Multiple Idiopathic Cervical Root Resorption: A Challenge for a Transdisciplinary Medical-Dental Team

Abstract

The goal of this perspective article is to use multiple idiopathic cervical root resorption (MICRR) as a model to demonstrate the need for transdisciplinary collaborations, from basic science to treatment planning, to improve the quality of health care for all. This is not a review of the literature on the current state of MICRR. Tooth root resorption is a normal physiological process required for resorption and exfoliation of primary teeth; however, root resorption of adult teeth is largely pathological. MICRR is an aggressive form of external root resorption, which occurs near the cemento-enamel junction (CEJ). The cause of MICRR remains elusive, however, it is mediated primarily by osteoclasts/odontoclasts. Accumulating case studies and experiments in animal models have provided insights into defining the etiologies and pathophysiological mechanisms for MICRR, which include: systemic conditions and syndromes, inherited genetic variants affecting osteoclast/odontoclast activity, altered periodontal structures, drug-induced root resorption and rebound effects after cessation of anti-resorptive treatment, chemotherapy, exposure to pets or viral infections, and other factors such as inflammatory conditions or trauma. To determine the causative factors for MICRR, as well as other oral-dental conditions, at minimum, a comprehensive health history should be collected for all patients by dental care providers, discussed with other health care providers and appropriate collaborations established. The examples highlighted in this perspective emphasize the need for transdisciplinary research collaborations coupled with integrated management strategies between medicine and dentistry in order to identify cause(s) early and improve clinical outcomes.

Multiple idiopathic external cervical root resorption in patient treated continuously with denosumab: a case report

“…The etiology of ECR remains incompletely characterized. Potential predisposing factors have been identified, such as dental trauma, orthodontic treatment, internal bleaching, periodontal surgery, Paget’s disease of bone, genetic predisposition, cystic lesions, impacted teeth, playing wind instruments, feline viruses transmissed to humans, and osteoclastic rebound effects after cessation of denosumab [ 3 , 20 , 22 – 24 ]. In the present case, we did not find any of the mentioned etiological factors for ECR, and we observed a progression of ECR despite ongoing antiresorptive therapy with denosumab.…”

“…The recent publication by Alyahya et al suggests that the use of denosumab could significantly predict the risk of developing ECR [ 29 ]. Yet the factors that activate osteoclasts/odontoclasts and recruit them to root surfaces rather than bone surfaces (noted in periodontitis) remain unknown [ 24 ].…”

“…Infection may not be a prerequisite for the initiation of ECR [ 15 ]. However, it may lead to damage of the protective cementum layer in the area of cemento-enamel junction, which is one of the known etiological factors for the development of ECR [ 24 ]. Periodontitis is known to be associated with elevated levels of pro-inflammatory cytokines such as IL-1, IL-6 and TNF-α.…”

The Medical, Clinical, and Radiographic Aspects of Multiple Idiopathic Tooth Resorption: A Systematic Review

“…When the resorption is cervical, it enables periodontal inflammation and early evolution to extensive lesions [ 39 ]. The decision between a conservative approach or extraction is traditionally based on accessibility and extension of the lesion [ 42 ]. For MIR, this decision-making process could lead to consider frequent extractions and prematurely complete removable dental prostheses [ 26 , 34 ].…”

“…This surgical approach could also be combined with a root canal treatment for more extensive lesions [ 10 , 35 ]. Non-idiopathic cavities, which communicate with the oral cavity, were managed by Patel et al using composite resin or glass ionomer cement restoration for their good mechanical and aesthetic properties or silicate-based materials for their proven biocompatibility and sealing ability [ 42 ]. However, it is of particular importance to note that this choice of a direct restoration is motivated by the fact that only one tooth is affected and did not support any removable prosthesis.…”