RESUMO

La reabsorción cervical externa es una patología poco frecuente y difícil de detectar, lo que complica el diagnóstico y pronóstico. El proceso destructivo provoca pérdida progresiva de tejido, comenzando en la superficie radicular y avanzando hacia la pulpa. Este tipo de reabsorción ocurre principalmente en la región cervical de la raíz dental pudiendo confundirse con lesión de caries radicular. El objetivo del reporte de caso es ilustrar al equipo de salud la existencia de esta condición y destacar la importancia del diagnóstico temprano y diferencial para evitar llegar a la pérdida del diente afectado.

External cervical resorption is a rare and difficult-to-detect condition, which complicates diagnosis and prognosis. The destructive process causes progressive loss of tissue, starting at the root surface and advancing towards the pulp. This type of resorption primarily occurs in the cervical region of the dental root and can be confused with root caries. The case report aims to inform the healthcare team about the presence of this condition and emphasizes the significance of early and differential diagnosis to prevent the loss of the affected tooth.

RESUMO

Evidências emergentes mostram que a pandemia teve impactos significativos na saúde mental, provocando aumento da ansiedade e maior isolamento social devido às políticas de distanciamento físico introduzidas para controlar a doença. Um dos relatos mais frequentes dos cirurgiões-dentistas na pandemia foi o aumento do número de casos de pacientes com bruxismo e apertamento. Em consequência, observou-se acentuado número de casos de trincas e fraturas. Outra possível consequência do quadro de bruxismo e apertamento dos pacientes é a ocorrência de reabsorção cervical externa. O objetivo deste estudo é avaliar o número de casos com a presença de fratura, trinca e reabsorção cervical externa antes, durante e pós pandemia da COVID-19. Os dados foram obtidos através de tomografia computadorizada cone beam no centro de radiologia Slice, uma clínica particular de radiologia referência em endodontia na cidade de Belo Horizonte Minas Gerais, Brasil. O presente estudo observou um aumento no número de casos de trinca e fratura nos anos de 2020, 2021 e 2022. Os casos de reabsorção cervical externa apresentaram um aumento nos anos de 2021 e 2022. A pandemia da COVID-19 trouxe várias consequências negativas para a população, dentre elas o aumento da ansiedade e do estresse, que estão diretamente relacionados com o hábito do bruxismo e apertamento dental, consequentemente os casos de trincas, fraturas e reabsorção cervical externa aumentaram.

Emerging evidence shows that the pandemic has had significant impacts on mental health, causing increased anxiety and greater social isolation due to physical distancing policies introduced to control the disease. One of the most frequent reports from dental surgeons during the pandemic was the increase in the number of cases of patients with bruxism and clenching. As a result, a high number of cases of cracks and fractures were observed. Another possible consequence of patients' bruxism and clenching is the occurrence of external cervical resorption. The objective of this study is to evaluate the number of cases with the presence of fractures, cracks and external cervical resorption before, during and after the COVID-19 pandemic. The data were obtained through cone beam computed tomography at the Slice radiology center, a private radiology clinic that is a reference in endodontics in the city of Belo Horizonte Minas Gerais, Brazil. The present study observed an increase in the number of crack and fracture cases in 2020, 2021 and 2022. Cases of external cervical resorption increased in 2021 and 2022. The COVID-19 pandemic brought several negative consequences for the population, among them the increase in anxiety and stress, which are directly related to the habit of bruxism and clenching teeth, consequently the cases of cracks, fractures and external cervical resorption have increased.

