Multidisciplinary management of an external cervical resorption and cemental tear

Aim: The case report presents the management of two different pathologies, external cervical resorption (ECR) and cemental tear, in two different central incisors, owing to the same predisposing factor i.e. trauma from occlusion.

Summary: A 53-year-old man was referred to the University Dental Clinic complaining of a pink spot that he noticed on his right maxillary central incisor. After thorough clinical and radiographic examination, including (FOV) cone-beam computed tomography (CBCT), revealed an external cervical resorption (ECR) classified as class 3Bp in tooth 11 and a probable cemental tear on tooth 21. A root canal treatment was performed on tooth 21 using a single master gutta-percha cone and a bioceramic sealer (Bioroot™ RCS).  Subsequently, due to the extent of the ECR lesion, a combined internal and external approach was planned for tooth 11. The treatment consisted of raising a modified papilla preservation technique over the ECR lesion of tooth 11, followed by a complete rubber dam isolation, using trichloroacetic acid 90%, and blocking the canal with a single gutta-percha cone. The defect was then restored with a resin modified glass ionomer cement (Geristore®). A simplified papilla preservation technique was then extended to treat the cemental tear on tooth 21, within the same intervention, after which the root canal treatment for tooth 11 was completed. A 10-months follow-up examination showed a successful outcome of the apical radiolucency of tooth 21 with clinically stable gingival margins and no further evidence of ECR recurrence.

Key learning points

• ECR and cemental tear can occur together owing to the same predisposing factor.
• CBCT proves to be an indispensable tool in the detection and extent of ECR and cemental tears.
• The case report also confirms the easy handling, favorable physical and biological properties of Geristore® cement to restore ECR cavities.