Primary failure of eruption and tooth resorption / Défaut primaire d'éruption et résorption radiculaire externe

Introduction: The number of adult patients who seek an orthodontic treatment is increasing. These Primary failure of eruption (PFE) is defined as the partial or complete failure of eruption of at least one posterior tooth, without any mechanical obstacle. A better understanding of the biological mechanisms involved in PFE would enable to refine the diagnostic and prognostic criteria. This rare disease is currently related to PTHR1 gene variants. This gene codes for a transmembrane receptor involved in bone metabolism. However, there is few evidence associating PFE and bone remodeling abnormalities such as external root resorption. External root resorption is the loss of cementum and dentin tissues, resulting from the activation of clastic cells. Materials and Methods: Human teeth affected by PFE were extracted and histological sections were made after fixation of the tissues in 4% PFA. The observations were correlated with three-dimensional imaging by cone beam computed tomography (CBCT) carried out in the preoperative phase. Results: Histological and radiographic analysis confirm the presence of ankylosis area in patients with no history of orthodontic treatment. Large areas of resorption of external root replacement were detected. Discussion: The results call the causal link between the appearance of ankylosis areas and the establishment of orthodontic traction in patients with PFE into question. The installation of an orthodontic force in this context could be only an aggravating factor, accelerating the processes of ankylosis or triggering them more prematurely. Conclusion: With or without orthodontic treatment, teeth with PFE are likely to progress to ankylosis and resorption of replacement external root.

Introduction: Les défauts primaires d'éruption (DPE) se caractérisent par l'échec total ou partiel de l'éruption d'une ou plusieurs dents postérieures, sans obstacle mécanique. Une meilleure compréhension des mécanismes biologiques impliqués dans les DPE permettrait d'affiner les critères diagnostiques et pronostiques. Cette pathologie rare est actuellement imputée à des variants du gène PTHR1. Ce gène code pour un récepteur transmembranaire impliqué dans le métabolisme osseux. Cependant, on trouve peu de données associant DPE et anomalies du remodelage osseux de type résorption radiculaire externe. La résorption radiculaire externe correspond à la perte de tissus cémentaire et dentinaire résultant de l'activation de cellules clastiques. Matériels et méthodes: Des dents d'origine humaine atteintes de DPE ont été avulsées et des coupes histologiques réalisées après fixation des tissus. Les observations ont été corrélées avec l'imagerie tridimensionnelle par tomographie volumique à faisceau conique (TVFC ou encore CBCT). Résultats: Les analyses histologiques et radiographiques montrent la présence de plage d'ankylose chez des patients sans antécédent de prise en charge orthodontique. De larges zones de résorptions radiculaires externes de remplacement ont été détectées. Discussion: Les résultats remettent en cause le lien de causalité entre l'apparition d'ankylose et la mise en place de traction orthodontique chez les patients atteints de DPE. La mise en place d'une force orthodontique dans ce contexte pourrait n'être qu'un facteur aggravant, accélérant les processus d'ankylose ou les déclenchant plus prématurément. Conclusion: Avec ou sans traitement orthodontique, les dents atteintes de DPE sont susceptibles d'évoluer vers l'ankylose et la résorption radiculaire externe de remplacement.

Tooth resorption-Part 2: A clinical classification.

Tooth resorption is either a physiological or a pathological process resulting in loss of dentin and/or cementum. It may also be associated with bone loss. Currently there is no universal classification for the different types of tooth resorption. This lack of a universal classification leads to both confusion amongst practitioners and poor understanding of the resorptive processes occurring in teeth which can result in incorrect/inappropriate diagnoses and mis-management. When developing a classification of diseases and/or conditions that occur within the body, several criteria should be followed to ensure a useful classification. The classification should not only include pathological conditions but also physiological conditions. Since tooth resorption can be either pathological or physiological, a classification of tooth resorption should include both of these categories. Any classification of diseases should be possible to use clinically, meaningful, useful, clear and universal. It should enable easy storage, retrieval and analysis of health information for evidenced-based decision-making. It should also be possible to share and compare data and information between different institutions, settings and countries. A classification of tooth resorption should be developed by combining anatomical, physiological and pathological approaches. For some types of resorption, the aetiological approach should also be incorporated. A classification of tooth resorption that uses simple, relevant and appropriate terminology based on the nature and location of the resorptive process occurring in teeth is proposed. There are two broad categories of internal and external tooth resorption which are sub-divided into three types of internal tooth resorption (surface, inflammatory, replacement) and eight types of external tooth resorption (surface, inflammatory, replacement, invasive, pressure, orthodontic, physiological, idiopathic). The clinician's understanding, diagnosis and management of tooth resorption can be facilitated by using this simple classification which should ideally be used universally by the entire dental profession to ensure clarity and to avoid confusion.

