Generalized cervical root resorption associated with periodontal disease.
BACKGROUND AND DESCRIPTION OF CASE: The etiology and pathogenesis of generalized cervical root resorptions is not well understood. In the present report, a case of severe cervical root resorption involving 24 anterior and posterior teeth is presented. The lesions developed within a period of 2 years after the patient had changed to an acid-enriched diet. They extended far into the coronal dentin and were associated with gingival inflammation and crestal bone resorption. However, no generalized clinical attachment loss had occurred. Culturing of subgingival plaque revealed the presence of several putative periodontal pathogens among which Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. Treatment consisted of mechanical debridement supported by systemic antibiotics (amoxycillin plus metronidazole) and dietary advice.


RESULTS
Within 1 year after the onset of treatment, all resorptive lesions had repaired by ingrowth of a radio-opaque mineralized tissue. The crestal areas showed radiological evidence of bone repair. 3 years after the onset of therapy, one premolar was extracted and examined histologically. It appeared that irregularly-shaped masses of woven bone-like tissue had invaded into the domain of the resorbed coronal dentin and were bordered by thin layers of acellular cementum.


CONCLUSIONS
It is concluded that, in this patient, the cervical resorptions were likely the result of an osteoclastic response extending into the roots because the root-protective role of the junctional epithelium did not develop. We hypothesize that this was due to the combined effects of a periodontopathogenic microflora and a dietary confounding factor.
Beertsen
W
W
Department of Periodontology, Academic Center for Dentistry Amsterdam, The Netherlands. w.beertsen@acta.nl
Piscaer
M
M
Van Winkelhoff
A J
AJ
Everts
V
V
D000143:Acids; D000328:Adult; D016976:Aggregatibacter actinomycetemcomitans / Q000187:drug effects / Q000254:growth & development; D016301:Alveolar Bone Loss / Q000150:complications / Q000188:drug therapy; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015169:Colony Count, Microbial; D003646:Debridement; D003739:Dental Cementum / Q000473:pathology; D003773:Dental Plaque / Q000382:microbiology; D003804:Dentin / Q000473:pathology; D004032:Diet / Q000009:adverse effects; D004338:Drug Combinations; D005891:Gingivitis / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D010510:Periodontal Diseases / Q000150:complications* / Q000188:drug therapy; D010518:Periodontitis / Q000150:complications / Q000188:drug therapy; D016966:Porphyromonas gingivalis / Q000187:drug effects / Q000254:growth & development; D012391:Root Resorption / Q000209:etiology* / Q000628:therapy; D019237:Tooth Cervix / Q000473:pathology*; D019228:Tooth Crown / Q000473:pathology; D014945:Wound Healing
D000143:Acids; D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D010406:Penicillins; D008795:Metronidazole; D000658:Amoxicillin