Age and Timing of Pulp Extirpation as Major Factors Associated with Inflammatory Root Resorption in Replanted Permanent Teeth

Introduction

External root resorption (ERR) is a serious complication after replantation, and its progressive inflammatory and replacement forms are significant causes of tooth loss. This retrospective study aimed to evaluate the factors related to the occurrence of inflammatory ERR (IERR) and replacement ERR (RERR) shortly after permanent tooth replantation in patients treated at the Dental Trauma Clinic at the School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Methods

Case records and radiographs of 165 patients were evaluated for the presence, type, and extension of ERR and its association with age and factors related to the management and acute treatment of the avulsed tooth by using the logistic regression model.

Results

The patient's age at the moment of trauma had a marked effect on the ERR prevalence and extension. The patients older than 16 years at the moment of trauma had less chance of developing IERR and RERR (77% and 87%, respectively) before the pulp extirpation, regardless of the extension of the resorption. The patients older than 11 years of age at the moment of trauma showed the lowest indices of IERR (P = .02). Each day that elapsed between the replantation and the pulp extirpation increased the risk of developing IERR and RERR by 1.2% and 1.1%, respectively, and also raised the risk of severe IERR by 0.5% per day.

Conclusions

The risk of mature teeth developing severe IERR before the onset of endodontic therapy was directly affected by the timing of the pulpectomy and was inversely proportional to age. Systemic antibiotic therapy use had no effect on the occurrence and severity of IERR in mature teeth. The occurrence of RERR before the onset of endodontic treatment stimulates further investigations of the early human host response to trauma and subsequent infection.     

Regenerative Endodontic Procedures for Traumatized Immature Permanent Teeth with Severe External Root Resorption and Root Perforation

External root resorption (ERR) is often a complication of traumatic injury to the teeth. Traditionally, external inflammatory root resorption is treated with calcium hydroxide. The outcome of ERR, especially replacement resorption, is unpredictable. The purpose of the present case report was to describe regenerative endodontic procedures (REPs) for 1 replanted avulsed tooth with severe external root resorption and root perforation (tooth #9) and 1 extruded tooth (tooth #8). A 9-year-old girl was referred for the treatment of teeth #8 and #9 4 months after the initial trauma. Clinical examination showed that tooth #9 had a sinus tract present near the periapical area, was tender to percussion and palpation, and did not respond to pulp sensibility tests. Tooth #8 responded to pulp sensibility tests. Periapical radiographic and cone-beam computed tomographic examination showed that tooth #9 had a periapical radiolucent lesion and severe ERRs with a root perforation. Tooth #9 was diagnosed with a necrotic pulp and symptomatic apical periodontitis. Regenerative endodontic procedures (REPs) were initiated. Tooth #8 became nonresponsive to pulp sensibility tests and developed a periapical lesion 12 months after REPs of tooth #9 and was also treated with REPs. The clinical symptoms and apical lesions resolved for both teeth after REPs. The severe ERRs were arrested, and root perforation was repaired for tooth #9. Teeth #8 and #9 underwent canal obliteration by hard tissue formation after REPs and were in function at 18 months and 30 months, respectively. REPs may be used to manage traumatized immature permanent teeth with a necrotic pulp and apical periodontitis associated with severe ERR and root perforation.     

Influence of Atopy in the Outcome of Avulsed and Replanted Teeth during 5 Years of Follow-up

Introduction

The goal of replantation after dental avulsion is to maintain the tooth in its socket. Presence of vital periodontal ligament cells on the root surface of the replanted tooth and the immunologic status of the patient are factors that protect against root resorption. It is known that dental constituents play an active role in root resorption by inducing specific and non-specific immune responses; however, little information exists regarding the influence of the acquired immune response on replantation. Therefore, the aim of this study was to evaluate the 5-year outcome of replantation in non-atopic and atopic patients.