Assuntos

RESUMO

Objectives: This study investigated the prevalence and characteristics of external cervical resorption (ECR) regarding sex, age, tooth, stages of progression, and portal of entry, using cone-beam computed tomography (CBCT) scans. Materials and Methods: CBCT scans of 1,313 patients from a Brazilian subpopulation comprising 883 female and 430 male patients (mean age, 55.2 years), acquired using a PreXion 3D CBCT unit, were evaluated. All permanent teeth included in the scans were evaluated for the presence of ECR according to the 3-dimensional classification and the portal of entry. The association between the presence of ECR and the factors studied was assessed using the χ2 test. Intra-observer agreement was analyzed with the kappa test (α = 0.05). Results: In total, 6,240 teeth were analyzed, of which 84 (1.35%) were affected by ECR. A significant association was found between the presence of ECR and sex, with a higher prevalence in male patients (p = 0.002). The most frequently affected teeth were the mandibular and maxillary central incisors. The most common height was the mid-third of the root. For the portal of entry, 44% of cases were on the proximal surfaces, 40.5% on the lingual/palatal surface and 15.5% on the buccal surface. Intra-observer agreement was excellent. Conclusions: The prevalence of ECR was 1.35%, with a higher prevalence in male patients and a wide age distribution. The mandibular and maxillary central incisors were the most commonly affected teeth, and cases of ECR most frequently showed a height into the mid-third of the root and proximal entry.

RESUMO

Root resorption consists of the loss of mineralized tissue (enamel, dentin, and cementum) of the inner or outer surface of the tooth due to the action of clastic cells. The correct diagnosis, the location, degree of tissue destruction, and the type of treatment are obstacles to the resolution of these lesions. The external cervical resorption is initiated in the amelocemental region progressively resorbing cementum, dentin, and enamel, constituting multiples ducts of resorption in an apical direction. This study reports a clinical case of treatment of a tooth affected by external cervical resorption with six-year clinical and radiographic follow-up. A 28-year-old male patient attended the clinic reporting a stain in the element 11. On clinical examination, there was a pinkish stain in the cervical lingual region, small cavitation in the enamel cervical region, and gingival bleeding with no insertion loss. Radiographically was observed a change at the root in the right central incisor, which was diagnosed as external root resorption. The negative response to the pulp sensitivity test confirmed the condition of pulp necrosis, indicating the need for endodontic treatment. To the treatment, it was opted for a minimally invasive approach, with endodontic access, instrumentation, and monthly exchanges of calcium hydroxide, for three months. After this period, the root canal has been filled with gutta-percha and sealer 26, in the apical third. The cervical and medium third were filled with MTA (mineral trioxide aggregate) leaving a central space for later fiberglass posts placing. The fiberglass post has been cemented with resinous cement and the tooth restored with resin composite. After six years of a radiographic control semiannual and annual, noticed normality in the periradicular tissues and disruption of the resorption process, was observed. The clinical management minimally invasive adopted reported in this case presents a viable treatment for external root resorption of the cervical third, especially in anterior teeth.

RESUMO

Invasive multiple cervical root resorptions after vital tooth bleaching is a rare condition. The aim of this article is to present a case of multiple external cervical root resorptions (ECRR) after a misguided home whitening treatment. A 34 year old male patient presented with slight sensitivity and mobility in several teeth. Despite the manufacturer's recommendations, the patient used a 22% carbamide peroxide-based tooth bleaching gel at home for 4 days consecutively, at night, on the upper and lower arches. Clinical examination revealed gingival swelling, probing depths ranging 5-7 mm on the buccal and proximal surfaces, and grade 2 mobility of the teeth affected by ECRR. Radiographs revealed presence of ECRR in several teeth during initial examination, and development of multiple new lesions 6 months later. The teeth were subsequently extracted. Histological analysis showed multiple dentine lacunae and areas of dentine reparation. The careful use of these products can prevent sequelae such as those reported in this clinical case. As the vital bleaching has a variable success rate, patients should be informed through a consent form of the benefits and risks of tooth bleaching treatment.

