Advertisement

Vital Pulp Therapy as a Conservative Approach for Management of Invasive Cervical Root Resorption: A Case Series

  • Saeed Asgary
    Affiliations
    Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
    Search for articles by this author
  • Mahdieh Nourzadeh
    Affiliations
    Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
    Search for articles by this author
  • Prashant Verma
    Affiliations
    Department of Advanced Oral Sciences and Therapeutics, Division of Endodontics, School of Dentistry, University of Maryland, Baltimore, Baltimore, Maryland
    Search for articles by this author
  • M. Lamar Hicks
    Affiliations
    Department of Advanced Oral Sciences and Therapeutics, Division of Endodontics, School of Dentistry, University of Maryland, Baltimore, Baltimore, Maryland
    Search for articles by this author
  • Ali Nosrat
    Correspondence
    Address requests for reprints to Dr Ali Nosrat, Department of Advanced Oral Sciences and Therapeutics, Division of Endodontics, School of Dentistry, University of Maryland Baltimore 650 West Baltimore Street, 4th Floor, Baltimore, MD 21201.
    Affiliations
    Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran

    Department of Advanced Oral Sciences and Therapeutics, Division of Endodontics, School of Dentistry, University of Maryland, Baltimore, Baltimore, Maryland
    Search for articles by this author

      Abstract

      Introduction

      Clear treatment guidelines with predictable outcomes for invasive cervical root resorption (ICRR) do not exist. Recent studies show that an internal approach for the excavation and repair of resorptive lacunae using bioactive materials might be preferred over external surgical approaches in cases with extensive ICRR. The procedure appears to interrupt and stop the resorptive process and preserves the periodontium. The aim of this case series was to report on the clinical and radiographic outcomes in cases with ICRR treated with vital pulp therapy techniques using calcium-enriched mixture cement.

      Methods

      Teeth with the diagnosis of ICRR and normal pulpal and periodontal status were included. After rubber dam isolation and the removal of existing restorations, the resorptive lacunae were accessed internally, and the contents were partially or fully removed. A vital pulp therapy technique was chosen based on the accessibility of the resorptive lacunae during excavation. Teeth were then restored and followed up.

      Results

      Six teeth with ICRR (Heithersay class 2, 3, or 4) were selected. One tooth was treated with pulp capping, 1 with partial pulpotomy, 2 with full pulpotomy, and 2 with partial pulpectomy. The average follow-up time was 19.6 months. After treatment, all teeth remained functional and asymptomatic with a normal periodontium. No progression of the resorption or development of new resorption was observed.

      Conclusions

      Internal excavation of the contents of resorptive lacunae in combination with vital pulp therapy with calcium-enriched mixture cement could be a reliable approach for the treatment of ICRR.

