case_images: PMC11320676_01
case_images: Periapical radiographs were taken according to the horizontal tube shift method, which included eccentric (a) and orthoradial (b) projection. (b) Intraoral view of the right lower first molar. (c) Three- (A) and bidimensional (B) view of the lesion. (d) The ECR appears to be located over the buccal bone peak.. ECR: external cervical resorption.
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case_images: Using the tube shift method, a second periapical radiograph was taken to evaluate the relationship between the lesion and the tooth (Figure 1(a) and (b)). The patient presented with a thick periodontal biotype, no history of tobacco use, good general health, and no contraindication to surgical treatment (Figure 1(c)). A cone-beam computed tomography (CBCT) examination was requested to investigate the three-dimensional extent of the lesion to plan and discuss the treatment options with the patient (Figure 1(d)).
case_images: (a) Higher magnification of ECR lesion after mucoperiosteal flap reflection (A). After excavation, a shallow vestibular intrabony defect is evident at the bottom of the lesion (B). (b) Correction of the inverse anatomy of the marginal osseous defect using hand instrument (A, B). (c-A) Dentin surface suitable for bonding to resin, application of bonding material, (B) restoration polishing, (C) restoration refined and polished. (d) Flap sutured at the CEJ level.. ECR: external cervical resorption; CEJ: cemento-enamel junction.
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case_images: PMC11320676_01_10.1177_2050313X241269588-fig2.jpg
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case_images: A mucoperiosteal flap was reflected to allow adequate access to the lesion (Figure 2(a-A) and (a-B)). The granulomatous tissue was removed from the root resorption area with a sharp excavator (HuFriedy EXC19; Hu-Friedy Italy Slr, Milan, Italy) under dental microscope examination (Leica M400; Mikros, Milan, Italy) (Figure 2(a)). To correct the inverse anatomy of the alveolar bone defect, minimizing the crater-like shape of the lesion, a bone remodeling was performed using hand instruments: Ochsenbein Periodontal Chisels (HuFriedy Och.1, Och.2; Hu-Friedy Italy Srl) and Rhodes Back-Action Periodontal chisel (HuFriedy C 36/37; Hu-Friedy Italy Srl) (Figure 2(b)). The reparative tissue was refreshed with a Muller burr (KOMET H1SML31.205.010; KOMET Italia Srl, Milan, Italy) and ultrasonic tip (SF 66; KOMET Italia Srl) to provide a dentin surface suitable for bonding to resin (Figure 2(c-A)). Thus, ensuring the complete removal of NaOCl and proper neutralization of its effects is crucial for optimal resin adhesion and the longevity of restorative dental work.   A two-step self-etching adhesive was used (Clearfil SE BOND 2; Kuraray Noritake, Hattersheim, Germany) and the cavity was then filled with resin composite (Enamel Plus Hri; Micerium, Avegno (GE), Italy) (Figure 2(c)). The restoration was accurately refined and polished using diamond composite polishers (KOMET Italia Srl) (Figure 2(c-B) and (c-C)). The flap was sutured at the CEJ with 5-0 Vicyrl suture by completely covering the restored cavity (5-0 Vicryl, Ethicon; Johnson & Johnson, Pomezia, Italy) (Figure 2(d)). A complete sequence of the surgical and restorative procedures is shown (Figure 2).
case_images: (a) Postoperative CBCT scan taken immediately after treatment. (b) Periapical radiograph at the 1-year follow-up. (c) CBCT Scan after 3 years of the therapy: paraxial view (A), axial view (B), and three-dimensional view (C) of the treated lesion. Bone remodeling occurred with new bone formation over the treated lesion.. CBCT: cone-beam computed tomography.
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case_images: A postoperative CBCT scan was done to evaluate the relationship between the alveolar bone, the restored root, the pulp cavity, and the distal canal of the treated tooth (Figure 3(a)). The treated tooth was vital, and the surrounding tissues were healthy (Figure 3(b)). CBCT revealed no bone loss and a coronal bone remodeling with new bone formation over the treated lesion (Figure 3c). Clinically, the gingival attachment appeared healthy with a probing depth of <=3 mm and no tooth mobility.
case_images: Postoperative CBCT scan (a); CBCT scan after 3 years of the treatment (b). Superimposition of the 3-year CBCT scan with the postoperative CBCT (a); amount of bone remodeling over the treated lesion (b). (c) Vertical bone augmentation remodeling was measured at the center of the lesion after matching improvement using a best-fit algorithm.. CBCT: cone-beam computed tomography.
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case_images: Finally, bone augmentation was measured at the center of the lesion (Figure 4); the range amount varies from a minimum of 0.2 mm to a maximum of 1.2 mm.