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Case Report/Clinical Techniques

Invasive Cervical Resorption Class III in a Maxillary Central Incisor: Diagnosis and Follow-up by Means of Cone-Beam Computed Tomography
Roberto Estevez, DDS,* Jose Aranguren, DDS,* Alfonso Escorial, DDS,* Cesar de Gregorio, DDS,* Francisco De La Torre, DDS,* Jorge Vera, DDS,† and Rafael Cisneros, DDS*
Abstract
Introduction: Invasive cervical resorption (ICR)is a type of external resorption that begins below the epithelial attachment. The etiology of ICR is mainly caused by trauma or orthodontic treatment. In many cases, cone-beam computed tomography (CBCT) is a very useful tool to achieve proper diagnosis. Methods: This case presented with invasive cervical resorption class III (Heithersay) caused by trauma on tooth #9. CBCT was performed allowingobservation of the extent of the lesion in the three spatial planes. Results: Treatment was combined: surgical treatment to expose the resorptive defect and nonsurgical root canal therapy to remove the necrotic pulp and disinfect the root canal system; finally, the resorptive defect was filled up with resin ionomer (Geristore; Den-Mat Corporation, Santa Maria, CA). Conclusions: Follow up x-ray filmsshowed healing of the periradicular tissues, and then a control CBCT was performed to assess the reliability of the conventional x-ray film; a small periapical lesion was observed in two of the CBCT sections. (J Endod 2010;36:2012–2014)

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Key Words
Cone-beam computed tomography, invasive cervical resorption, maxillary central incisor

From the *Department of Endodontics, Universidad Europeade Madrid, Madrid, Espana; and †Department of ˜ Endodontics, Universidad Autonoma de Tlaxcala, Tlaxcala, Mexico. Address requests for reprints to Dr Roberto Estevez, Department of Endodontics, Universidad Europea de Madrid, Purchena 36, 3 A, 28033 Madrid, Spain. E-mail address: puenteareascity@yahoo.com 0099-2399/$ - see front matter Copyright ª 2010 American Association of Endodontists.doi:10.1016/j.joen.2010.08.012

nvasive cervical resorption (ICR) is a type of external resorption that begins below the epithelial attachment. It commonly affects mineralized tissues (cementum and dentin), and, except for some advanced stages, the predentin layer protects the pulp tissue because it is less mineralized. Heithersay (1–4) established a clinical classification of ICR based on intensiveresearch studies, observing possible causes for this pathology as well as different therapeutic approaches to treat this condition. Even though the etiology remains partially unclear, it seems that trauma, orthodontic treatment, and tooth-whitening procedures are the main causes for ICR. Recently, von Arx et al (5) discussed the possible role of a feline herpes virus (FeHV-1) as an etiologic(co-)factor in the development of multiple cervical resorption cases in humans. Although root cementum in the surface of the radicular dentin prevents it from being resorbed, damage to it as a result of any of the aforementioned causes may expose root dentin to osteoclasts, therefore initiating the resorptive process (6, 7). Heithersay divides ICR into four classes according to the degree of damage tomineralized tissues. Class I corresponds to a small invasive resorptive lesion near the cervical area with shallow penetration into dentin, class II presents a well-defined resorptive lesion close to the coronal pulp chamber with little or no extension into the radicular dentin, class III presents a resorptive defect involving the coronal third of the root, and class IV presents a resorptive defectextending beyond the root’s cervical third. For this last type of resorption as established by Heithersay (8), treatment is more likely to be tooth extraction because of the extent of the lesion and the risk of failure. The diagnosis and extent of the lesion are hard to evaluate with conventional x-ray films. In the case presented here, cone-beam computed tomography (CBCT) was performed to further...
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