Minimally invasive intervention in external cervical resorption: a case report with six-year follow-up

Abstract

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.

Keywords: Dental trauma; MTA; external cervical resorption; external root resorption; minimally invasive intervention; treatment of reabsorption.

Figure 1

Initial radiograph of element 11, in the mesial-radial position (A), in the ortho-radial position (B), and the distal-radial position (C), confirming the presence of external resorption.

Figure 2

Monitoring of intracanal medication exchange after 30 days (A), follow-up of the exchange of intra-canal medication with 60 days, it is possible to observe minimal communication with the resorption defect (B), and follow-up of the last exchange of intracanal medication, after 90 days. It was possible to observe the control of root resorption defect (C).

Figure 3

Image of obturation of the root canal, without apical third with conical gutta-percha and in the middle and cervical third, the MTA was used (A), and control radiograph after one year, for the reassessment of element 11, not being observed bone alterations in the region of resorption or presence of periapical lesion (B).