External Cervical Resorption Treatment: A Single-Center Retrospective Cohort Study of Cases Treated Over a 20-Year Period

Abstract

Aim: External cervical resorption is a clinically challenging destructive process, with its etiology poorly understood. This study aimed to evaluate the survival of external cervical resorption treatments performed by a single operator over 20 years.

Materials and methods: A dataset of recalled external cervical resorption cases treated from 1996 to 2023 was created. The measured metrics included Heithersay classification, tooth type, historical treatment period, treatment modality, and pre-treatment pulp status. Adverse sequelae such as extractions, revisions, and surgeries were analyzed. A multivariable Cox regression analysis was performed for independent predictors of tooth extraction. The analysis included Heithersay classification, tooth type, time period, and treatment modality.

Results: The 5-year censored survival rate was 83.6%. The most commonly treated resorption was Heithersay class 2, yielding a 5-year survival rate of 89.5%. Anterior teeth exhibited the lowest survival rate (76.6%), and molars possessed the highest survival rate (95.2%) at 5 years. Combined non-surgical endodontic treatment with surgery resulted in the highest five-year survival rate (91.0%). A non-surgical internal root approach yielded a survival rate of 82.2% at 5 years. No statistical survival difference was observed between the teeth initially presenting with root canal filling, as necrotic, or with vital pulps. The treatment period from 2014 to 2018 exhibited the highest survival rate at 93.3%. The hazard ratio was highest for anterior teeth at 6.225. Adverse sequelae were noted in 29.7% (n = 47) of the cases. These included root fracture, progressive resorption, endodontic pathosis, periodontal pockets, and percussion sensitivity; root fracture led to extraction, and other sequelae could be managed.

Conclusions: The clinical management of external cervical resorption has previously been regarded as unpredictable, with outcomes often considered short-to-medium term and frequently leading to eventual extraction. This study suggests that most teeth with external cervical resorption can be treated successfully and saved.

Keywords: biodentine; cone‐beam computed tomography; external cervical resorption; non‐surgical root canal therapy; portals of entry; surgical resorption treatment; survival rate.