Asgary Saeed, Nosrat Ali
Iranian Center For Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Iranian Center For Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Division of Endodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland.
J Endod. 2016 Aug;42(8):1291-4. doi: 10.1016/j.joen.2016.05.001. Epub 2016 Jun 14.
Class 4 invasive cervical root resorption (ICRR) presents a treatment dilemma in endodontics. The widely accepted treatment options for a class 4 ICRR are to leave these teeth untreated for as long as they are asymptomatic or extraction. This report presents a conservative approach for the management of class 4 ICRR. A 28-year-old woman was referred for root canal treatment of tooth #26. The patient had a history of orthodontic treatment. Radiographic evaluation showed class 4 ICRR that had perforated the root canal space, a radiolucent crestal bony defect, and a periapical lesion. Clinically, a deep (6-mm) probing area was found on the mesial side of the tooth that bled on probing. The tooth was sensitive to percussion. After the treatment options were discussed with the patient, she chose to save the tooth. After complete chemomechanical preparation of the root canal, the entire canal space and perforation area were filled with calcium-enriched mixture cement. No attempt was made to mechanically remove the resorptive lacuna. Twenty four months after treatment, the tooth was functional and asymptomatic, and probing was within normal limits (<3 mm) with no bleeding during probing. Radiographic examination revealed no progression of resorption, osseous healing of the crestal bony defect, and healing of the periapical lesion. Obturation of the root canal space with calcium-enriched mixture cement may be a viable treatment option for an otherwise non-treatable tooth with class 4 invasive cervical root resorption.
4类侵袭性颈根吸收（ICRR）在牙髓病学中呈现出治疗难题。对于4类ICRR，广泛接受的治疗选择是在牙齿无症状时不予治疗或拔牙。本报告介绍了一种治疗4类ICRR的保守方法。一名28岁女性因26号牙根管治疗前来就诊。患者有正畸治疗史。影像学评估显示4类ICRR已穿通根管腔，有透射性牙槽骨嵴缺损和根尖周病变。临床上，在牙齿近中侧发现一个深（6毫米）的探诊区，探诊时出血。牙齿对叩诊敏感。在与患者讨论治疗方案后，她选择保留牙齿。在对根管进行彻底的化学机械预备后，整个根管腔和穿孔区域用富钙混合水门汀充填。未尝试机械去除吸收腔。治疗24个月后，牙齿功能正常且无症状，探诊在正常范围内（<3毫米），探诊时无出血。影像学检查显示吸收未进展，牙槽骨嵴缺损骨愈合，根尖周病变愈合。用富钙混合水门汀充填根管腔可能是治疗4类侵袭性颈根吸收的原本无法治疗的牙齿的一种可行治疗选择。
