classification, diagnosis, management and clinical cases. AUTORS: F. ... most used, although many authors are starting to use MTA and Biodentine. Technology ...
Invasive Cervical Resorption (ICR): a literature Review of Heithersay’s classification, diagnosis, management and clinical cases. AUTORS: F. Di Leone, D. Nicchio and A. Sallorenzo GROUP: M4B INTRODUCTION AND OBJETIVS Classification of the ICR, find the best way for the diagnosis, recognize clinical signs and option of possible treatment. ICR: uncommon external resorption, that could occur in every permanent tooth. Loss of dentin and cement due to cementoclasts action, between the epithelial union of the gum with the root and the alveolar bone’s coronal portion. Ethology: Possible causes: Orthodontic treatment, trauma, internal bleaching, surgery with damage of cement-enamel junction, bruxism. Heithersay’s Classification: ✻ Class I: small invasive lesion near cervical area. Shallow penetration into dentine. Irregular gingival margin, with bleeding on probing. XRay: small radiolucent lesion. ✻ Class II: deeper penetration of the dentine, near pulp chamber, with possible extension to root dentine. Small layer of dentina between pulp and resorption tissue: asymptomatic. ✻ Class III: the penetration of dentine affect the coronal portion and the cervical third of the root. Normally is asymptomatic, if pain: infection of pulp or periodontal tissues. ✻ Class IV: invasion below the cervical third of the root. X-Ray: more extension of the lesion
WITHOUT SURGERY CLASSIC TREATMENT
CLASS I –II: 90% Trichloroacetic acid for 30 seconds + scaling + Endodontic treatment if necessary + CVI restoration CLASS III: 90% Trichloroacetic acid for 30 seconds + Ledermix past + Endodontic treatment + CVI restoration. Orthodontic extrusion if necessary CLASS IV: No treatment. If necessary extraction
WITH SURGERY
MATERIALS AND METHODS Literature review of Scientifics articles, founded on high impact dentals journals and Pub Med. DISCUSSION Diagnosis and management: ✻ CBCT allows early treatments that can avoid dental extraction. ✻ Conventional Rx no information about deep of the lesion (2D). ✻ CBCT allows to know the necessity of lift flap or not (difference with Heithersay). ✻ The majority of the authors use aqueous solution of 90% trichloroacetic acid (as Heithersay). ✻ Unlike Heithersay’s theory, many authors decide to treat classes IV ✻ The microscope is a very helpful tool to improve the ICR treatment.
CASE II 78 years old patient, slight harassment in upper left central incisor. 25 years before he had a trauma in that tooth à ICR class II à Endodontic treatment with NaOCl 1,25% and EDTA 17% + periodontal surgery to access the lesion + 90% Trichloroacetic acid for 30 seconds + hybrid ionomer cement + antiinflammatory, antibiotic and chlorhexidine treatments.
Surgery flap + 90% Trichloroacetic acid for 30 seconds + scaling + Endodontic treatment if necessary + MTA restoration
CLINICAL CASES CASE I 28 years old patient, dental trauma in upper left central incisor. Negative to vitality test à ICR class III à Endodontic treatment with NaOCl 1,25% and EDTA 17% + 90% Trichloroacetic acid for 30 seconds and lightcuring glass ionomer cement.
CASE III 46 years old patient, in treatment with invisible orthodontic, slight harassment in upper right second premolar. Positive to vitality test à class IV à Endodontic treatment with NaOCl 5,25% and EDTA 19% + removal of granulation tissue with bone curette, ceramics burs and ultrasonic tips + hydrogen peroxide to stop bleeding + MTA to fill .
CONCLUSIONS ICR is an unusual tooth pathology that could have different causes .CBCT is fundamental to make early diagnosis, and to decide the treatment (surgery/endodontic). Rx is useful to make a first diagnosis but has many limits (2D).Exist many materials of restoration, the resin ionomer cement is the most used, although many authors are starting to use MTA and Biodentine. Technology advances (microscope and CBCT) allows the treatment of lesions (class IV) always considered intractable. Heithersay’ s clasification is very useful but the management depends on the lesion we have in front. An early diagnosis is the best way to ensure a good prognostic. REFERENCES 1. Heithersay, G. (2004). Invasive cervical resorption. Endodontic Topics, 7(1), pp.73-92. 2. Kandalgaonkar SD, Gharat LA, Tupsakhare SD, Gabhane MH. Invasive Cervical Resorption: A Review. J Int Oral Health 2013;5(6):124-30. 3. Estevez, R., Aranguren, J., Escorial, A., de Gregorio, C., De La Torre, F., Vera, J. and Cisneros, R. (2010). Invasive Cervical Resorption Class III in a Maxillary Central Incisor: Diagnosis and Follow-up by Means of Cone-Beam Computed Tomography. Journal of Endodontics, 36(12), pp.2012-2014. 4. Harris, B., Caicedo, R., Lin, W. and Morton, D. (2014). Treatment of a maxillary central incisor with class III invasive cervical resorption and compromised ferrule: A clinical report. The Journal of Prosthetic Dentistry, 111(5), pp.356-361. 5. Salzano, S. and Tirone, F. (2015). Conservative Nonsurgical Treatment of Class 4 Invasive Cervical Resorption: A Case Series. Journal of Endodontics, 41(11), pp.1907-1912.