Assuntos

RESUMO

ABSTRACT External cervical resorption is caused, almost exclusively, by dental trauma - especially those characterized by concussion - and is a dental disease to be diagnosed and treated accurately by endodontists. However, the vast majority of the cases is initially diagnosed by an orthodontist, due to the imaging possibilities in standardized documentations. Among the causes of external cervical resorption, it is common to mistakenly attribute it to orthodontic treatment, traumatic occlusion or even to chronic inflammatory periodontal disease. External cervical resorption is associated to dental trauma in several situations mentioned in this paper. In old cases, and eventually still nowadays, it may have been induced by internal tooth bleaching, which is increasingly less frequent in endodontically treated teeth. There are some tips to be followed and some care that must be taken during the diagnosis and treatment of external cervical resorption clinical cases. The present study lists foundations that will allow the professional to perform safely and accurately in each specific case. Some of these tips and care measures are of orthodontic nature.

RESUMO A reabsorção cervical externa é provocada, quase exclusivamente, pelo traumatismo dentário, especialmente os do tipo concussão. Ela constitui uma doença dentária a ser diagnosticada e tratada com precisão pelo endodontista, mas a grande maioria dos casos é inicialmente diagnosticada pelo ortodontista, em função das oportunidades imagiológicas nas documentações padronizadas. Entre as causas da reabsorção cervical externa, é comum atribuí-la equivocamente ao tratamento ortodôntico, à oclusão traumática ou, ainda, à doença periodontal inflamatória crônica. A reabsorção cervical externa está associada ao traumatismo dentário em várias situações mencionadas neste trabalho. Em casos mais antigos - e ainda hoje, eventualmente -, pode ter sido induzida pelo clareamento dentário interno, cada vez menos realizado em dentes endodonticamente tratados. Algumas dicas e cuidados devem ser tomados no diagnóstico e no tratamento dos casos clínicos de reabsorção cervical externa. No presente trabalho, são listados fundamentos para que o clínico possa atuar com segurança e precisão em cada caso, especificamente. Nessas dicas e cuidados, encontram-se alguns de natureza ortodôntica.

Assuntos

RESUMO

External Cervical Resorption in maxillary canines with pulp vitality is frequently associated with dental trauma resulting from surgical procedures carried out to prepare the teeth for further orthodontic traction. Preparation procedures might surgically manipulate the cementoenamel junction or cause luxation of teeth due to applying excessive force or movement tests beyond the tolerance limits of periodontal ligament and cervical tissue structures. Dentin exposure at the cementoenamel junction triggers External Cervical Resorption as a result of inflammation followed by antigen recognition of dentin proteins. External Cervical Resorption is painless, does not induce pulpitis and develops slowly. The lesion is generally associated with and covered by gingival soft tissues which disguise normal clinical aspects, thereby leading to late diagnosis when the process is near pulp threshold. Endodontic treatment is recommended only if surgical procedures are rendered necessary in the pulp space; otherwise, External Cervical Resorption should be treated by conservative means: protecting the dental pulp and restoring function and esthetics of teeth whose pulp will remain in normal conditions. Unfortunately, there is a lack of well-grounded research evincing how often External Cervical Resorption associated with canines subjected to orthodontic traction occurs.

A reabsorção cervical externa em caninos superiores com vitalidade pulpar em sua quase totalidade está associada a traumatismo dentário decorrente de procedimentos cirúrgicos associado à preparação desse dente para ser tracionado ortodonticamente. Nessa preparação pode se manipular cirurgicamente a junção amelocementária ou luxar o dente com forças excessivas ou com testes de movimentação além dos limites de tolerância estrutural do ligamento periodontal e tecidos cervicais. A exposição dentinária na junção amelocementária é o estopim para se iniciar uma reabsorção cervical externa a partir de uma inflamação induzida na região seguida de reconhecimento antigênico das proteínas dentinárias. A reabsorção cervical externa é indolor, não induz pulpites e tem uma evolução lenta. Em geral, a lesão está associada e recoberta por tecidos moles gengivais que mantêm, por longos períodos, os aspectos clínicos normais, induzindo diagnósticos tardios, quando o processo se aproxima dos limites pulpares. O tratamento endodôntico está indicado apenas em função de procedimentos operatórios que se fazem necessários no espaço pulpar; caso contrário, a reabsorção cervical externa deve ser tratada de forma conservadora, protegendo a polpa dentária e restaurando a função e estética do dente que permanecerá com sua polpa normal. Infelizmente, não sabemos, com base em pesquisas de casuísticas bem estabelecidas, qual é a frequência da reabsorção cervical externa associada a caninos ortodonticamente tracionados.

