An immediate implant approach to replace failing maxillary anterior dentition due to orthodontically induced severe root resorption.

Incomplete orthodontic therapy can lead to severe root resorption, resulting in mobile and non-restorable teeth. This clinical report presents the diagnosis, treatment planning and oral rehabilitation of a young woman with failing dentition in the anterior maxilla due to orthodontically induced root resorption. The patient's chief complaint was mobile maxillary anterior teeth 2 years after discontinuing orthodontic treatment. Radiographic and clinical evaluations revealed a missing right first premolar and left premolars and grade III mobility from the right canine to the left lateral incisor. Due to a hopeless prognosis, extraction of the maxillary anterior teeth was planned, followed by grafting procedures. Four implants were immediately placed in the fresh sockets of the canine and central sites, and a removable provisional appliance was delivered to contour the soft tissues involved. The final restorations consisted of two three-unit layered zirconia implant-supported fixed dental prostheses. Well-planned immediate implant therapy and zirconia restorations can successfully replace mobile teeth with severe root resorption caused by external surface resorption from incomplete orthodontic treatment. Combining grafting procedures during implant placement can replace hard tissue lost due to extractions, whereas provisional restorations can re-establish optimal tissue architecture in the aesthetic zone. The present case offers insight into effective strategies for treating non-compliant or uncooperative patients with failing dentition due to orthodontically induced root resorption.

Intentional replantation and management of avulsion related ankylosis and external cervical resorption. A 10-year follow up case report.

Replantation is the treatment of choice for avulsed permanent teeth; ankylosis and cervical root resorption are among survival complications. A 9.5-year-old boy presented with an avulsed maxillary permanent central incisor with an open root apex following a school accident. The tooth was kept in milk, after a dry time of 15-20 min. Its replantation was performed 60 min after the accident. At 8 months, apexification with apical plug was attempted upon radiographic evidence of apical periodontitis. Ankylosis sound with infraocclusion and radiographic evidence of external cervical root resorption (ECR) were evident at 3 years and 3 months. At the patient's return one year later with esthetic concerns (2 mm infraocclusion) there was a 5 mm diameter ECR cavity. After intentional atraumatic extraction the resorptive cavity was debrided and restored with Biodentine; subsequently the tooth was reimplanted and splinted at an extruded position. At the 10-year follow up since the first avulsion the tooth remains esthetically pleasing, asymptomatic, non-ankylotic and functional. The present case supports intentional replantation as an option in managing infraoccluded teeth with advanced ECR.

Intentional Replantation of a Second Premolar with Internal Resorption and Root Fracture: A Case Report.

AIM: This case aims to detail intentional replantation as a last resort to save an otherwise hopeless premolar with perforated internal resorption and root fracture. BACKGROUND: Internal root resorption, progressive destruction of intraradicular dentin, is a condition that sometimes renders a tooth non-restorable. In the rare cases reported where severe internal resorption leads to root fracture, extraction of the tooth seemed to be a common treatment of choice, and a few literatures had reported endodontic surgery as an alternative treatment option. To date, there had been no report of treating internal root resorption using intentional replantation. CASE DESCRIPTION: A 20-year-old male presented swelling at the buccal region of his left maxillary second premolar (#13). Clinical examination revealed a sinus tract and fractured dens evaginatus at the occlusal surface of the tooth. Radiographically, a large area of radiolucency was detected within the middle third of the root, where root fracture was present, leaving a triangular-shaped mature root apex. The condition was diagnosed as internal root resorption and root fracture. Endodontic surgery was excluded from treatment choices due to potential damage of periodontal bone. Instead, intentional replantation was performed, with the application of biomaterials including mineral trioxide aggregate (MTA) and platelet-rich fibrin (L-PRF). The tooth achieved satisfactory healing and remained asymptomatic after 2 years of follow-up. CONCLUSION: The successful outcome of the case suggests that intentional replantation could preserve a fractured tooth caused by internal root resorption. Incorporated application of biomaterials, such as MTA and L-PRF, might as well improve the chances of saving this otherwise hopeless tooth. CLINICAL SIGNIFICANCE: Through careful planning and execution, intentional replantation is a viable alternative treatment option to preserve a fractured tooth caused by internal root resorption, while leaving periodontal bone architecture almost intact. How to cite this article: Yang Y, Zhang B, Huang C, et al. Intentional Replantation of a Second Premolar with Internal Resorption and Root Fracture: A Case Report. J Contemp Dent Pract 2021;22(5):562-567.

