Sealing the cervical defect with biodentine

Anjna Sharma; Rahul Maria; Pankaj Mishra; Aditya Pethiya

doi:10.4103/2455-3069.198382

CASE REPORT

Year : 2016 | Volume : 2 | Issue : 2 | Page : 125-128

Sealing the cervical defect with biodentine

Anjna Sharma¹, Rahul Maria¹, Pankaj Mishra¹, Aditya Pethiya²
¹ Department of Conservative Dentistry and Endodontics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
² Clinical Practitioner, Bhopal, Madhya Pradesh, India

Date of Submission	26-Oct-2016
Date of Acceptance	03-Dec-2016
Date of Web Publication	13-Jan-2017

Correspondence Address:
Pankaj Mishra
Department of Conservative Dentistry and Endodontics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/2455-3069.198382

Abstract

External cervical resorption (ECR) is a type of external resorption that can be quite devastating for the tooth and in extreme cases can even lead to tooth extraction. Its diagnosis and management present many challenges for a dental practitioner. This case report describes the treatment of an ECR in the upper left central incisor, which was treated surgically following endodontic treatment using the new dental cement Biodentine to repair the cervical defect.

Keywords: Biodentine, cervical defect

How to cite this article:
Sharma A, Maria R, Mishra P, Pethiya A. Sealing the cervical defect with biodentine. J Curr Res Sci Med 2016;2:125-8

How to cite this URL:
Sharma A, Maria R, Mishra P, Pethiya A. Sealing the cervical defect with biodentine. J Curr Res Sci Med [serial online] 2016 [cited 2023 May 29];2:125-8. Available from: https://www.jcrsmed.org/text.asp?2016/2/2/125/198382

Introduction

External resorption is a process that may lead to an irreversible loss of cementum, dentin, and bone. It takes place in both vital and pulpless teeth and the identification is mostly made during routine radiographic or clinical examination, as the majority of cases are asymptomatic. External resorptions may be physiological or pathological.^[1],[2] External root resorption occurs on the outer surface of the root.^[3],[4] The lesions are rarely symptomatic but may be associated with bleeding from the hyperemic and often proliferative tissue which occupies the resorption defect.^[5],[6]

Clinically, cervical external resorption is associated with inflammation of the periodontal tissues and does not have any pulpal involvement.^[7] The pulp remains protected by a thin layer of predentin until late in the process, and it has been postulated that bacteria in the sulcus sustain the inflammatory response in the periodontium.^[8],[9] The radiographic appearance of the cervical resorption is characteristic and often the presenting feature.^[10],[11]

Relatively uniform progress of the resorption over the entire front results in a macroscopically concave cavity with a radiographic appearance of uniform radiolucency and a smooth, regular outline. However, a nonuniform preferential spread is also possible and may result in “fingers” of resorptive tissue extending in different directions, often with little lateral spread at the site of initiation.

This is observed radiographically as an irregular, diffuse radiolucency of nonuniform radiodensity.^{[5],[10],[11],[12]} Although the precise pathogenic mechanisms and the natural history of external cervical resorption (ECR) are only loosely identified, a number of possible contributory factors have been implicated. These include trauma, orthodontic tooth movement, dentoalveolar surgery, and periodontal disease and its treatment (Tronstad 1988, Bakland 1992).^[8],[13] In the endodontic literature, intracoronal bleaching is the most commonly cited etiological factor.^{[13],[14],[15]}

This case report presents the surgical management of ECR which was present in the cervical one-third of the root involving most of the labial aspect of 21.

Case Report

A 22-year-old male patient was referred to the Department of Conservative Dentistry and Endodontics. The patient reported a history of fall 10 years back. Clinical examinations revealed Grade I mobility of the upper left central incisor; palpation, and percussion tests induced pain with 21, 22. The labial gingival tissue was inflamed and slightly tender to palpation [Figure 1].