Orthodontic-induced External Root Resorption of Endodontically Treated Teeth: A Meta-analysis

Introduction

The difference in the amount of orthodontic-induced external root resorption (OIERR) of endodontically treated teeth (ETT) compared with vital pulp teeth (VPT) treatment is controversial. This systematic review and meta-analysis assessed the available evidence regarding OIERR of ETT compared with VPT.

The positive influence of atopy on the prognosis of avulsed and replanted teeth despite differences in post-trauma management

Introduction

The aim of this study was to evaluate any potential influence of a patient’s Th2 immunologic profile on the occurrence of root resorption in avulsed and replanted teeth; tooth replantation cases in which different post-trauma management protocols were examined.

Materials and Methods

In this study, the presence or absence of root resorption was evaluated in 88 avulsed and replanted teeth. In the International Association of Dental Traumatology (IADT) group, the replantation technique and endodontic treatments were performed in accordance with the IADT guidelines. In the non-IADT group, the teeth were replanted using techniques and protocols that deviated from the IADT guidelines in some way. Follow-up of the replanted teeth included monthly clinical and radiographic examinations over the course of 1 year. Evaluation of patients’ atopy was based on a medical examination, personal and family allergic history, and a skin prick test.

Results

Of 47 teeth of atopic patients, 39 (82.98%) did not exhibit root resorption, whereas 8 (17.02%) did. Of the 41 teeth of nonatopic patients, 24 (58.54%) did not exhibit resorption, whereas 17 (41.46%) did.

Conclusions

These results show the importance of a predominantly Th2 immunological profile, which was represented by atopic patients, in replantation after dental avulsion despite differences in post-trauma management.     

Incidence of Root Resorption after the Replantation of Avulsed Teeth: A Meta-analysis

Introduction

An avulsion injury is a serious trauma to pulp and periodontal tissues. After avulsion and replantation, teeth are at risk of infection and root resorption, which may affect treatment outcome and survival rate. Thus, the purpose of this systematic review was to evaluate the incidence of root resorption after the replantation of avulsed teeth.

Multiple Cervical Root Resorption Involving 22 Teeth: A Case with Potential Genetic Predisposition

A rare case of extensive multiple idiopathic cervical root resorption with potential genetic predisposition was presented. A heathy 19-year-old Chinese male with no contributory medical or family/social history complained of pain during mastication that lasted for several months. Oral examination identified 7 missing teeth and external cervical root resorption involving 9 teeth. Comparison of orthopantomograms taken in May 2021 and February 2022 identified that cervical root resorption occurred in 22 teeth. Resorption commenced at the cementoenamel junction and progressed rapidly over the 9-month period. Laboratory test results were within normal limits. Trio-based whole-exome sequencing showed a missense mutation c.5630 C > T in the filamin A (FLNA) gene at chromosome X of the subject. This is suggestive of the possibility of sex-linked recessive inheritance. This is the first study to report FLNA mutation in human subjects with cervical root resorption involving multiple teeth.     

面型对正畸支抗牙牙根吸收影响的临床研究

目的 探讨不同面型在正畸治疗中对支抗牙牙根吸收的影响。方法 选择120例经方丝弓矫治器治疗的患者,按面型分为高角型、正常型、低角型3个组,每组患者治疗前后分别拍摄头颅侧位定位片,配对测量分别被确定作为支抗的后牙或前牙正畸治疗前后牙根长度,将牙根长度改变量以计算机进行统计分析,并评价牙根吸收情况。结果3组病例正畸治疗前后支抗牙牙根长度改变有统计学意义(P<0.001)。3组之间相对应牙齿的牙根吸收量不同,高角型病例牙根吸收轻,而低角型病例牙根吸收重。组间不同的吸收量差异有统计学意义(P<0.01)。结论 在正畸治疗中不同面型对支抗牙牙根吸收程度有不同影响,面型是影响支抗牙牙根吸收的一个重要因素。     

Regenerative Endodontics: A Potential Solution for External Root Resorption (Case Series)