Autotrasplante de un 3.8 incluido, en el lecho de un 3.7 con reabsorción radicular: a propósito de un caso / Autotransplantation of a 3.8, instead of a 3.7 with root resorption: a case report

INTRODUCCIÓN: El autotrasplante es una opción predecible para sustituir dientes no restaurables. El presente caso clínico describe el autotrasplante de un tercer molar inferior (3.8) en lugar de un segundo molar inferior (3.7).Caso clínico: Paciente varón de 22 años de edad que acude a una revisión general. A la exploración radiográfica, se observa reabsorción radicular del 3.7, producida por el 3.8 incluido. Se valoró el caso mediante un CBCT confirmando la inviabilidad del 3.7 y una correcta anatomía para la sustitución del 3.8. Después de valorar junto al paciente, las diferentes opciones de tratamiento posibles, se decide realizar el autotrasplante del diente 3.8, en el lugar del 3.7. Se realizó la exodoncia de ambos dientes, realizando el tratamiento de conductos extraoralmente del diente donante, bajo magnificación, y en un tiempo inferior a 20 minutos. Posteriormente se coloca una ferulización semirrígida a los dientes ad-yacentes durante 2 meses. Después del tratamiento quirúrgico/endodóntico, en el control a los 6 meses debido a la buena evo-lución clínica y la ausencia de sintomatología se realiza el trata-miento rehabilitador del diente autotrasplantado. CONCLUSIÓN: Las ventajas del autotrasplante quedan demostradas con los altos porcentajes de éxito que se obtienen al elegir esta opción de tratamiento. Es fundamental el uso del CBCT, tanto para la planificación, como para los posteriores controles radiográficos

INTRODUCTION: Autotransplantation is a predictable option to replace non restaurable teeth. This clinical case describes the autotransplantation of a lower third molar instead of a lower second molar. Clinical case: A 22 years-old male patient came to the clinic. On radiographic examination, it was observed root resorption of the lower second molar (3.7), produced by an included lower third molar (3.8). After checking with the patient all possible treatments, we decided to perform an autotransplant of tooth 3.8, instead of 3.7. Extraction of both teeth was necessary, performing the extraoral root canal treatment of the donor tooth, under magnification, and in less than 20 minutes. After that, a semi-rigid splint was placed to the adjacent teeth for 2 months. After the surgical / endodontic treatment, in the 6-month follow-up due to the good clinical evolution and the absence of symptoms, autotransplanted molar prosthetic rehabilitation treatment takes place. CONCLUSION: The advantages of autotransplantation are demonstrated by the high success rates that we obtain when choosing this treatment option. The use of CBCT is essential both for planning and for subsequent radiographic controls

Clinical and histopathological characterization of root resorption in replanted teeth: Two case reports.

RATIONALE: The frequency of tooth avulsion is on the rise due to increasing rates of maxillofacial trauma. Avulsed teeth present with varying degrees of root resorption, and are generally asymptomatic; therefore, they often go undiagnosed. The etiopathogenesis of root resorption in replanted teeth following avulsion remains unclear. PATIENT CONCERNS: In case 1, the left upper lateral incisor became loose after 10 years of replantation. In case 2, the patient underwent tooth replantation after external root canal treatment due to tooth dislocation caused by trauma 8 years ago. DIAGNOSIS: According to the medical history, clinical manifestations and imaging studies of the 2 patients, root resorption after replantation was diagnosed. INTERVENTIONS: The teeth extraction was given to one patient. Besides the histological examination of extracted teeth was performed. OUTCOMES: Teeth that underwent pulp treatment presented with external resorption. On the other hand, the tooth that had received no pulp treatment showed both external and internal resorption; residual vital pulp tissue was detected within the pulp cavity. LESSONS: The dental pulp tissues may be involved in the initiation or development of internal resorption. Trauma to the periodontal ligament might play a major role in external resorption, whereas internal tooth resorption may be caused as a result of injury to the residual pulp tissue. Thus, the effective management of these tissues during the treatment of replanted teeth is essential.

