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Case Study: Management of External Cervical Resorption in a Sound ToothPatient Presentation

A patient was referred for treatment for possible ECR the tooth was hypersensitive to cold on the tooth’s upper right third molar (UR3) that otherwise appeared sound. A periapical (PA) radiograph was suggestive of external cervical resorption (ECR). In response to this initial finding, a CBCT scan was performed, which confirmed the diagnosis. In the meantime, the tooth developed irreversible pulpitis.


The Treatment

The treatment plan involved root canal treatment, followed by an external surgical repair with restoration.


The root canal treatment effectively managed the irreversible pulpitis. The external surgical repair and restoration successfully addressed the ECR, with the patient reporting a significant reduction in hypersensitivity.


Learning Outcomes

This case highlights several key points in the management of ECR:

  1. Diagnostic Limitations of PA Radiographs: While a PA radiograph can suggest the presence of ECR, it may not be sufficient to confirm its extent and location. This case underscores the importance of further imaging for a definitive diagnosis.
  2. Advantages of CBCT Scans: A CBCT scan provides a 3D visualisation of the lesion, offering valuable insights into whether the approach should be purely external repair or combined with root canal treatment, particularly when symptoms are unclear.
  3. Patient Education: Despite initial anxiety about the proposed treatment, the patient agreed to proceed once the process was explained in detail. This emphasises the importance of thorough patient education in dental care.
  4. Early Detection: Thanks to the dentist’s knowledge and awareness of ECR, the case was identified early. The resorption was very limited and localised at the cervical level, which improves the prognosis and longevity of the tooth.
  5. Restoration Materials: If the lesion is supracrestal, it should be restored with either composite if moisture control and isolation under the rubber dam is possible, or glass ionomer cement (GIC). If the lesion is subcrestal, bioceramic material can be used.

In conclusion, this case illustrates the importance of advanced imaging techniques, patient education, early detection, and appropriate choice of restoration materials in managing ECR effectively.


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