Invasive cervical resorption following trauma.

Invasive cervical resorption is an insidious and often aggressively destructive form of external root resorption which may occur as a late complication following dental trauma particularly where it involves damage to cementum and supporting tissues. While this resorption may be evident clinically as a pink coronal discolouration, later with cavitation of the enamel, often there are no obvious external signs and the condition is only detected radiographically. It is characterised by the invasion of the cervical region of the root by fibrovascular tissue which progressively resorbs dentine, enamel and cementum. The dental pulp remains protected by an intact layer of dentine and predentine until late in the process. Ectopic calcifications can be observed in advanced lesions both within the invading fibrous tissue and deposited directly onto the resorbed dentine surface. The aetiology of invasive cervical resorption is unknown but trauma has been documented as a potential predisposing factor. A recent study by the author of 222 patients with a total of 257 teeth which displayed varying degrees of invasive cervical resorption showed that trauma alone was a potential predisposing sole factor in 14% of patients and 15.1% of teeth. Trauma in combination with bleaching, orthodontics or delayed eruption was found in an additional 11.2% of patients or 10.6% of teeth and of these a combination of trauma and bleaching occurred in a relatively high proportion of 7.7% of patients or 7.4% of teeth. This study also revealed that of other potential predisposing factors orthodontics was the most common sole factor constituting 21.2% of patients and 24.1% of teeth examined. Successful treatment of invasive cervical resorption is dependent on the extent of the resorptive process. Teeth with invasive cervical resorption have been divided into four classes. Whilst several treatment modalities are possible, a clinical evaluation of the treatment of this condition by the topical application of a 90% aqueous solution of trichloracetic acid, curettage, endodontic therapy where necessary and restoration with a glass ionomer cement has been evaluated on 94 patients with a total of 101 teeth with a minimum follow-up period of three years. Results indicate a satisfactory treatment outcome can be anticipated in Class 1, 2 and 3 cases. In Class 4 resorption no treatment or alternative therapy is recommended. Diagnosis of lesions at an early stage of development is highly desirable and therefore the patients who have a potential for the development of this condition by virtue of a history such as trauma should be monitored radiographically at intervals throughout life.