Monday, June 26, 2017

External Cervical Resorption

External Cervical Resorption Treatment options

External cervical resorption and the subset of extra canal invasive resorption can be detrimental to a tooth. This pages discusses external cervical resorption treatment options and also discusses some general information about external invasive cervical root resorption.

What is External Cervical Resorption and external invasive cervical root resorption?

External resorption originates in the PDL and forms an irregular radiolucent area overlying the root canal; the canal outline remains visible and intact. Sometimes external resorption is not easy to diagnose from the radiograph when the canal outline is indistinct. Three types of external resorption are:

  • Inflammatory Resorption
    – Result of trauma, orthodontics, or pulpal necrosis
  • Replacement Resorption
    – Ankylosis
  • Extra Canal Invasive Resorption
    – Variable, may have inflammation and/or replacement

Extra Canal Invasive Resorption (ECIR) ECIR is a clinical term in use since 1998 to describe an uncommon, insidious and often aggressive form of external resorption.

External cervical resorption treatment options vary depending on the severity of the situation.

I prefer to monitor cases of ECR if the the location or severity of the lesion is “requiring” extraction. If you can access then treatment with geristore or similar and possibly TCA to remove tissue fragments. A root canal may need to be done depending on severity and pain levels. I think some of the newer research shows that leaving them alone will likely lead to them refilling with a bone like materiel. If that is the case then treatment will only be done when there is an esthetic issue or pain.

Does external cervical resorption actually cause necrotic pulps?

When we see x-rays of teeth with ECR the tooth will sometimes have an apical radiolucency.  Many times the tooth appears to be in good shape other than the ECR and that leads us to believe the external cervical resorption causes necrosis of pulpal tissue.  However, if one is to accept that trauma is a risk factor for ECR development, one must consider that the trauma is the cause for both the ECR and the necrotic pulp. Hence although the two diagnosis are correlated one may not be causative of the other. Take this case for example.  If #7 was the only tooth with an apical radiolucency then one may assume the ECR is the cause for the necrosis.  However, the fact that #8 also has necrosis as well strongly points to anterior trauma being the probable culprit for both teeth having apical radiolucencies.

ecr treatment

Did trauma or ECR cause this tooth to become necrotic?

We know the pulp defends itself from external cervical resorption lesions with a pericanalar resorption-resistant sheet or PRRS for short.

What is the pericanalar resorption-resistant sheet or PRRS?

Pericanalar resorption-resistant sheet is the name given to the material that forms around the pulp of teeth that have external invasive cervical resorption. The PRRS forms as a protective measure against the resorption and it consists of predentin, dentin, and eventually reparative (bonelike) tissue apposition.  The thickness of PRRS varies and at least some of it eventually turns into reparative bonelike tissue.

Is no treatment for external cervical resorption the best option?

This is my believe and seems to have support in Mavirdou 2016 JOE article when they show the lesions fill in with a bone like material. I think many dentists seem something different and like a surgeon jump to a surgical intervention.


external cervical resorption treatment

Dentaltown has several nice threads on resorption cases that include the one shown above.

Heithersay classification and treatment recommendations for Extra Canal Invasive Resorption (ECIR).

I feel the recommendations are overly aggressive in light of Mavirdou article above but those are merely my thoughts and go against the commonly held beliefs in our profession. This an excellent reference that Dr. Herbert put together on the Heithersay classification.

Cases with External cervical resorption that I am not treating but monitoring.

External cervical resorption treatment options



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