Impact of orthognathic surgery on root resorption: A systematic review.

OBJECTIVE: This systematic review was performed to assess the potential influence of orthognathic surgery on root resorption (RR). MATERIAL AND METHODS: An electronic search was conducted using PubMed, Web of Science, Cochrane Central and Embase for articles published up to April 2022. Following inclusion and exclusion criteria, a total of six articles were selected that reported on RR following orthognathic surgery. Risk of bias assessment was performed according to the ROBINS-1 and ROB-2 tools. RESULTS: The design of five studies was retrospective and one randomized clinical trial was included, with a follow-up period ranging between six months and ten years. The assessment methodologies mostly relied on two-dimensional imaging modalities where only one study used cone-beam computed tomography (CBCT) for objective quantification via linear measurements. The percentage of teeth affected by RR varied between approximately 1 and 36%, where surgically assisted rapid maxillary expansion (SARME) and Le Fort I osteotomy showed the highest percentage of RR followed by bilateral sagittal split osteotomy. CONCLUSIONS: The present data tend to indicate that specific orthognathic procedures such as SARME and Le Fort I osteotomy may induce or reinforce RR. Yet, considering lack of evidence related to objective quantification of RR following orthodontic and/or orthognathic treatment, further CBCT-based prospective studies are required for an improved understanding of RR following different surgical procedures.

Present status and future directions: Root resorption.

Root resorption is the loss of dental hard tissue because of odontoclastic action. In permanent teeth, it is undesirable and pathological in nature. Root resorption may occur on the inner aspect of the root canal (internal root resorption) or on the outer aspect of the root (external root resorption). Regardless of its location, root resorption is irreversible, and may result in discomfort for the patient, requires management and/or, in some cases, results in the premature loss of the affected tooth. Root resorption is often challenging to accurately diagnose and manage. The aim of this narrative review is to present the relevant literature on the aetiology, pathogenesis, diagnosis and management, as well as discuss the future directions of diagnosis and management of root resorption.

A Bioinformatics Systems Biology Analysis of the Current Oral Proteomic Biomarkers and Implications for Diagnosis and Treatment of External Root Resorption.

External root resorption (ERR) is a silent destructive phenomenon detrimental to dental health. ERR may have multiple etiologies such as infection, inflammation, traumatic injuries, pressure, mechanical stimulations, neoplastic conditions, systemic disorders, or idiopathic causes. Often, if undiagnosed and untreated, ERR can lead to the loss of the tooth or multiple teeth. Traditionally, clinicians have relied on radiographs and cone beam computed tomography (CBCT) images for the diagnosis of ERR; however, these techniques are not often precise or definitive and may require exposure of patients to more ionizing radiation than necessary. To overcome these shortcomings, there is an immense need to develop non-invasive approaches such as biomarker screening methods for rapid and precise diagnosis for ERR. In this review, we performed a literature survey for potential salivary or gingival crevicular fluid (GCF) proteomic biomarkers associated with ERR and analyzed the potential pathways leading to ERR. To the best of our knowledge, this is the first proteomics biomarker survey that connects ERR to body biofluids which represents a novel approach to diagnose and even monitor treatment progress for ERR.

Comparative assessment of mouse models for experimental orthodontic tooth movement.

