delayed eruption, developmental defects, and restorations were assessed from the patients' history and oral examination. Of the potential predisposing factors identified, orthodontics was the most common sole factor, constituting 21.2% of patients and 24.1% of teeth examined. Other factors were present in an additional 5.0% of orthodontically treated patients (4.3% of teeth), and these consisted principally of trauma and/or intracoronal bleaching. Trauma was the second most frequent sole factor (14.0% of patients and 15.1% of teeth). Trauma in combination with intracoronal bleaching, orthodontics, or delayed eruption constituted an additional 11.2% of patients (10.6% of teeth). Intracoronal bleaching was found to be the sole potential predisposing factor in 4.5% of patients and 3.9% of teeth, and an additional 10.4% of patients and 9.7% of teeth showed a combination of intracoronal bleaching with trauma and/or orthodontics. Surgery, particularly involving the cementoenamel junction area, was a sole potential predisposing factor in 6.3% of patients and 5.4% of teeth. Periodontal therapy, including deep root scaling and planing, showed a low incidence, as did other factors, such as bruxism and developmental defects. The presence of an intracoronal restoration was the only identifiable factor in 15.3% of patients and 14.4% of teeth, while 15.0% of patients and 16.4% of teeth showed no identifiable potential pedisposing factors. These results indicated a strong association between invasive cervical resorption and orthodontic treatment, trauma, and intracoronal bleaching, either alone or in combination.
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              Invasive cervical resorption

              Geoffrey S. Heithersay (2004)
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Conserv Dent
                Journal ID (iso-abbrev): J Conserv Dent
                Journal ID (publisher-id): JCD
                Title: Journal of Conservative Dentistry : JCD
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0972-0707
                ISSN (Electronic): 0974-5203
                Publication date (Print): May-Jun 2017
                Volume: 20
                Issue: 3
                Pages: 214-218
                Affiliations
                [1]Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
                [1 ]Department of Periodontology, Goa Dental College and Hospital, Bambolim, Goa, India
                Author notes
                Address for correspondence: Dr. Marina Fernandes, Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim - 403 202, Goa, India. E-mail: doc_marina@ 123456yahoo.co.in
                Article
                Publisher ID: JCD-20-214
                DOI: 10.4103/0972-0707.218312
                PMC ID: 5706326
                PubMed ID: 29279629
                SO-VID: 28c2932b-3aeb-4972-ab11-351afde02b41
                Copyright © Copyright: © Journal of Conservative Dentistry
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 02 November 2015
                Date revision received : 28 July 2016
                Date accepted : 29 August 2016
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Dentistry
                Keywords: external resorption,invasive cervical resorption,mineral trioxide aggregate,odontoclasts,resin modified glass ionomer cement,trichloroacetic acid
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: external resorption, invasive cervical resorption, mineral trioxide aggregate, odontoclasts, resin modified glass ionomer cement, trichloroacetic acid

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