原文題目(出處)： Multiple idiopathic cervical resorption: case report and discussion of management options. Int Endod J 2011;44:77-85
原文作者姓名： V. S. H. Yu, H. H. Messer & K. B. Tan
通訊作者學校： Faculty of Dentistry, National University of Singapore, Singapore; and Melbourne Dental School, University of Melbourne, Melbourne, Vic., Australia
報告者姓名(組別)： Intern G 梁任宏
報告日期： 2011.2.8
內文：
□ Introduction：
a. Cervical root resorption is an uncommon condition of largely unknown etiology
b. In contrast to invasive cervical resorption, which typically affects only one tooth and may be related to trauma or other local factors (Heithersay 1999, 2004)
c. The distribution varies from a single region (e.g. mandibular incisors) to most teeth within one arch or more generally distributed throughout the entire dentition
d. Most affected individuals are healthy, with noncontributory medical histories
e. An attempt has been made to link multiple idiopathic cervical root resorption to feline invasive cervical resorption (von Arx et al. 2009, DeLaurier et al. 2009)
f. Root canal treatment does not arrest the resorption (Moody et al. 1990) g. Management poses serious problems and the condition is generally
progressive and leads to loss of affected teeth
□ Case report：
a. 33-year-old Chinese male, with the intention of seeking implant replacement for lost teeth
□ Medical and family/social history：
b. medical history was noncontributory and the patient was healthy, with no record of systemic disease or abnormal blood picture
c. no other family member (father, mother, one older brother and one older sister) had a similar condition
□ Dental history and clinical assessment：
c. Teeth were not tender to percussion and gave a normal sound on percussion.
Mobility was normal. Periodontal probing was consistently 3 mm or less and no bleeding on probing was detected
□ Radiographic assessment(Including CBCT)：
a. All remaining teeth showed radiographic evidence of cervical resorption, including tooth 38 which was unerupted (impacted)
(Figure 2) Periapical radiographs taken at the most recent visit. A small lesion is present on the distal cervical margin of impacted tooth 38 and larger lesions on first and second molars. Alveolar bone has extended into the resorption cavities, especially in teeth 46 and 47, where the bone has extended even into the coronal defect beneath enamel. Despite the bony ingrowth, the teeth did not show clinical evidence of ankylosis
(Figure 3) Periapical radiograph and CBCT image of tooth 25. A small lesion on the
(Figure 4) Periapical radiographs of the maxillary molar region and a CBCT slice through the first molars. Extensive lesions on the buccal and palatal surfaces of tooth 16 and the buccal surface of tooth 26 were not detected by conventional radiography but are clearly present in the CBCT image.
(Figure 5) Periapical radiograph and CBCT images (bucco-lingual and axial slices) of tooth 23. The CBCT images appear to show an extensive pulp exposure on the buccal surface with bone growing into the lesion and expansion of the buccal plate. This is not apparent on the periapical radiograph. Clinically the tooth tested within normal limits to pulp tests and the gingiva was normal in appearance with a probing depth of less than 3 mm.
(Figure 6) CBCT axial slice through the cervical region of the maxillary teeth. Tooth 15 (white arrow) shows the resorptive defect extending beneath enamel and involving most of the circumference of the tooth.
□ Discussion：
a. The present case represents an extreme example of multiple cervical root resorption, involving every tooth and leading progressively to the loss of 14 teeth, at a relatively young age
b. The pattern of resorption in this and other similar cases differs in character from that described for invasive cervical resorption affecting predominantly single teeth
c. In invasive cervical resorption the lesion tends to have a small point of entry on the root surface and most of the resorption occurs within the bulk of
dentine, avoiding both the root surface and the pulp chamber (Heithersay 1999, 2004). The lesions in this case are more in the form of an external defect
□ Management
Typically, involved teeth are extracted when the lesions progress to the point where a crown fracture is likely or has actually occurred (Moody et al. 1990, Liang et al.
2003), eventually leading to the extraction of all teeth and fabrication of complete dentures (Kerr et al. 1970)
(i) observation, with episodic extraction and prosthetic replacement of fractured teeth
(ii) early intervention with surgical exposure, curettage of lesions and restoration with glass ionomer cement (sometimes with root canal treatment of involved teeth)
(iii) crown resection with root submergence to preserve alveolar bone, and prosthetic replacement
(iv) extraction and replacement with implants (v) extraction of all teeth, with full dentures
(vi) medical management using bisphosphonates to arrest resorption.
□ A fixed prosthesis to replace lost mandibular incisors failed when abutment teeth subsequently underwent resorption
□ A removable partial denture to replace lost maxillary incisors resulted in extensive loss of alveolar bone, making subsequent implant placement more difficult
□ There are a number of problems with this conservative approach: CBCT shows that lesions are more widely distributed than appears on conventional radiographs, including buccal and lingual/palatal surfaces; many lesions will be inaccessible;
and ongoing periodontal management will be needed because gingival reattachment is unlikely. In addition, lesions tend to recur
□ Extraction of teeth and replacement with implant-supported prostheses is a more radical intervention, but may serve the long-term interests of the patient by maintaining healthy bone support.
□ In one case report, resorption ceased after the patient was placed on
bisphosphonate therapy for an orthopaedic condition (Iwamatsu-Kobayashi et al.
2005), over a period of 6 years
□ If lesions are detected early, surgical exposure and restoration with GIC will probably maintain most teeth for many years. As resorption progresses and more teeth are involved, staged extraction and implant placement to support removable partial prostheses should follow
□ CBCT was useful in demonstrating the extent of the lesions more precisely, especially on buccal and lingual/palatal surfaces
題號 題目
1 The external resorption process usually begin with (A) Distinct border of teeth
(B) Internal resorption of teeth (C) Symptom and sign
(D) Indistinct border of teeth 答案
( D)
出處：Contemporary Oral and Maxillofacial Pathology 2nd edition, p371, p372
題號 題目
2 Ankylosis appears that whenever the connective tissue of the periodontal membrane is lost, it allow______ to come in direct contact with alveolar bone
(A) Only cementum (B) Only dentin (C) enamel (D) Both A and B
答案(D) 出處： Contemporary Oral and Maxillofacial Pathology 2nd edition, p372
