A clinical approach strategy for the diagnosis, treatment and evaluation of external cervical resorption

To propose a clinical approach strategy on the diagnosis, treatment and evaluation of external cervical tooth resorption (ECR) cases. To investigate and discuss the outcome of this approach.

A clinical approach strategy on ECR was developed based on a retrospective observation study of 542 teeth. Forty-seven teeth were excluded due to lack of clinical/radiographical information, and 182 were immediately extracted. This approach had three steps: diagnosis, treatment planning and evaluation. During diagnosis, the medical, dental history and clinical/radiographical characteristics were evaluated. Depending on the resorption extent, ECR cases were categorized into four classes according to Heithersay's classification. During treatment planning, a treatment decision flowchart was prepared based on four main decisive criteria: probing feasibility, pain, location and extent of resorption (class), and existence of bone-like tissue. Three treatment options were applied: (a) extraction, (b) monitoring or (c) conservative treatment by external, internal or combination of internal-external treatments. During evaluation, assessment of ECR progression, tooth survival and other factors like aesthetics and periodontal attachment were performed. Descriptive statistical analysis of the outcome for up to 10 years (for the overall clinical approach and for each individual treatment decision), was carried out with OriginLabs OriginPro 9 and Microsoft Excel 365.

A three-step strategy was developed on how to deal with ECR cases. Indicative examples of each treatment decision were presented and discussed. The overall survival rate of this strategy was 84.6% (3 years), 70.3% (5 years), 42.7% (8 years) and 28.6% (10 years). Higher survival rate was observed for external treatment decision than for internal. The success of each treatment decision depended on the extent of the resorption (class). The success of a treatment decision should be based on the long-term outcome, as a different evolution can be observed with time.

A clinical approach strategy was introduced on ECR pathosis. This strategy was not solely based on ECR class, as other important decisive criteria were considered. This step-wise approach, has a 70.3% survival rate with a mean of 5 years. This work will hopefully provide an incentive for a broader collaboration, to potentially establish a universally accepted ECR treatment strategy.