I am recognised by my peers for my expertise in the diagnosis and management of root resorption, in particular External cervical resorption (ECR). I have carried out novel clinical research aimed at accurately diagnosing and treating external cervical and internal resorption. Dentists regularly refer their patients to me for specialist advice and management of root resorption, and increasingly patients self-refer for advice and treatment of ECR.
I published the first clinical paper demonstrating that CBCT enables the early and accurate diagnosis of root resorption, as well as co-authoring several highly cited papers on root resorption. I am the lead author of the European Society of Endodontology (ESE) position statements on ECR (2018) and root resorption (2023) — the clinical guidelines that specialists and dentists across Europe follow when managing these conditions.
What is root resorption?
Root resorption is due to the body's own bone cells nibbling away the root of the tooth. Root resorption is a normal 'physiological' process associated with baby (deciduous) teeth; it dissolves the root away, loosening the tooth and therefore allowing it to naturally fall out making way for the permanent (adult) tooth to emerge (erupt) into the jaw.
Occasionally, root resorption may occur in adult (permanent) teeth, which in some cases if left untreated and/or inappropriately treated may result in toothache and/or loss of the affected tooth.
There are broad categories of root resorption, which may occur on the outside or inside of the root. Depending on the type and/or severity root resorption may require periodic monitoring, however, or require simple or complex (multidisciplinary) treatment to retain the tooth in a healthy and functional condition. One specific type of root resorption which often does require effective management is ECR.
Why is ECR becoming more common?
The prevalence of ECR appears to be increasing. This is partly down to greater awareness, and partly to the growing use of 3D cone beam computed tomography (CBCT), which is far more sensitive at detecting all types of root resorption than conventional 2D dental X-rays.
External cervical resorption usually begins at the outer surface of the tooth, just under the gum, and dissolves the root from there. If left untreated it can eventually irritate or infect the root canal, and in some cases the tooth may need to be extracted.
What causes ECR?
The cause is not fully understood, but it is associated with several factors, including dental trauma to the affected tooth (for example a sports injury, a fall or an assault), orthodontic treatment, and some types of dental treatment. Because we don't know exactly what triggers it, ECR cannot be prevented. It does not spread to other teeth, it is not contagious, and it is not sinister or cancerous.
How do I know if I have ECR?
ECR is often silent and is usually found by chance on a dental X-ray, or on a 3D cone beam computed tomography scan. In more advanced cases you may notice a pink spot at the neck of the tooth, temperature sensitivity, toothache, an abscess, or a tooth that looks pink or darkly discoloured. If you notice any of these, it is best to see a dentist.
How is ECR treated?
I carry out a thorough assessment and a 3D CBCT scan to establish the true nature of the resorption defect before devising a treatment plan. The CBCT lets me grade the severity of the ECR in three dimensions using the Patel (3D) classification which helps determine the treatment approach and prognosis.
Treatment depends on several factors, including symptoms, and the accessibility and size of the defect. It ranges from periodic review (no active treatment) to gently removing the resorbing tissue with a minimally invasive approach and sealing the defect with a tooth-coloured filling. In advanced or symptomatic cases, root canal treatment is also needed. As part of a multi-centre international study, I published my own treatment outcomes, which showed survival rates of 93–95% depending on the severity and the treatment approach taken.
Molar (back) teeth and smaller lesions, as graded by the Patel classification, have a better prognosis.
How is internal resorption treated?
As with ECR, I use a CBCT to plan treatment. Internal resorption starts inside the tooth and burrows outwards into the root, and is always associated with a root canal infection. If the tooth is salvageable, root canal treatment is indicated, sometimes combined with a minor surgical procedure.
Misdiagnosis
External cervical resorption is not uncommonly mistaken for internal resorption, which can lead to the wrong treatment. ECR can also be misdiagnosed as dental decay (caries). An accurate diagnosis is essential for effective treatment and for the long-term survival of the tooth, which is why I assess these cases with a high-resolution 3D CBCT scan.
What types of root resorption are there?
Root resorption can begin on the outside of the root (external resorption) or from inside the tooth (internal resorption). The most clinically significant type is ECR, which starts just beneath the gum and dissolves the root from the outside inward. Treatment depends on the type, the severity, and whether the root canal has been affected.
How is ECR diagnosed?
I use a high-resolution, small field of view CBCT scan to establish the size, location, and extent of the resorption in three dimensions. This allows me to grade the defect using the Patel (3D) classification, which helps determine the most appropriate treatment approach and gives a realistic prognosis before any treatment begins.
What are the chances of saving the tooth?
For ECR, survival rates of 93–95% are achievable depending on the Patel classification grade of the lesion and the treatment approach. Smaller lesions and molar teeth tend to have a better prognosis. The earlier the diagnosis, the more treatment options are available.
Do I need a referral?
A referral from your dentist is the usual route, but you are welcome to contact me directly if you have a specific concern and your dentist is unsure whether to refer. I am happy to advise.