Figure 1: View of preopeative cervical defect of 21 and 22

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On radiographic examination, intraoral periapical radiograph revealed an oval-shaped radiolucent area in the cervical third of the root involving crown. There were periapical lesion involving 21, 22 [Figure 2]. Vitality testing was done with upper anterior where 21, 22 were found to be nonvital. On the basis of history, clinical examination, and radiographic findings, a diagnosis of external cervical root resorption (Class 3 invasive cervical resorption as described by Heithersay) along with the periapical lesion with 21, 22 was made.

Figure 2: Preoperative radiograph showing th defect in 21, 22

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Access opening was done, working length was determined, and cleaning and shaping was done. Intracanal medicament of calcium hydroxide was given with 21, 22. The dressing was changed and replaced by intracanal medicament of triple antibiotic paste after 1 week. On next recall, the canal was dried, master cone was selected, and obturation was done by lateral condensation technique till just below the resorptive area.

As the lesion was clinically not accessible, surgical approach was done to repair the resorptive defect. After administering local anesthesia, flap was reflected. The resorptive cavity was curetted to remove the devitalized tissue, and the cavity was thoroughly irrigated with sterile saline solution; intraoral periapical radiograph was taken. The resorptive defect was filled with biodentine. It was mixed according to the manufacturer's instructions and was firmly condensed in the resorptive cavity. Intraoral periapical radiograph was taken to confirm the sealing of the resorptive cavity [Figure 3]. The flap was repositioned and sutured, and postsurgical instructions were given to the patient.

Figure 3: Postoperative radiograph with 21, 22 (cervical defect sealed with biodentine 21)

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Patient was recalled after a week; suture removal was done. No symptoms and signs were noted. Postobturation restoration was done with composite with 21 and 22 and intraoral periapical radiograph was taken. For aesthetic reasons, labially, the biodentine was reduced and composite build-up was done [Figure 4].

Figure 4: Postoperative view of corrected 21

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Discussion

The present case describes a presentation of external cervical root resorption at cervical third of the root involving crown. In this case, the etiology was trauma. Dental trauma is considered as a major potential predisposing factor in cases of ECR.^[16] ECR is the loss of dental hard tissue as a result of odontoclastic action.^[17] The reciprocal activity between the newly formed granular tissue and dentinoclasts initiates and progresses the resorption process inside the endodontic space which could be compared to pathogenetic changes in the periapical region.^[18] A pink spot in the cervical region of the tooth is usually the clinical sign noticed by the patient and/or dentist that brings the problem to light. If there is no pink spot indicating ECR, then the condition might go unnoticed until there is pulpal and/or periodontal involvement because these lesions are usually painless. ECR defects are commonly detected as chance findings on radiographs. The lesions vary from well-delineated radiolucencies that are quite obvious, to poorly defined lesions with irregular borders and sometimes resemble caries.^[17]

Successful treatment of cervical resorption depends on the extent of the resorptive process and its accurate diagnosis.^[19] The diagnosis of cervical resorption is made more precise with currently available radiographic technology.^[20] Appropriate treatment should aim at the inactivation of all resorbing tissue and the reconstitution of the resorptive defect by the placement of a suitable filling material.^[17] Various materials are available to fill the resorptive defect, e.g., glass ionomer cement, composite resin, mineral trioxide aggregate, white ProRoot MTA, Portlant cement, Biodentine.^{[21],[22],[23],[24],[25]} Biodentine was used. Biodentine powder is mainly composed of tricalcium silicate, calcium carbonate, and zirconium oxide as the radiopacifier, while the liquid form contains calcium chloride as the setting accelerator and water reducing agent. It is interesting to note that biodentine can develop watertight interfaces both with dental structures and with adhesive systems.^[24] As biodentine requires a minimum waiting period of 2 weeks for adequate maturation, the composite restoration with respect to 21 was done after 2 weeks.

The aim of the treatment in this case was to prevent resorption and improve aesthetics. Access to the resorptive cavity was obtained surgically. In addition, surgery facilitated in removing the inflamed and growth soft tissues and in the improvement in esthetics.

