ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title External Root Resorption May Be a Postoperative Complication Encountered Following Subepithelial Connective Tissue Graft Procedures
Clinical Question Are patients who are undergoing subepithelial connective tissue graft procedures at risk for developing root resorption?
Clinical Bottom Line External root resorption may be a post-operative complication encountered following subepithelial connective tissue graft procedures. This has only been reported in 2 clinical cases and further studies are needed to examine if it is a significant risk of the procedure and to characterize the resorptive process. Following subepithelial connective tissue graft procedures, root surfaces should be closely monitored for any evidence of pathologic resorption.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 12956483Carnio/2003Male aged 37 years w/ class I facial gingival recession on tooth #6Case report
Key resultsA patient who received scaling and root planing, chemical root preparation with 50% citric acid, and connective tissue grafting procedures for a localized mucogingival defect was found to have developed an external resorptive defect 2 years later despite having achieved successful soft tissue root coverage. The resorptive defect was an incidental discovery, made when the tooth was planned for extraction in favor of a more appropriate restorative treatment plan. The extracted tooth was submitted for histological study; the resorptive defect was similar to anklyosis-related resorption, but without connection to the surrounding alveolar bone.
#2) 11922264Hokett/2002Female aged 57 years w/ class I facial gingival recession on tooth #10Case report
Key resultsA patient who received scaling and root planing and connective tissue grafting procedures for a localized mucogingival defect was found to have developed an external resorptive defect 1 year later upon routine examination despite having achieved successful soft tissue root coverage. The clinical manifestation of the external root resorption was a 5-mm deep and 5-mm wide pocket on the facial surface of the tooth. After raising a full mucoperiosteal flap elevation the defect was described as a “broad erosive lesion measuring 5 x 7 mm in diameter and 2 mm in depth.” The resorptive defect was successfully treated by elevating a mucoperiosteal flap, planing and chemically treating the affected root surface, and restoring with a light-cured compomer.
Evidence Search (resorption[All Fields] OR "root resorption"[All Fields]) AND ("subepithelial connective tissue graft"[All Fields] OR "connective tissue graft"[All Fields])
Comments on
The Evidence
Validity: There are only 2 case reports that have reported this complication following subepithelial connective tissue grafting procedures. As a result, no significant correlation or causal relationship can be measured. In both instances the procedure, albeit different technique, was performed to obtain increased soft tissue root coverage in maxillary anterior teeth with Miller class I gingival recession. The etiology for the recession and histological analysis of the resorptive defect was documented in only one of the cases (Carnio/2003). Perspective: Pathologic root resorption involves the activation of clastic cells which normally cannot adhere to non-mineralized collagen matrices that are found in an intact pre-cementum layer. Conceivably, connective tissue grafting procedures that involve mechanical and chemical treatment of denuded root surfaces could cause a disruption of the pre-cementum layer and allow the external root surface to be more vulnerable to the action of osteoclastic cells.
Applicability The resorptive defects in the case reports were incidentally discovered through careful exploration of the subgingival areas with an explorer or periodontal probe. In both instances, the clinical and radiographic appearances of the grafted areas appeared normal 1-2 years following the procedures. In order to diagnose subgingival resorption, one article suggested that straight vertical placement of the periodontal probe may be inadequate to measure the true pocket depth and that the probing technique may need to be modified to account for teeth whose root morphology has been altered to receive the connective tissue graft. Although there is limited evidence to suggest there is a significant correlation between external root resorption and connective tissue grafting procedures, clinicians should be astute in monitoring this complication during their patients’ periodontal recall appointments since it may be disguised in the absence of any clinical symptoms or radiographic signs. Early or late detection of the resorptive defect maybe critical in influencing the overall prognosis in successfully treating it.
Specialty/Discipline (Endodontics) (Periodontics)
Keywords Root Resorption, Connective Tissue Graft
ID# 3299
Date of submission: 11/20/2017spacer
E-mail wongd6@livemail.uthscsa.edu
Author David Wong
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