IntroductionRegenerative endodontic procedures (REPs) are aimed to treat apical periodontitis and promote root maturation of immature necrotic teeth. However, REPs are not intended to be a primary indication for treating or arresting external root resorption (ERR). The purpose of this study was to describe REP treatment in the cessation of ERR.MethodsFour cases (5 teeth) of posttraumatic immature teeth diagnosed with necrotic pulp and apical periodontitis or chronic apical abscess were treated with REPs using plasma-rich fibrin as a scaffold. All the teeth showed ERR and have been followed up to 3 years.ResultsThis case series shows how REPs arrested ERR. In 3 of the cases, replacement resorption was arrested, thus avoiding complications of ankylosis and the need for decoronation.ConclusionsIn addition to the known advantages of REPs, we show that REPs are a promising treatment modality for arresting ERR, warranting further clinical trials.     

微型种植体做矫正支抗和正颌外科配合矫正上前牙牙根吸收率的比较

目的:观察微型种植体作矫正支抗和正颌手术配合矫正治疗后患者上前牙牙根吸收情况,了解牙根吸收率与牙齿移动距离和受力时间的关系。方法:通过测量牙片中的牙根长度,计算牙根吸收率。比较两种方法治疗前后不同及相同牙位、拔牙组及非拔牙组的牙根吸收率,同时记录疗程长短。结果:两种治疗方法的牙根吸收率差异没有显著性;但是治疗疗程差异有显著性。结论:两种治疗方法的牙根吸收率是一致的;牙根吸收率与牙齿移动距离和受力时间没有关系。     

Discontinuation of Denosumab as a Potential Cause of Generalized External Cervical Root Resorption: A Case Report

Generalized occurrence of external root resorption in an adult patient is a rare finding. This case report describes external cervical root resorption extensively affecting the dentition that may be associated with the use and subsequent cessation of denosumab for the treatment of osteoporosis.     

External Cervical Resorption: A Volumetric Analysis on Evolution of Defects over Time

IntroductionThe aim of this study was to assess the temporal evolution of external cervical resorption (ECR) defects using a volumetric quantification method.MethodsCone-beam computed tomographic (CBCT) images of patients diagnosed with ECR who chose not to receive treatment and attended recalls were collected. ECR defects were segmented in CBCT images at baseline and recall, and their volumes were quantified. The volumetric ratio of resorption defects/teeth was calculated. Three-dimensional classification of defects at baseline and recall and the prevalence of root surface perforations ≥1 mm were determined. The Wilcoxon matched pairs signed rank test, chi-square test, and linear regression models were used to analyze the data.ResultsFifteen patients with 20 teeth diagnosed with ECR and an average recall time of 21 months were included. Nine (45%) teeth showed a change in 3-dimensional classification at recall. The volume of resorption defects (P = .0001) and the volumetric ratio of resorption defects/teeth (P = .0001) increased over time. The prevalence of root surface perforations ≥1 mm was higher at recall (n = 17, 85%) compared with baseline (n = 9, 45%) (P = .008). Linear regression models showed significant associations between the resorption defect volume at recall compared with baseline (P < .0001; 95% confidence interval, 0.053–0.081) and the volumetric ratio of resorption defects/teeth at recall compared with baseline (P < .0001; 95% confidence interval, 0.205-0.356). There was no association between the volume of resorption defects at recall with the length of the recall period, sex, or age (P > .05).ConclusionsWhen left untreated, ECR defects can increase in size and develop more root surface perforations. ECR has a dynamic nature, and its volumetric increase over time does not result from uniform/linear expansion of the defects.     

Prognosis of Second Molars with External Root Resorption Caused by Adjacent Embedded Third Molars

