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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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The current study aims to report a case of invasive cervical resorption in a maxillary left central incisor with a history of dental trauma. After thorough clinical and tomographic evaluations, cervical cavitation, an irregularity in the gingival contour and crown discoloration were observed. Furthermore, presence of an extensive and well-defined area of invasive cervical resorption with pulp communication was discovered. The suggested diagnosis was asymptomatic irreversible pulpitis. The resorption area was treated with the complete removal of granulation tissue, sealed with light-curing glass ionomer cement. Then, the chemo-mechanical preparation and obturation of the root canal were performed. After two years of clinical follow-up and cone-beam computed tomography examination, there were no clinical signs and symptoms, the filling of the resorption area remained intact, and no hypodense image in the cervical region of tooth #21 could be detected. The management reported in this case presented a possible viable treatment for invasive cervical resorption, provided that correct diagnosis is made.

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A reabsorção cervical invasiva (RCI) é um processo patológico e agressivo formado a partir de ações de células clásticas que provocam destruição da estrutura dental. Caracteriza-se pela invasão de tecido fibrovascular e fibro-ósseo na região cervical da raiz, reabsorvendo cemento, esmalte e dentina. A etiologia da RCI ainda não foi bem elucidada, mas já se sabe que seu início depende da lesão ou deficiência da camada de cemento na região cervical da raiz, na região correspondente a junção amelocementária. Vários fatores predisponentes já foram identificados como: tratamento ortodôntico, clareamento endógeno e trauma. Na maioria dos casos, a reabsorção é assintomática. Apresenta poucos sinais e sintomas clínicos, e sua identificação é comumente realizada através de exames radiográficos de rotina. Uma vez identificada, a tomografia computadorizada de feixe cônico é um exame essencial para o correto planejamento de condução do tratamento, devido ao fato de ser possível observar toda extensão da lesão, identificar a natureza do processo e localizar o portal de entrada da lesão. Existem vários tipos de tratamento, como extrusão do elemento dentário para exposição da região de reabsorção futura restauração com material biocompativel, exposição cirúrgica com retalho ou até mesmo exodontia nos casos mais graves. Quanto mais precoce for o diagnóstico maiores são as taxas de sucesso.

Invasive cervical resorption (ICR) is a pathological and aggressive process formed from the actions of clastic cells that cause destruction of the dental structure. It is characterized by the invasion of fibrovascular and fibro-osseous tissue in the cervical region of the root, resorbing cement, enamel and dentin. The etiology of ICR has not yet been well elucidated, but it is already known that its onset depends on the lesion or deficiency of the cementum layer in the cervical region of the root, in the region corresponding to the cementoenamel junction. Several predisposing factors have already been identified, such as orthodontic treatment, endogenous bleaching and trauma. In most cases, resorption is asymptomatic. It presents few clinical signs and symptoms, and its identification is commonly performed through routine radiographic examinations. Once identified, cone beam computed tomography is an essential exam for the correct planning of treatment, due to the fact that it is possible to observe the entire extension of the lesion, identify the nature of the process and locate the entrance portal of the lesion. There are several types of treatment, such as extrusion of the dental element to expose the resorption region for future restoration with biocompatible material, surgical exposure with a flap or even extraction in the most severe cases. The earlier the diagnosis, the higher the success rates.

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A 41-year-old male with a dental history of invasive cervical resorption (ICR) was initially treated with a surgical endodontics approach and secondly with antimicrobial photodynamic therapy (aPDT) along with endodontic retreatment. The use of aPDT was essential to promote bacterial reduction in the resorption defect. Combining these techniques allowed for clinical, radiographic, and tomographic success after five years of follow-up.

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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.

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Invasive cervical resorption is entirely an uncommon entity in dental community that is not well understood. Accurate diagnosis of the situation and immediate treatment execution are prerequisites for long term retention of the tooth. Treatment procedure includes elimination of the resorptive tissue followed by restoring the defect with a suitable biocompatible material. The necessity of endodontic treatment depends on whether the defect had invaded the root canal or not. This case report elaborates the surgical management of a class IV invasive cervical resorption in the central incisor followed by restoration of the defect with biodentine.

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This clinical case report describes the diagnosis and treatment of an external invasive cervical resorption. A 17-year-old female patient had a confirmed diagnosis of invasive cervical resorption class 4 by cone beam computerized tomography. Although, there was no communication with the root canal, the invasive resorption process was extending into the cervical and middle third of the root. The treatment of the cervical resorption of the lateral incisor interrupted the resorptive process and restored the damaged root surface and the dental functions without any esthetic sequelae. Both the radiographic examination and computed tomography are imperative to reveal the extent of the defect in the differential diagnosis.