PMC10335757_01
PRICE 2020 flowchart showing the steps involved in the case report. ECR, external cervical resorption; CBCT, cone-beam computed tomography; EPT, electric pulp testing; IOPA, intraoral periapical radiograph.
CRID2023-2103999.001.jpg
PMC10335757_01_CRID2023-2103999.001.jpg
fig1
The PRICE 2020 flowchart was shown in Figure 1.
Radiographic images taken during the patient's initial visit to the University Clinic. (a) Intraoral radiographic image. A large translucency was suggestive of ECR at the maxillary right lateral incisor, extending from the distal to the mesial side, can be observed. It was difficult to accurately determine the buccal-to-palatal extent of ECR. The pulp chamber appeared narrowed adjacent to the ECR lesion. (b) Selected horizontal and para-sagittal images of CBCT volume. 3D observation by CBCT shows that external resorption of the cervical area of the tooth was more pronounced on the palatal side and was diagnosed as a type 2Bp according to Patel's classification. The numbers given in the figure indicate a cross-sectional view of each line of that number.
CRID2023-2103999.002.jpg
PMC10335757_01_CRID2023-2103999.002.jpg
fig2
An intraoral radiograph (Figure 2(a)) revealed a large ECR lesion extending from the distal to the proximal side; however, no obvious radiolucency was evident at the root apex. CBCT was performed to further explore the extent of the ECR (Figure 2). It was accordingly diagnosed as a Class III according to Heithersay's classification and Class 2Bp lesion according to Patel's classification (Figure 2(b)).
Radiographic images before intentional replantation. (a) Endodontic treatment was performed on the maxillary right lateral incisor after the pulp sensibility test result was negative. The working length was confirmed using a gutta-percha cone. (b) Intraoral radiographic image was taken immediately after the root canal filling with a single cone method using a methacrylate resin sealer (MetaSEAL soft paste). (c) An orthodontic hook was placed to assist intentional replantation with minimal damage to the periodontal ligament.
CRID2023-2103999.003.jpg
PMC10335757_01_CRID2023-2103999.003.jpg
fig3
The working length was further confirmed on a periapical radiograph image by placing a gutta-percha cone (Figure 3(a)). Ltd., Shiga, Japan) and a single-matched taper gutta-percha cone (Figure 3(b)).
Clinical images of the custom orthodontic hook used for extrusion and intentional replantation. Videos are available online at https://doi.org/10.6084/m9.figshare.20787508.v1 and https://doi.org/10.6084/m9.figshare.20787613.v1. (a) After root canal filling, the gingiva of the ECR lesion on the palatal side was removed with an electro-scalpel to access the hook for extrusion. (b) A question mark-shaped bending Co-Cr wire was placed in the root canal with carboxylate cement. (c) Bent Co-Cr wires were also bonded to both adjacent teeth with 4META-MMA/TBB resin. (d) The extrusion hook was removed immediately before intentional replantation. (e) Tooth extraction was carried out with forceps. (f) Root fit in the extraction socket was confirmed after crown rotation. (g) The ECR area was detected using a red dye (caries detector) marketed for caries treatment and visualized using a DOM. (h) A resin-based composite construction with a fibre post was used. (i) After the extraoral procedure, the rotated lateral incisor was replanted.
CRID2023-2103999.004.jpg
PMC10335757_01_CRID2023-2103999.004.jpg
fig4
As the tooth was asymptomatic after RCT, an orthodontic hook device was placed for extrusion before intentional replantation (Figures 4(a), 4(b), and 4(c)). Intentional replantation was performed by one operator and two assistants in an operating room under magnification (Figures 4(d), 4(e), 4(f), 4(g), 4(h), and 4(i), refer to videos https://doi.org/10.6084/m9.figshare.20787613.v1).
Radiographic images after intentional replantation. (a) Intraoral radiographic image was taken immediately after intentional replantation with crown rotation. (b) Intraoral radiographic image was taken one month after intentional replantation. The periodontal ligament space appears to be slightly larger than that immediately after intentional replantation (c) Intraoral radiographic image was taken three months after intentional replantation. The periodontal ligament space is similar to that around the adjacent teeth. (d and e) Intraoral radiographic images were taken six months and one year after intentional replantation, respectively. Low-contrast component resin crowns are bonded with adhesive resin.
CRID2023-2103999.005.jpg
PMC10335757_01_CRID2023-2103999.005.jpg
fig5
Follow-up appointments were scheduled at various time points (Figures 5(a), 5(b), 5(c), 5(d), and 5(e)).
Follow-up visit 18 months after intentional replantation. (a) Intraoral photograph was taken 18 months after intentional replantation. No gingival redness or swelling was observed. (b) Intraoral radiograph was taken 18 months after intentional replantation, with no evidence of recurrence of ECR or secondary root resorption after intentional replantation. (c) Representative examples of horizontal and sagittal images of CBCT volumes; 3D evaluation by CBCT showed that the ECR lesion was now filled by the restorative material, and good healing was observed. The numbers in the figure indicate the cross-sectional view of each line of that number.
CRID2023-2103999.006.jpg
PMC10335757_01_CRID2023-2103999.006.jpg
fig6
These results demonstrate the success of ECR treatment with RCT and intentional replantation (Figure 6).