Reabsorções radiculares externas pós-traumática: uma revisão de escopo em busca de biomarcadores

Abstract

External root resorption (ERR) is the most common complication following dental trauma affecting dentoalveolar supporting structures. As a consequence, ERR can lead to the premature loss of anterior teeth, resulting in significant functional, aesthetic, psychological, and economic impacts for the patient, their family, and society at large. This study aimed to summarize and evaluate the available evidence regarding the involvement of immunoinflammatory biomarkers in the modulation of post-traumatic ERR. A comprehensive literature search was conducted across five major health science databases: Medline/PubMed, Embase, Scopus, Web of Science, and the Cochrane Library. Based on the PCC (Population, Concept, Context) strategy, the following review question was defined: "What are the biomarkers involved in ERR post trauma?" Studies were included if they evaluated biomarkers associated with the ERR process following trauma in permanent teeth. Exclusion criteria comprised studies focused solely on demographic, clinical, or treatment-related factors, as well as those addressing root resorption associated with orthodontic treatment. Abstracts, review articles, case reports, protocols, expert opinions, letters to the editor, posters, and publications without accessible full texts were also excluded. From 463 studies initially identified, 86 remained after duplicate removal. Of these, 51 were excluded based on title and abstract screening. Six additional studies were identified through reference lists. Ultimately, 25 studies were included after full-text reading. A wide range of biomarkers was identified, including those related to the RANK/RANKL/OPG axis, osteoclastic markers (TRAP, OSTF-1), osteogenic/regenerative markers (Oc, periostin, ALP, RUNX2), pro-inflammatory (IL1α, IL-1β, IL-6, TNF-α) and anti- inflammatory (IL-1Ra, IL-4), growth factors (TGF-β1, FGF-2), transcription factors (NFATc1, STAT6), macrophage markers (CD80, CD206), MMP/TIMP complexes, chemokines, neural components (CGRP, SP, NT-4), angiogenic (VEGF-A, PECAM- 1), dentin antigens (DSP) and humoral responses components. The RANK/RANKL/OPG axis and TRAP were the most consistently investigated markers in animal models. However, the heterogeneity in study design, biomarker detection methods, and sampling timepoints limited comparability across studies and clinical extrapolation. Immunoinflammatory biomarkers play central roles in the modulation of ERR following dental trauma. Despite notable advances, clinical translation remains limited due to the scarcity of human data and methodological variability. Future studies should focus on the integration of multi-marker panels, non-invasive sampling techniques, and multi-omics approaches to enable early diagnosis and personalized management of post-traumatic ERR.