      Key Words

      To read this article in full you will need to make a payment

      References

        • Heithersay G.
        Invasive cervical resorption following trauma.
        Aust Endod J. 1999; 25: 79-85
        • Mavridou A.M.
        • Hauben E.
        • Wevers M.
        • et al.
        Understanding external cervical resorption in vital teeth.
        J Endod. 2016; 42: 1737-1751
        • Patel S.
        • Saberi N.
        External cervical resorption associated with the use of bisphosphonates: a case series.
        J Endod. 2015; 41: 742-748
        • Kumar V.
        • Chawla A.
        • Kaur A.
        Multiple idiopathic cervical root resorptions in patients with hepatitis B virus infection.
        J Endod. 2018; 44: 1575-1577
        • Heithersay G.
        Treatment of invasive cervical resorption: an analysis of results using topical application of trichloracetic acid, curettage, and restoration.
        Quintessence Int. 1999; 30: 96-110
        • Schwartz R.
        • Robbins J.
        • Rindler E.
        Management of invasive cervical resorption: observations from three private practices and a report of three cases.
        J Endod. 2010; 36: 1721-1730
        • Salzano S.
        • Tirone F.
        Conservative nonsurgical treatment of class 4 invasive cervical resorption: a case series.
        J Endod. 2015; 41: 1907-1912
        • Asgary S.
        • Nosrat A.
        Conservative management of class 4 invasive cervical root resorption using calcium-enriched mixture cement.
        J Endod. 2016; 42: 1291-1294
        • Shemesh A.
        • Ben Itzhak J.
        • Solomonov M.
        Minimally invasive treatment of class 4 invasive cervical resorption with internal approach: a case series.
        J Endod. 2017; 43: 1901-1908
        • Patel S.
        • Mavridou A.M.
        • Lambrechts P.
        • Saberi N.
        External cervical resorption-part 1: histopathology, distribution and presentation.
        Int Endod J. 2018; 51: 1205-1223
        • Patel S.
        • Foschi F.
        • Condon R.
        • et al.
        External cervical resorption: part 2 - management.
        Int Endod J. 2018; 51: 1224-1238
        • Asgary S.
        • Eghbal M.
        • Parirokh M.
        • Ghoddusi J.
        Effect of two storage solutions on surface topography of two root-end fillings.
        Aust Endod J. 2009; 35: 147-152
        • Asgary S.
        • Shahabi S.
        • Jafarzadeh T.
        • et al.
        The properties of a new endodontic material.
        J Endod. 2008; 34: 990-993
        • Pierce A.
        Experimental basis for the management of dental resorption.
        Endod Dent Traumatol. 1989; 5: 255-265
        • Fallahinejad Ghajari M.
        • Asgharian Jeddi T.
        • Iri S.
        • Asgary S.
        Treatment outcomes of primary molars direct pulp capping after 20 months: a randomized controlled trial.
        Iran Endod J. 2013; 8: 149-152
        • Malekafzali B.
        • Shekarchi F.
        • Asgary S.
        Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2-year randomised clinical trial.
        Eur J Paediatr Dent. 2011; 12: 189-193
        • Nosrat A.
        • Seifi A.
        • Asgary S.
        Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial.
        Int J Paediatr Dent. 2013; 23: 56-63
        • Nosrat A.
        • Asgary S.
        Apexogenesis of a symptomatic molar with calcium enriched mixture.
        Int Endod J. 2010; 43: 940-944
        • Asgary S.
        • Eghbal M.J.
        • Fazlyab M.
        • et al.
        Five-year results of vital pulp therapy in permanent molars with irreversible pulpitis: a non-inferiority multicenter randomized clinical trial.
        Clin Oral Investig. 2015; 19: 335-341
        • Nosrat A.
        • Peimani A.
        • Asgary S.
        A preliminary report on histological outcome of pulpotomy with endodontic biomaterials vs calcium hydroxide.
        Restor Dent Endod. 2013; 38: 227-233
        • Asgary S.
        • Hassanizadeh R.
        • Torabzadeh H.
        • Eghbal M.J.
        Treatment outcomes of 4 vital pulp therapies in mature molars.
        J Endod. 2018; 44: 529-535
        • Asgary S.
        • Nosrat A.
        • Homayounfar N.
        Periapical healing after direct pulp capping With calcium-enriched mixture cement: a case report.
        Oper Dent. 2012; 37: 571-575
        • Asgary S.
        • Kemal Caliskan M.
        Vital pulp therapy of a mature molar with concurrent hyperplastic pulpitis, internal root resorption and periradicular periodontitis: a case report.
        Iran Endod J. 2015; 10: 284-286
        • Kim J.R.
        • Nosrat A.
        • Fouad A.F.
        Interfacial characteristics of Biodentine and MTA with dentine in simulated body fluid.
        J Dent. 2015; 43: 241-247
        • Asgary S.
        • Verma P.
        • Nosrat A.
        Periodontal healing following non-surgical repair of an old perforation with pocket formation and oral communication.
        Restor Dent Endod. 2018; 43: e17
        • Asgary S.
        • Nosrat A.
        • Seifi A.
        Management of inflammatory external root resorption by using calcium-enriched mixture cement: a case report.
        J Endod. 2011; 37: 411-413
        • Nosrat A.
        • Asgary S.
        • Eghbal M.J.
        • et al.
        Calcium-enriched mixture cement as artificial apical barrier: a case series.
        J Conserv Dent. 2011; 14: 427-431
        • Nosrat A.
        • Seifi A.
        • Asgary S.
        Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial.
        J Endod. 2011; 37: 562-567
        • Asgary S.
        • Fazlyab M.
        • Nosrat A.
        Regenerative endodontic treatment versus apical plug in immature teeth: three-year follow-up.
        J Clin Pediatr Dent. 2016; 40: 356-360
        • Patel S.
        • Foschi F.
        • Mannocci F.
        • Patel K.
        External cervical resorption: a three-dimensional classification.
        Int Endod J. 2018; 51: 206-214