IntroductionThis prospective study was designed to determine the prognosis of second molars with external root resorption (ERR-M2s) caused by embedded third molars (EM3s) following EM3 removal and explore related predictors.MethodsThis study consecutively enrolled 58 participants who had asymptomatic second molars with apical external root resorption caused by EM3s. EM3s were extracted, and follow-up examinations were conducted at 1 week, 4 weeks, and 6 months. The primary outcome was prognosis of ERR-M2s after third molar extraction without any further intervention, as assessed via clinical and radiographic examinations. Potential predictors (sex, age, number of roots, EM3s position, type and degree of external root resorption) of prognosis were analyzed via univariable and multivariable analyses.ResultsA total of 63 ERR-M2s from 58 patients (16 males and 42 females; 19–57 years of age) were evaluated. At the last follow-up, 56 teeth (89%) remained asymptomatic and normal response to heat and cold tests. According to univariable analyses, ERR-M2s were more likely to remain normal response to heat and cold tests in younger patients. In the multivariable analysis, older age (odds ratio, 1.118; 95% confidence interval, 1.026–1.219; P < .05) and the type of all roots affected (odds ratio, 0.073; 95% confidence interval, 0.007–0.754; P < .05) were significantly associated with poor prognosis.ConclusionsAsymptomatic ERR-M2s have a high probability of remaining normal pulp without further intervention after EM3 extraction, especially in younger patients. No intervention except follow-up and observation is necessary.     

Root surface treatment using diode laser in delayed tooth replantation: radiographic and histomorphometric analyses in rats

Abstract – Background aim: The aim of this study was to evaluate, by radiographic and histomorphometric analyses, the effects of high‐power diode laser irradiation on the root surfaces of delayed replanted rat teeth. Material and methods: Maxillary right incisors were extracted from 60 Wistar rats and kept dry for 60 min. Subsequently, the root canals were prepared and filled with calcium hydroxide paste. According to the root surface treatment before the replantation, the teeth were assigned to four groups (n = 15): G1 (negative control) – no root surface treatment; G2 (positive control) – treated with 2% sodium fluoride solution; G3 – irradiated with a high‐power diode laser (810 nm, continuous mode, 1.0 W, 30 s); and G4 – irradiated with a diode laser using the same parameters as those used for G3 but in pulsed mode. The rats were euthanized after 15, 30, and 60 days of replantation. The specimens were digitally radiographed and processed for histomorphometric analysis to determine the average root resorption areas and to evaluate the histological events. Results: The percentage of root resorption was in the following order: G1 > G2 > G4 > G3. Both histomorphometric and radiographic analyses showed significantly lower means (P < 0.05) of the occurrence of root resorption in the irradiated groups (G3 and G4) when compared to the control groups (G1 and G2). Replacement resorption and ankylosis were observed in histological sections only after 30 and 60 days; however, such events were not observed in G3. Conclusion: Root surface treatments with high‐powered diode laser irradiation prior to delayed replantation reduced the occurrence of external root resorption compared to no treatment or sodium fluoride treatment at up to 60 days.     

家兔乳恒磨牙齿式及下颌乳磨牙牙根吸收规律的观察

目的：为探讨乳牙生理性根吸收机制提供理想的实验动物资料。方法：观察日龄0、4、10、16及22 d家兔下颌齿式,拍X线片,并苏木精-伊红染色,观察根吸收情况。结果：家兔上下颌单侧各有3颗及2颗乳磨牙,磨牙单侧均为3颗。下颌第二乳磨牙牙根于第4天已开始吸收,分别于10 d1、6 d吸收了约1/3、2/3,22 d左右时脱落,下方恒牙开始萌出。结论：本实验证实家兔为双生齿类,替换周期短,为经济适用的研究乳牙生理性根吸收及乳恒牙替换的实验动物。     

Root Resorption Caused by Jaw Infiltration of Multiple Myeloma: Report of a Case and Literature Review

Introduction

Infiltration of the maxillofacial region by multiple myeloma is common and typically appears as punched out osteolytic lesions of the jaws. Although swelling, bone pain, and tooth mobility are characteristic clinical symptoms, root resorption is rare in conjunction with myeloma nests.

Methods

A case of a 67-year-old man with multiple myeloma is presented. Root resorption of the second mandibular premolar and the first and second molars on the right side, with consecutive tooth mobility, was the initial manifestation of the disease and was primarily detected on a periapical radiograph. The treating dentist referred the patient to the department for further examination, which revealed multiple myeloma. The patient received tandem high-dose chemotherapy and autologous stem cell transplantation as standard myeloma treatment. Intravenous bisphosphonates were administered to curb the osteolytic lesions.