Manejo endoperiodontal de una reabsorción cervical externa tipo II bajo aislamiento absoluto y técnicas adhesivas / Endoperiodontal management of an external cervical resorption type II under absolute isolation and adhesive techniques

INTRODUCCIÓN: Las reabsorciones cervicales externas suelen ser asintomáticas y se detectan casualmente durante revisiones rutinarias. Puede aparecer una mancha rosácea conocida como "pink spot". Existe sintomatología cuando se afecta el tejido pul-par. La etiología es incierta pero existen factores de riesgo asociados. Caso Clínico: Tratamiento de un 4.2 afectado por una reabsorción cervical externa tipo II supraósea distal según la clasificación de Heithersay. Se realizó un colgajo y bajo aislamiento absoluto se trató la reabsorción y el sistema de conductos. Finalmente, se restauró con poste de fibra de vidrio, se selló la reabsorción con resina nanohíbrida y se suturó el colgajo. CONCLUSIÓN: Es necesario un CBCT para conocer la localización, extensión y determinar el plan de tratamiento exacto. Las reabsorciones cervicales externas supraóseas pueden tratarse mediante aislamiento absoluto para realizar el tratamiento de conductos y la restauración en la misma cita

INTRODUCTION: External cervical reabsorption is usually asympto-matic and is detected casually during routine check-ups. A pink spot may appear at cervical level. Symptoms exist when the pulp tissue is affected. The etiology is uncertain but there are associa-ted risk factors. Clinical Case: Treatment of a 4.2 affected by a distal supra-os-seous type II external cervical reabsorption according to the Hei-thersay classification. A flap was performed and under absolute isolation, the resorption and the duct system were treated. Finally, it was restored with a glass fiber post, the resorption was sealed with composite resin and the flap was sutured. CONCLUSIONS: A CBCT is necessary to know the location, extension and determine the exact treatment plan. Supra-osseous external cervical resorptions can be treated by absolute isolation to perform root canal treatment and restoration at the same appointment

Trans-Endodontic Zirconium Oxide Implants: A Clinical Alternative / Implantes trans-endodónticos de óxido de zirconia: Una alternativa clínica

Abstract 24. Dental trauma, mainly from the anterior area of the mouth in the incisor teeth at the level of the radicular third, has the extraction of the dental organ as an elective treatment, depending on the severity of the lesion and the site where it presented. This paper reports two cases: one in a young 13-year-old male patient with dental trauma in central incisors, and another in an 18-year-old female patient with radicular reabsorption in central incisors. Both were treated using trans-endodontic implants on teeth 2.1 and 1.1-2.2 each case, respectively. The treatment approach proposed for each case provided good functional and esthetic outcomes. Clinical and radiographic results after 1 year were successful.

Resumen 28. El traumatismo dental del área anterior de la boca en los dientes incisivos a nivel del tercio radicular, indica la extracción del órgano dental como un tratamiento electivo dependiendo de la gravedad de la lesión y el sitio donde se presentó. Este artículo reporta dos casos: uno en un paciente masculino joven de 13 años con trauma dental en los incisivos centrales y otro en una paciente de 18 años con reabsorción radicular en los incisivos centrales. Ambos fueron tratados con implantes trans-endodónticos en los dientes 2.1 y 1.1-2.2 en cada caso, respectivamente. El enfoque de tratamiento propuesto para cada caso proporcionó buenos resultados funcionales y estéticos. Los resultados clínicos y radiográficos después de 1 año fueron exitosos.

Multiple Cervical Root Resorption in a Young Adult Female Previously Treated with Chemotherapy: A Case Report.

Multiple idiopathic cervical root resorption is an aggressive form of external root resorption that occurs at the cementoenamel junction and can affect multiple teeth (a minimum of 3) throughout the entire dentition. Most of the individuals affected are healthy with noncontributory medical histories. The resorption is usually detected as an incidental finding on radiographs or during dental examination. This case report describes an adult female with multiple cervical root resorptions who had been treated with chemotherapy for ovarian cancer at 16 years old. Nine years later, a total of 12 teeth were diagnosed with cervical root resorption. All of the known causative factors for external cervical resorption were discarded. To our knowledge, this is the first case reported of multiple cervical root resorption related to chemotherapy.

External cervical resorption: part 2 - management.

Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2-week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues.