Animal experiments are essential for the elucidation of biological-cellular mechanisms in the context of orthodontic tooth movement (OTM). So far, however, no studies comparatively assess available mouse models regarding their suitability. OTM of first upper molars was induced in C57BL/6 mice either via an elastic band or a NiTi coil spring for three, seven or 12 days. We assessed appliance survival rate, OTM and periodontal bone loss (µCT), root resorptions, osteoclastogenesis (TRAP+ area) and local expression of OTM-related genes (RT-qPCR). Seven days after the elastic bands were inserted, 87% were still in situ, but only 27% after 12 days. Survival rate for the NiTi coil springs was 100% throughout, but 8.9% of the animals did not survive. Both methods induced significant OTM, which was highest after 12 (NiTi spring) and 7 days (band), with a corresponding increase in local gene expression of OTM-related genes and osteoclastogenesis. Periodontal bone loss and root resorptions were not induced at a relevant extent by neither of the two procedures within the experimental periods. To induce reliable OTM in mice beyond 7 days, a NiTi coil spring is the method of choice. The elastic band method is recommended only for short-term yes/no-questions regarding OTM.

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.

Development of a clinical practice guideline for orthodontically induced external apical root resorption.

OBJECTIVES: To develop a clinical practice guideline on orthodontically induced external apical root resorption (EARR), with evidence-based and, when needed, consensus-based recommendations concerning diagnosis, risk factors, management during treatment, and after-treatment care. MATERIALS AND METHODS: The Appraisal of Guidelines for Research and Evaluation II instrument and the Dutch Method for Evidence-Based Guideline Development were used to develop the guideline. Based on a survey of all Dutch orthodontists, we formulated four clinical questions regarding EARR. To address these questions, we conducted systematic literature searches in MEDLINE and Embase, and we performed a systematic literature review. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. After discussing the evidence, a Task Force formulated considerations and recommendations. The drafted guideline was sent for comments to all relevant stakeholders. RESULTS: Eight studies were included. The quality of evidence (GRADE) was rated as low or very low. Only the patient-related risk factors, 'gender' and 'age', showed a moderate quality of evidence. The Task Force formulated 13 final recommendations concerning the detection of EARR, risk factors, EARR management during treatment, and after-treatment care when EARR has occurred. Stakeholder consultation resulted in 51 comments on the drafted guideline. After processing the comments, the final guideline was authorized by the Dutch Association of Orthodontists. The entire process took 3 years. LIMITATIONS: The quality of the available evidence was mainly low, and patient-reported outcome measures were lacking. CONCLUSIONS/IMPLICATIONS: This clinical practice guideline allows clinicians to respond to EARR based on current knowledge, although the recommendations are weak due to low-quality evidence. It may reduce variation between practices and aid in providing patients appropriate information.

[Dental root resorption etiology, diagnosis and treatment]. / Rezorbtsiia kornia zuba - étiologiia, patogenez, lechenie.

The process of resorption of hard tooth tissues is associated with the activity of osteoclasts. However, the initiation of resorption can be caused by many factors acting separately or simultaneously. The paper presents the characteristics of pathological tooth resorption. The main etiological factors, pathogenesis, clinical manifestations, as well as treatment of various forms of tooth resorption are described.

Biomarkers of inflammatory external root resorption as a result of traumatic dental injury to permanent teeth in children.

OBJECTIVE: External inflammatory root resorption (EIRR) is a common complication of traumatic dental injury (TDI) that can be detected radiologically. During EIRR, various proteins are released into gingival sulcus fluid (GCF). The aim of the study was to monitor the levels of selected proteins in GCF in children (8-16 years of age) in order to assess their utility in the early diagnosis of EIRR. DESIGN: Twenty five children who experienced TDI to permanent incisors with ended root development were enrolled. GCF was collected from injured and control teeth with paper strips within seven days after TDI and on three visits during six-month follow-up. Concentrations of IL-1α, IL-1ß, IL-6, IL-8, TNFα, RANKL and MMP-9 in GCF were measured using enzyme-linked immunosorbent assays. EIRR was confirmed by radiological imaging techniques. RESULTS: Of all analyzed proteins, only the levels of IL-1α, Il-1ß and TNFα in GCF from the injured teeth with resorption were higher than in GCF from control teeth on the visit during which the EIRR was diagnosed. In univariate logistic regression model, the concentration of IL-1α in GCF was found as the strongest risk factor for the occurrence of EIRR. CONCLUSIONS: The composition of GCF may be indicative of EIRR after TDI. The monitoring of selected biomarkers in GCF may help to detect EIRR at its early stage and might be useful in reducing radiological exposure in children after TDI. IL-1α can be considered as a potential marker of the EIRR in children after TDI to the permanent teeth.