Results

No signs of bisphosphonate-related osteonecrosis of the jaw were observed until the end of the follow-up period.

Conclusions

Only 5 reports of myeloma-associated root resorption have been reported in the literature. In all cases, mandibular premolars or molars were involved, and the patients exhibited extensive involvement of the jaw by myeloma. This report highlights the importance of correct interpretation of clinical signs and radiographs by dental specialists in the diagnostic algorithm of systemic diseases. Furthermore, this is an example for the inevitable part of bisphosphonates in the treatment of osteolytic processes.     

Accuracy of Digital Periapical Radiography and Cone-beam Computed Tomography for Diagnosis of Natural and Simulated External Root Resorption

Introduction

The aim of this study was to compare the sensitivity and specificity of digital periapical radiography and cone-beam computed tomographic (CBCT) imaging in the detection of natural and simulated external root resorptions (ERRs) with micro–computed tomographic (micro-CT) imaging as the reference standard.

Comparison of Orthodontic Root Resorption of Root-filled and Vital Teeth Using Micro–computed Tomography

ObjectiveTo evaluate the difference in orthodontic root resorption between root-filled and vital teeth.Material and MethodsSixteen individuals who required bilateral premolar tooth extraction due to orthodontic treatment and had a previously root-filled premolar tooth on one side were included in the study. The experimental group consisted of root-filled premolar teeth, and the control group consisted of contralateral vital premolar teeth. A 150-g buccally directed force was applied to these teeth using 0.017 × 0.025-inch TMA cantilever springs. The premolars were extracted 8 weeks after the application of force. Images were obtained using micro–computed tomography. Resorption measurements were obtained using the Image J program.ResultsThe mean values for resorption were 0.08869 mm³ for the root-filled teeth and 0.14077 mm³ for the contralateral teeth, indicating significantly less resorption for the root-filled teeth compared with the contralateral teeth after the application of orthodontic force (P = .003). In both groups, the most resorption was seen on the cervical-buccal and apical-lingual surfaces. The mean resorption value of the cervical region was 0.06305 mm³ in the control group and 0.0291 mm³ in the experimental group, and the difference was statistically significant (P = .002).ConclusionsRoot-filled teeth showed significantly less orthodontic root resorption than vital teeth.     

根尖倒充填术用于慢性根尖周炎伴牙根外吸收治疗的临床报道

目的观察根尖手术治疗慢性根尖周炎伴牙根外吸收的临床效果。方法选择慢性根尖周炎伴牙根外吸收患者6例,术前常规根管治疗,局麻下翻瓣、去骨、清理病变肉芽组织,行根尖倒预备和倒充填。术后3个月、半年和1年复诊,行临床检查及拍摄X线片观察根尖周骨质恢复情况。结果6例患牙临床症状全部消失,X线片复查牙根外吸收停止,其中4例根尖周骨质破坏完全恢复,2例根尖周骨质破坏范围明显减小。结论根尖手术对慢性根尖周炎伴牙根外吸收有良好的治疗效果。     

Stresses in Teeth with External Cervical Resorption Defects Restored with Different Biomimetic Cements: A Finite Element Analysis

IntroductionThis 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.MethodsA maxillary central incisor created in a scanned model using HyperWorks software (Altair Engineering Inc, Troy, MI) served as the 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, Biodentine, glass ionomer cement, and Bioaggregate. On all the models, a force of 100 N was applied on the palatal aspect 2 mm incisal to the cingulum directed at 45° along the long axis of the tooth.ResultsThe stresses generated in dentin and cementum are less, with a restorative material having a high Young’s modulus. For the 1Bd defect, MTA and Bioaggregate showed least stresses in dentin and cementum, respectively, whereas Biodentine had consistently lower stresses in dentin and cementum. Larger defects like 2Bd and 3Bd restored with Bioaggregate exhibited minimum stresses in dentin and cementum.ConclusionsBioaggregate 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.