Manejo quirúrgico-endodóncico de una reabsorción cervical invasiva clase III empleando composite / Endo-surgical management of a class III invasive cervical resorption using composite

La reabsorción cervical invasiva (RCI) es un tipo de reabsorción radicular insidiosa y agresiva que se origina en la superficie radicular externa. Típicamente, suele pasar inadvertida puesto que en la mayoría de los casos es asintomática. El uso de la tomografía computarizada con haz cónico (CBCT) mejora el diagnóstico y la planificación y la utilización dental mejora la realización del tratamiento. El objetivo principal de un tratamiento óptimo de ICR es la eliminación e inactivación del proceso de reabsorción y la reconstrucción del defecto. Entre los materiales empleados en la literatura para el sellado del defecto, el composite parece ser una opción válida. En el presente caso clínico se describe el tratamiento combinado quirúrgico-endodóncico de una reabsorción cervical invasiva clase III de Heithersay sellada con composite. Después de un año de seguimiento, el paciente se mostraba asintomático y la rarefacción ósea peri radicular ha disminuido significativamente no existiendo recidiva de la reabsorción

Invasive cervical resorption (ICR) is an aggressive type of radicular resorption that originates in the external radicular surface. It can typically go unnoticed since it is often asymptomatic. The use of cone beam computed tomography (CBCT) increases in a greater diagnostic and planning and a dental microscope increases the proper execution of the treatment. The main objective of an optimal treatment of ICR is the elimination and inactivation of the resorptive process, and the reconstruction of the defect. Among the dental material used in the literature for sealing the defect, composite seems to be a valid option. The present case-report describes a combined surgical and endodontic treatment of a Heithersay class III invasive cervical resorption sealed with dental composite. A one-year follow-up shows the patient to be asymptomatic, and the bone rarefaction to have decreased significantly, with no evidence of a resorption recurrence

The effectiveness of various irrigation protocols on organic tissue removal from simulated internal resorption defects.

AIM: To evaluate the effectiveness of NaOCl, NaOCl-EDTA and NaOCl + HEBP activated by ultrasonics and XP-endo Finisher on organic tissue removal from simulated internal root resorption cavities. METHODOLOGY: The root canals of 144 single-rooted teeth were instrumented. The teeth were split longitudinally, and semicircular cavities were prepared in the canal walls on each half of the roots. Samples obtained from ground bovine muscle tissue were weighed and adapted into the semicircular cavities. The root fragments were reassembled and cemented to create a circular simulated resorption cavity within the canal. Teeth were divided into twelve groups (n = 12) according to the irrigation protocols: group 1: NaOCl, no activation; group 2: NaOCl, passive ultrasonic irrigation (PUI); group 3: NaOCl, XP-endo Finisher; group 4: NaOCl-EDTA, no activation; group 5: NaOCl-EDTA, PUI; group 6: NaOCl-EDTA, XP-endo Finisher; group 7: NaOCl + HEBP, no activation; group 8: NaOCl + HEBP, PUI; group 9: NaOCl + HEBP, XP-endo Finisher; group 10: distilled water, no activation; group 11: distilled water, PUI; and group 12: distilled water, XP-endo Finisher. The teeth were disassembled, and the tissue remaining inside the resorption cavities were weighed. The data were analysed statistically using two-way anova and Fisher's LSD tests with a significance level of 0.05. RESULTS: The use of XP-endo Finisher with the experimental solutions resulted in the greatest tissue weight loss compared to the other activation protocols (P < 0.001). There was no significant difference between NaOCl and NaOCl + HEBP in terms of tissue removal. CONCLUSION: The use of a NaOCl + HEBP mixture activated with XP-endo Finisher was an effective irrigation regimen for removing simulated organic tissues from artificial internal root resorption cavities in the straight root canals of single-rooted teeth.

Single tooth torque correction in the lower frontal area by a completely customized lingual appliance.