European Society of Endodontology position statement: External Cervical Resorption.

This Position Statement represents the consensus of an expert committee convened by the European Society of Endodontology (ESE) on External Cervical Resorption (ECR). The statement is based on current clinical and scientific evidence as well as the expertise of the committee. The primary aim is to provide a current authoritative position on the aetiology, histopathology, clinical presentation and management of ECR, and also to highlight areas where there is minimal evidence. Previously published review articles provide more detailed background information and the basis for this position statement (International Endodontic Journal 51, 1205, 2018, International Endodontic Journal 51, 1224, 2018). It is intended that this position statement will be updated at appropriate intervals, as further evidence emerges.

Accuracy of linear and volumetric measurements of artificial ERR cavities by using CBCT images obtained at 4 different voxel sizes and measured by using 4 different software: an ex vivo research.

OBJECTIVES: To compare the accuracy of linear and volumetric measurements of artificial external root resorption (ERR) cavities by cone beam CT (CBCT) images obtained at four voxel sizes and by using four different software ex vivo. METHODS: ERR cavities were created on 40 extracted single rooted anterior teeth. Images were obtained by using Planmeca CBCT unit at endo mode (0.075 mm); high-resolution mode (0.1 mm); high-definition mode (0.15 mm) and normal resolution mode (0.2 mm) voxel sizes. Images were analyzed by two observers using four different software (Romexis, 3D Doctor, ITK-SNAP, and OsiriX). (1) Diameter; (2) height; (3) depth; and (4) volume of the ERR were measured. CBCT measurements were then compared with direct physical measurements. ANOVA was used with general linear model analysis. The significance level was set at p < 0.05. RESULTS: One-way ANOVA general linear model analysis showed no significant difference between or within observers for diameter, height, depth and volume measurements (p > 0.05). We found significant differences for diameter and volume measurements among softwares in terms of mean differences as compared to mean standard direct measurements (p < 0.05). We found statistically significant differences among voxel sizes and software for height measurements (p < 0.05). In addition, we found significant differences for diameter and volume measurements (p < 0.05) suggesting more accurate measurements for the cervical region when compared to apical region. CONCLUSIONS: Observers using CBCT images obtained at four voxel sizes performed similarly in the quantification of artificial ERR with clinically insignificant distinction between CBCT softwares used.

The ins and outs of root resorption.

Root resorption is a poorly understood phenomenon and is often misdiagnosed and, as a result, inappropriately treated. The aim of this paper is to provide a practical guide for diagnosis of root resorption lesions using a simple classification, and to describe the principles of management of these resorptive defects in everyday practice.

External apical root resorption diagnosis by using FII human dentine fraction and salivary IGg.

BACKGROUND: External apical root resorption as a consequence of orthodontic treatment is an inflammatory pathological process that results in permanent loss of tooth structure from the root apex. OBJECTIVES: This study aimed to investigate the diagnostic potential of human dentine fractions and salivary IgG in external apical root resorption. PATIENTS AND METHODS: Saliva samples were collected from 10 patients before (T0) and after 3 (T3), 6 (T6) and 12 (T12) months of orthodontic treatment. The total dentinal extract, obtained from human third molars, was fractioned by gel filtration chromatography in three fractions denominated FI, FII and FIII. The root resorption analysis of the upper central incisors was performed by digital image subtraction method. Reactivity of salivary IgG to antigenic fractions of dentine was determined by enzyme-linked immunosorbent assay (Elisa). RESULTS: Regardless of treatment, FI dentin fraction with high MM (<300kDa) was the one that presented highest reactivity with salivary IgG. However, it was found higher salivary IgG reactivity for FII (69 to 45 kilodalton [kDa]) as compared to FIII (<45kDa) at (T6) and (T12), (P<0.05), the same periods in that the root resorptions were detected. CONCLUSION: Our results suggest that FII human dentine fraction and salivary IgG have potential to be used in diagnosis and monitoring of external apical root resorption. The development of a practical and accessible biochemical test using saliva and FII dentine fraction may help in the prevention of severe root resorption.

Comparison between Two Radiological Methods for Assessment of Tooth Root Resorption: An In Vitro Study.

