Reabsorção radicular externa cervical invasiva: revisão de literatura

Abstract

INVASIVE EXTERNAL CERVICAL ROOT RESORPTION: LITERATURE REVIEW External cervical resorption (ECR), also called invasive cervical resorption (ICR), is defined as a localized resorptive process that commences on the surface of root below the epithelial attachment and the coronal aspect of the supporting alveolar process, namely the zone of the connective tissue attachment. It is an aggressive type of external resorption characterized by invasion of the cervical region of the root by fibrovascular tissue in the early stages and then by fibro-osseous tissue that progressively reabsorbs cementum, dentin and enamel.The resorptive cavity contains granulomatous fibrovascular tissue separated from the healthy pulp tissue by a thin layer of dentin and predentin, called pericanalar resorption resistant sheet (PRRS). According to Heithersay (2004) they can be classified in 4 stages according to their clinical and radiographic features. Because the majority of cases of REC is an insidious asymptomatic entity, the diagnosis is mostly made during routine radiographic examination. Cone-beam computed tomography (CBCT) is also used as a complementary technique to asses and manage this type of resorption. The onset of REC depends on the presence of gaps in the cement layer in the cervical region of the root, just below the junctional epithelium. Orthodontics, dental trauma, endogenous bleaching and surgical procedures represent the main predisposing factors. Additional factors that continuously stimulate the resorptive cells rendering ERC progressive are not well known. Some authors consider it purely inflammatory while others as aseptic resorption that can be contaminated by microorganisms originating from the gingival sulcus and, more rarely, from the pulp canal trough dentinal tubules. in teeth with necrotic pulp. Surgical/restorative treatment is indicated in the stages 1 to 3 (Heythersay, 1999) achieving higher success rates in earlier diagnosis. Teeth diagnosed with stage 4 of REC have puor prognosis.