BACKGROUND: Aim of this study was to analyze the efficacy and precision of the completely customized lingual appliance (CCLA) regarding the single tooth torque correction. The study also examined external apical root resorptions as possible side effects of torque correction and the changings of the periodontal situation. METHODS: A case series of three patients were included. The patients showed a single tooth torque problem with a gingival recession and were treated with the CCLA. Plaster casts before and after treatment and plaster casts of the set up were scanned and superimposed. Deviations between the two plaster casts were analyzed at different points of interest. Changes of the gingival recession were compared before and after treatment. Relative root resorptions were measured by the orthopantomograms. Treatment times were assessed by the records of the patients. Results were presented descriptively. RESULTS: The mean change of the most apical part of the root reached by the orthodontic treatment was 1.8 ± 0.3 mm. The largest deviation between set up and final model was measured on the occlusal surface of the tooth 36 with 0.8 mm. Most measurement points showed a deviation of 0.5 mm or less. The depths of the gingival recession showed a significant reduction of 4.7 mm. The widths of the gingival recession were reduced by 1.1 mm. The average relative root resorption of the corrected teeth was 2.7 ± 1.5%. The average treatment time was 13.8 ± 4.5 months. CONCLUSIONS: This is the first study showing that the CCLA with its high precision is very effective in correcting single tooth torque problems. Orthodontic torque correction resulted in a significant reduction of gingival recessions and caused only negligible root resorptions.

Autotransplantation: A Reliable Treatment Modality for Severely Malpositioned Teeth.

Maxillary canines are the most commonly impacted teeth, second only to third molars. Various treatment methods may be used to recover impacted maxillary canines. This is a report of a 14-year-old girl with a severely malpositioned impacted right maxillary canine which accompanied severe root resorption of adjacent tooth, treated by autotransplantation with a computer aided rapid prototyping model as a surgical guide. This case report demonstrates that autotransplantation can be a reliable treatment alternative, in cases with a severely malpositioned impacted canine, providing acceptable prognosis.

Taking advantage of an unerupted third molar: a case report.

INTRODUCTION:: Treatments with dental surgery seek to displace tooth to the correct position within the dental arch. OBJECTIVE:: To report a clinical case that took advantage of an unerupted third molar. CASE HISTORY:: A male patient, 18 years of age, was referred by his dentist to evaluate the third molars. The clinical exam revealed no visible lower third molars. The computed tomography (CT) exam showed the presence of a supernumerary tooth in the region of the mandibular ramus, on the left side, and impaction of the third molar, which was causing root resorption on the second molar, thus making it impossible to remain in the buccal cavity. The preferred option, therefore, was to remove both second molar and the supernumerary tooth, in addition to attaching a device to the third molar during surgery for further traction. RESULTS:: After 12 months, the third molar reached the proper position. CONCLUSION:: When a mandibular second permanent molar shows an atypical root resorption, an impacted third molar can effectively substitute the tooth by using an appropriate orthodontic-surgical approach.

Orthodontic-surgical retreatment of facial asymmetry with occlusal cant and severe root resorption: A 3-year follow-up.

Our objective was to report the orthodontic and surgical retreatment of a patient who had undergone a prolonged orthodontic treatment with extractions, but who had unsatisfactory results and persistent side effects. The man, aged 25 years 3 months, sought treatment with major complaints of facial and smile asymmetries. The clinical examination showed a mandibular deviation to the right and a maxillary occlusal cant. A Class II Division 1 subdivision right was observed. Radiographic examination showed extensive root resorptions in the maxillary second premolars and absence of the 4 first premolars. The maxillary midline was deflected 2 mm to the left, and the mandibular midline was shifted 5 mm to the right. Aligning and leveling were performed with orthodontic fixed appliances, with a standard edgewise system (0.022 × 0.028 in), followed by LeFort I maxillary impaction and bilateral sagittal split osteotomy with asymmetrical advancement. Retreatment showed outstanding results that remained stable after 3 years of follow-up. Root resorption in the second premolars did not seem to increase. Orthodontic-surgical intervention is the main choice for correcting esthetic and functional problems in facial asymmetry, particularly in cases of retreatment.

Taking advantage of an unerupted third molar: a case report

ABSTRACT Introduction: Treatments with dental surgery seek to displace tooth to the correct position within the dental arch. Objective: To report a clinical case that took advantage of an unerupted third molar. Case history: A male patient, 18 years of age, was referred by his dentist to evaluate the third molars. The clinical exam revealed no visible lower third molars. The computed tomography (CT) exam showed the presence of a supernumerary tooth in the region of the mandibular ramus, on the left side, and impaction of the third molar, which was causing root resorption on the second molar, thus making it impossible to remain in the buccal cavity. The preferred option, therefore, was to remove both second molar and the supernumerary tooth, in addition to attaching a device to the third molar during surgery for further traction. Results: After 12 months, the third molar reached the proper position. Conclusion: When a mandibular second permanent molar shows an atypical root resorption, an impacted third molar can effectively substitute the tooth by using an appropriate orthodontic-surgical approach.

