PMC9868990_01
A) Preoperative intraoral photograph shows a pink shadow in the cervical aspect of the tooth 21 with loss of hard tissue; B) Preoperative CBCT frontal, sagittal and axial views of maxillary first left incisor shows external cervical resorption
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F1
Clinical examination revealed a characteristic sign of ECR - a pink shadow in the cervical aspect of the tooth 21 with loss of hard tissue (Figure 1A). CBCT (Cranex 3Dx, Soredex, KaVo Imaging, PA, USA) with a small field of view (FOV) 40x40 mm and voxel size 0.125 mm was performed to assess an extent of the resorption (Figure 1A). Class 2Bd external cervical resorption according to Patel et al. [8] was diagnosed.
Steps of treatment performed: A) External cervical resorption defect after flap reflection; B) Cavity after resorption tissue removal; C) Resorption cavity restored with adhesive and resin composite; D) Intraoral photograph after flap reposition and suture; E) Postoperative radiograph; F) Intraoral photograph after seven days
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F2
Under local anesthesia of 2% lidocaine with epinephrine (Xylodont 1:50000, Molteni Stomat, Krakow, Poland) intrasulcular incision from tooth 21 to 22 with vertical release was performed to expose the resorption cavity (Figure 2A). In the next step, the resorptive tissue was removed using an excavator (Figure 2B). The cavity was filled using Single Bond Universal adhesive (3M ESPE, MN, USA) and Estelite Sigma Quick A3 (Tokuyama, Tokyo, Japan) (Figure 2C). Finally, the flap was repositioned and sutured with 4.0 monofilament suture (Figure 2D) and postoperative RVG image was taken (Figure 2E). The sutures were removed seven days after the surgery-normal tissue healing was found (Figure 2F).
Status after 30 months: A) Intraoral photography showing good esthetic effect, B) CBCT frontal, sagittal and axial views of treated tooth show periapical lesion and defect of bone; C) Radiograph after endodontic treatment and fiber post cementation
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F3
The esthetic effect was satisfactory (Figure 3A). A CBCT with FOV 40x40 mm and voxel size 0.125 mm revealed 2 mm vertical defect of the alveolar bone from the labial side under a composite filling and periapical radiolucency (Figure 3B). The postoperative radiographic image was taken (Figure 3C).