Conclusion

It is important for clinicians to understand the restorative aspect while treating ECR. Proper management requires skill and knowledge in all three aspects, i.e., endodontics, surgery, and restorative dentistry. Biodentine is a part of a new approach seeking to simplify clinical procedures for the present case; in treating ECR, biodentine was an available option which can improve the healing outcome, and the patient was satisfied with the result of treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Bergmans L, Van Cleynenbreugel J, Verbeken E, Wevers M, Van Meerbeek B, Lambrechts P. Cervical external root resorption in vital teeth. J Clin Periodontol 2002;29:580-5.
2.	Andreasen JO. External root resorption: Its implication in dental traumatology, paedodontics, periodontics, orthodontics and endodontics. Int Endod J 1985;18:109-18.
3.	Kuo TC, Cheng YA, Lin CP. Clinical management of severe external root resorption. Chin Dent J 2005;24:59–64.
4.	Benenati FW. Root resorption: Types and treatment. Gen Dent 1997;45:42-5.
5.	Southam JC. Clinical and histological aspects of peripheral cervical resorption. J Periodontol 1967;38:534-8.
6.	Patel K, Darbar UR, Gulabivala K. External cervical resorption associated with localized gingival overgrowth. Int Endod J 2002;35:395-402.
7.	Frank AL, Torabinejad M. Diagnosis and treatment of extracranial invasive resorption. J Endod 1998;7:500-4.
8.	Tronstad L. Root resorption – Etiology, terminology and clinical manifestations. Endod Dent Traumatol 1988;4:241-52.
9.	Heithersay GS. Clinical, radiographic, and histopathological features of invasive cervical resorption. Quintessence Int 1999;30:27-37.
10.	Gartner AH, Mack T, Somerlott RG, Walsh LC. Differential diagnosis of internal and external root resorption. J Endod 1976;2:329-34.
11.	Gulabivala K, Searson LJ. Clinical diagnosis of internal resorption: An exception to the rule. Int Endod J 1995;28:255-60.
12.	Makkes PC, Thoden van Velzen SK. Cervical external root resorption. J Dent 1975;3:217-22.
13.	Bakland LK. Root resorption. Dent Clin North Am 1992;36:491-507.
14.	Goon WW, Cohen S, Borer RF. External cervical root resorption following bleaching. J Endod 1986;12:414-8.
15.	MacIsaac AM, Hoen CM. Intracoronal bleaching: Concerns and considerations. J Can Dent Assoc 1994;60:57-64.
16.	Vineeta N, Vipin A, Padmnabh J, Mukul V. Non surgical management of trauma induced external root resorption at two different sites in a single tooth with Biodentine: A case report. Endodontology 2012;24:150-55.
17.	Abdelmoumen E, Skhiri SZ, Boughzela A. Use of Biodentine™ in the treatment of invasive cervical resorption: A case report. IJRD 2015;4:10-16.
18.	Maria R, Mantry V, Koolwal S. Internal resorption: a review and case report. Endodontology 2010;22:100-8.
19.	Heithersay GS. Clinical endodontic and surgical management of tooth and associated bone resorption. Int Endod J 1985;18:72-92.
20.	Pruthi PJ, Yadav P, Kaur H, Talwar S. Management of a class III Invasive cervical resorption using a new biomaterial. Int J Res Dent 2014;4:174-81.
21.	Johnson BR. Considerations in the selection of a root-end filling material. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:398-404.
22.	Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical and chemical properties of a new root-end filling material. J Endod 1995;21:349-53.
23.	Dammaschke T, Gerth HU, Züchner H, Schäfer E. Chemical and physical surface and bulk material characterization of white ProRoot MTA and two Portland cements. Dent Mater 2005;21:731-8.
24.	Dejou J, Raskin A, Colombani J, About I. Physical, chemical and mechanical behavior of a new material for direct posterior fillings. Eur Cells Mater 2005;10:22.
25.	Bogen G, Kuttler S. Mineral trioxide aggregate obturation: A review and case series. J Endod 2009;35:777-90.