Assuntos

RESUMO

Nesse trabalho, procurou-se explicar - anatômica e funcionalmente - como se estrutura e se organiza a região cervical dos dentes, para fundamentar os seguintes questionamentos: 1) Por que ocorre Reabsorção Cervical Externa na dentição humana?; 2) Por que na gengivite e na periodontite não se tem Reabsorção Cervical Externa?; 3) Por que depois do traumatismo dentário e da clareação interna pode ocorrer a Reabsorção Cervical Externa?; 4) Por que o movimento ortodôntico não altera a cor e o volume gengival durante o tratamento?; 5) Por que o movimento ortodôntico não induz Reabsorção Cervical Externa, mesmo sabendo-se que a região cervical pode ser muito exigida? A existência de antígenos sequestrados na dentina, a presença de janelas de dentina na região cervical de todos os dentes, a reação do epitélio juncional e a distribuição dos vasos sanguíneos gengivais podem justificar por que a Reabsorção Cervical Externa não ocorre e nem a cor e o volume gengival são alterados no movimento ortodôntico.

This study sought to explain, both anatomically and functionally, how the cervical region of human teeth is structured and organized in order to address the following questions: 1) Why does External Cervical Resorption (ECR) occur in human dentition? 2) Why is there no ECR in gingivitis and periodontitis? 3) Why ECR can occur after dental trauma and internal bleaching? 4) Why does orthodontic movement not change the gingival color and volume during treatment? 5) Why does orthodontic movement not induce ECR although it is common knowledge that the cervical region can undergo much stress? The existence of sequestered antigens in the dentin, the presence of dentin gaps in the cervical region of all teeth, the reaction of the junctional epithelium and the gingival distribution of blood vessels may explain why ECR does not occur, nor do gingival color and volume change when teeth are orthodontically moved.

Assuntos

RESUMO

O presente relato descreve uma reabsorção cervical externa em incisivo central superior previamente tratado endodônticamente em paciente de 19 anos. A cavidade reabsortiva foi observada apicalmente à crista alveolar, na superfície mesio-palatina. A etiologia da reabsorção foi atribuída ao trauma, por destruição local do ligamento periodontal devido avulsão na adolescência. O retratamento endodôntico, seguido de reconstituição da cavidade reabsortiva com resina fotopolimerizável sob abordagem cirúrgica foram realizados. Após 6 meses, o elemento em questão não apresentou nenhum sintoma patológico. A remoção do tecido de granulação oriundo da cavidade reabsortiva e o selamento da mesma são fundamentais para o processo de cicatrização. Os objetivos do tratamento do presente caso eram: prevenir a progressão do processo reabsortivo e viabilizar o tratamento ortodôntico. Este relato é de interesse multidisciplinar, onde o dilema clínico da recorrência do quadro patológico em função do tratamento ortodôntico e os riscos de insucesso do tratamento foram discutidos.

This case report describes an external cervical resorption in a maxillary central incisor in a patient previously treated endodontically. The resorption cavity was observed apically to the alveolar crest in the mesio-palatal surfaces. The etiology of resorption was attributed to trauma by local destruction of the periodontal ligament as result of an teeth avulsion in adolescence. The endodontic retreatment, followed by reconstitution of the resorption cavity with light-cured resin were performed under surgical approach. After twelve months, the element in question did not show any pathological symptom. The removal of granulation tissue from the resorption cavity and the cavity seal are key to the healing process. The goals of treatment of this case were: to prevent the progression of the resorptive process and facilitate orthodontic treatment. This is a multidisciplinary interest report, where the clinical dilemma of recurrence of the pathological picture in the light of orthodontic treatment and risk of treatment failure were discussed.