PURPOSE: This study aims to verify the validity of the radiographic image and the most effective radiological techniques for the diagnosis of root resorption to prevent, cure, and reduce it and to verify if radiological images can be helpful in medical and legal situations. METHODS: 19 dental elements without root resorption extracted from several patients were examined: endooral and panoramic radiographs were performed, with traditional and digital methods. Then the root of each tooth was dipped into 3-4 mm of 10% nitric acid for 24 hours to simulate the resorption of the root and later submitted again to radiological examinations and measurements using the same criteria and methods. RESULTS: For teeth with root resorption the real measurements and the values obtained with endooral techniques and digital sensors are almost the same, while image values obtained by panoramic radiographs are more distorted than the real ones. CONCLUSIONS: Panoramic radiographs are not useful for the diagnosis of root resorption. The endooral examination is, in medical and legal fields, the most valid and objective instrument to detect root resorption. Although the literature suggests that CBCT is a reliable tool in detecting root resorption defects, the increased radiation dosage and expense and the limited availability of CBCT in most clinical settings accentuate the outcome of this study.

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

[External cervical root resorption]. / Externe cervicale wortelresorptie.

External cervical root resorption begins at the root surface as result of odontoclastic activity in the cervical area and is progressive in character. The pulp is only affected at a later stage of the process. The aetiology and pathogenesis of external cervical root resorption is not fully understood. Possible predisposing factors are, among others, orthodontic treatment, trauma, internal bleaching, damaged cemento-enamel junction, bruxism and hypoxia. A 'pink spot' often is the first clinical sign and a two-dimensional radiograph usually presents an amorphous radiolucency with undefined borders. Cone-beam computed tomography is an emerging technique aiding the diagnosis of and prognosis and treatment plans for external root resorption. An external or internal treatment approach can be chosen, depending on the size of the defect.

Multiple invasive cervical resorption and celiac disease: A case report.

Multiple invasive cervical resorption (MICR) is a rare disease of unknown etiology. A case of a patient with MICR of six teeth, with low vitamin D3 level detected, is presented. Applied surgical and general treatments were only partially effective, as they failed to stop the resorption, although the parameters of calcium-phosphate management appreciably improved, and secondary hyperparathyroidism was successfully resolved.

A pilot study of the metabolomic profiles of saliva from female orthodontic patients with external apical root resorption.

BACKGROUND: Orthodontically induced external apical root resorption (OIEARR) is one of the most severe complications of orthodontic treatment, which is hard to diagnose at early stage by merely radiographic examination. This study aimed to identify salivary metabolic products using unbiased metabolic profiling in order to discover biomarkers that may indicate OIEARR. MATERIALS AND METHODS: Unstimulated saliva samples were analyzed from 19 healthy orthodontic patients with EARR (n=8) and non-EARR (n=11). Metabolite profiling was performed using 1H Nuclear Magnetic Resonance (NMR) spectroscopy. RESULTS: A total of 187 metabolites were found in saliva samples. With supervised partial least squares discriminant analysis and regression analysis, samples from 2 groups were well separated, attributed by a series of metabolites of interest, including butyrate, propane-1,2-diol, α-linolenic acid (Ala), α-glucose, urea, fumarate, formate, guanosine, purine, etc. Indicating the increased inflammatory responses in the periodontal tissues possibly associated with energy metabolism and oxidative stress. CONCLUSIONS: The effective separation capacity of 1H NMR based metabolomics suggested potential feasibility of clinical application in monitoring periodontal and apical condition in orthodontic patients during treatment and make early diagnosis of OIEARR. Metabolites detected in this study need further validation to identify exact biomarkers of OIEARR. Saliva biomarkers may assist in diagnosis and monitoring of this disease.

Management of extensive external apical root resorption leading to root perforation.

Resorption is both a physiological and pathological process which results in loss of hard tissues of the tooth, i.e , cementum and dentine and the surrounding bone. External resorption is much more common than internal resorption and can occur when tooth is luxated or avulsed. If remained unchecked, resorption can eventually lead to loss of the tooth. Timely management of the affected tooth can slow down the resorptive lesion and increase the prognosis of the survival of the tooth. This case report describes the surgical management of extensive external root resorption leading to perforation of apical one-third of the root area which was managed through root canal along with periapical surgery and bone grafting. A 6-month follow-up showed arrest of the resorptive defect and progressive healing as evident on the cone-beam computed tomography.