RESUMO Introdução: o objetivo do tratamento odontológico cirúrgico é deslocar os dentes para a posição correta na arcada dentária. Objetivo: relatar um caso clínico de aproveitamento de terceiro molar não irrompido. Histórico do caso: paciente do sexo masculino, com 18 anos de idade, foi encaminhado, pelo dentista responsável pelo caso, para avaliação dos terceiros molares. Ao exame clínico, os terceiros molares inferiores não eram visíveis. Com a tomografia computadorizada (TC), foi possível identificar a presença de um dente supranumerário na região do lado esquerdo do ramo da mandíbula, além de impacção do terceiro molar, causadora de reabsorção radicular no segundo molar, tornando impossível a permanência desse dente na cavidade bucal. Logo, optou-se pela remoção tanto do segundo molar quanto do dente supranumerário, além da instalação de um aparelho no terceiro molar, durante o procedimento cirúrgico, para posterior tracionamento. Resultados: após 12 meses, o terceiro molar alcançou a posição adequada. Conclusão: nos casos em que o segundo molar inferior permanente apresenta reabsorção radicular atípica, um terceiro molar impactado pode substituir o dente reabsorvido, de maneira eficaz, através de uma abordagem ortocirúrgica apropriada.

Comparison of 4 and 6 weeks of rest period for repair of root resorption.

BACKGROUND: The study was designed to evaluate and compare the rest periods of 4 and 6 weeks for healing of orthodontically induced root resorption craters. METHODS: The study was conducted with a split-mouth design, with the right and left mandibular first premolars of 14 subjects serving as the two groups of the study. The right premolars constituted group A and the left ones, group B. Intrusive force was applied on these teeth for a period of 6 weeks, followed by retaining the teeth for 4 weeks (group A) and 6 weeks (group B) as rest periods before extraction. The extracted teeth were prepared for histologic examination with haematoxylin and eosin staining and studied under a light microscope. The histological sections were scored based on the level of repair (none, partial, functional, or anatomic) seen in the deepest craters in the apical third region of the roots. The mean values of the scores in the two groups were compared using Mann-Whitney U test. RESULTS: All the teeth showed healing in their deepest craters. The teeth in group A showed partial repair more frequently (84.6%), with the remaining (15.4%) showing functional repair. The teeth in group B showed anatomic repair more frequently (60%), with the remaining (40%) showing functional repair. The mean level of repair was higher in group B (2.6 ± 0.5) as opposed to that in group A (1.15 ± 0.37). The difference between these values was of very high significance (P < 0.05). CONCLUSIONS: Longer rest period of 6 weeks showed more advanced healing than a shorter rest period of 4 weeks. Six weeks of rest period is adequate only for the functional repair of resorption craters.

Minimally Invasive Treatment of Class 4 Invasive Cervical Resorption with Internal Approach: A Case Series.

Invasive cervical resorption (ICR) is a type of external resorption that can involve the coronal, middle, and apical parts of the root in its advanced stages. The diagnosis and treatment of ICR depend on the extent of the resorption into the dentin. The treatment of advanced ICR is challenging, and these teeth have poor prognoses. This article describes 4 cases of class 4 ICR diagnosed by using cone-beam computed tomography and treated with a minimally invasive internal approach with sodium hypochlorite irrigation and calcium hydroxide dressing. All cases were followed for at least 3 years.

Severe root resorption of the upper central incisors as a consequence of playing the flute.

This study presents a case of severe root resorption of the maxillary central incisors in an 18-year-old woman who was referred for orthodontic treatment of irregular dental arches. A detailed history revealed that she used to play the block flute on an everyday basis during childhood. Against all warnings, she continued to firmly press her teeth into the mouthpiece of the instrument. Impressions of the upper central incisors were clearly visible on the instrument. Although it is well known that excessive occlusal forces can result in root resorption, to the authors' knowledge, this case involves one of the first reported occurrences of extensive root resorption that was most likely caused by playing a wind instrument during childhood.