Bioactive Resin as a Primising Alternative in the Treatment of Invasive Cervical Reabsorption: a Case Report
Keywords:
A reabsorção cervical invasiva (RCI) é uma condição patológica incomum e, geralmente, assintomática, que acomete simultaneamente tecidos periodontais e dentários. Seu diagnóstico é frequentemente incidental, realizado durante exames clínicos e radiográficos de rotina. A etiologia é multifatorial, envolvendo fatores como trauma, tratamento ortodôntico e estímulos inflamatórios, o que torna o manejo clínico desafiador. Este relato de caso descreve o tratamento conservador e o acompanhamento clínico de dois anos de uma paciente de 36 anos, diagnosticada com RCI no dente 23, classificada como tipo 2Bd segundo Patel et al. (2018). O tratamento foi conduzido em três etapas: remoção cirúrgica do tecido reabsortivo, tratamento endodôntico e selamento restaurador da cavidade cervical com resina composta bioativa Beautifil Injectable XSL. A tomografia computadorizada de feixe cônico (TCFC) foi essencial para o diagnóstico preciso e o planejamento do tratamento. Após dois anos de acompanhamento, o dente permaneceu assintomático e funcional, sem sinais clínicos ou radiográficos de recidiva, inflamação ou perda óssea. A resina bioativa apresentou excelente compatibilidade periodontal, integração estética e estabilidade clínica, destacando-se como uma alternativa promissora para o tratamento restaurador de casos de RCI. O diagnóstico precoce, aliado à escolha de materiais bioativos adequados, é fundamental para o sucesso terapêutico e preservação do elemento dentário. Estudos adicionais são necessários para confirmar o desempenho clínico de longo prazo das resinas bioativas no manejo da reabsorção cervical invasiva.Abstract
A reabsorção cervical invasiva (RCI) é uma condição patológica incomum e, geralmente, assintomática, que acomete simultaneamente tecidos periodontais e dentários. Seu diagnóstico é frequentemente incidental, realizado durante exames clínicos e radiográficos de rotina. A etiologia é multifatorial, envolvendo fatores como trauma, tratamento ortodôntico e estímulos inflamatórios, o que torna o manejo clínico desafiador. Este relato de caso descreve o tratamento conservador e o acompanhamento clínico de dois anos de uma paciente de 36 anos, diagnosticada com RCI no dente 23, classificada como tipo 2Bd segundo Patel et al. (2018). O tratamento foi conduzido em três etapas: remoção cirúrgica do tecido reabsortivo, tratamento endodôntico e selamento restaurador da cavidade cervical com resina composta bioativa Beautifil Injectable XSL. A tomografia computadorizada de feixe cônico (TCFC) foi essencial para o diagnóstico preciso e o planejamento do tratamento. Após dois anos de acompanhamento, o dente permaneceu assintomático e funcional, sem sinais clínicos ou radiográficos de recidiva, inflamação ou perda óssea. A resina bioativa apresentou excelente compatibilidade periodontal, integração estética e estabilidade clínica, destacando-se como uma alternativa promissora para o tratamento restaurador de casos de RCI. O diagnóstico precoce, aliado à escolha de materiais bioativos adequados, é fundamental para o sucesso terapêutico e preservação do elemento dentário. Estudos adicionais são necessários para confirmar o desempenho clínico de longo prazo das resinas bioativas no manejo da reabsorção cervical invasiva.
References
ARNETT, T. R. et al. Hypoxia is a major stimulator of osteoclast formation and bone resorption. Journal of Cellular Physiology, v. 196, n. 1, p. 2-8, 2003. DOI: 10.1002/jcp.10321. Disponível em: [https://onlinelibrary.wiley.com/doi/10.1002/jcp.10321](https://onlinelibrary.wiley.com/doi/full/10.1002/jcp.10321?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
ARNETT, T. R. Acidosis, hypoxia and bone. Archives of Biochemistry and Biophysics, v. 503, n. 1, p. 103-109, 2010. DOI: 10.1016/j.abb.2010.07.021. Disponível em: [https://www.sciencedirect.com/science/article/abs/pii/S0003986110003000](https://www.sciencedirect.com/science/article/abs/pii/S0003986110003000?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
BAI, X. et al. The chemical and optical stability evaluation of injectable restorative materials under wet challenge. Journal of Dentistry, v. 146, art. 105031, 2024. DOI: 10.1016/j.jdent.2024.105031. Disponível em: [https://www.sciencedirect.com/science/article/pii/S030057122400201X](https://www.sciencedirect.com/science/article/pii/S030057122400201X?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
BASRANI, B. R. et al. Interaction between sodium hypochlorite and chlorhexidine gluconate. Journal of Endodontics, v. 33, n. 8, p. 966-969, 2007. DOI: 10.1016/j.joen.2007.04.001. Disponível em: [https://www.sciencedirect.com/science/article/pii/S0099239907003391](https://www.sciencedirect.com/science/article/pii/S0099239907003391?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
CARDINALI, F.; CAMILLERI, J. A critical review of the material properties guiding the clinician’s choice of root canal sealers. Clinical Oral Investigations, v. 27, n. 8, p. 4147-4155, 2023. DOI: 10.1007/s00784-023-05140-w. Disponível em: [https://link.springer.com/article/10.1007/s00784-023-05140-w](https://link.springer.com/article/10.1007/s00784-023-05140-w?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
CHEN, Y.; HUANG, Y.; DENG, X. A review of external cervical resorption. Journal of Endodontics, v. 47, n. 6, p. 883-894, 2021. DOI: 10.1016/j.joen.2021.03.004. Disponível em: [https://www.sciencedirect.com/science/article/pii/S0099239921001564](https://www.sciencedirect.com/science/article/pii/S0099239921001564?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
COLCERIU BURTEA, L. et al. New pre-reacted glass containing dental composites (giomers) with improved fluoride release and biocompatibility. *Materials*, v. 12, n. 23, art. 4021, 2019. DOI: 10.3390/ma12234021. Disponível em: [https://www.mdpi.com/1996-1944/12/23/4021](https://www.mdpi.com/1996-1944/12/23/4021?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
DAO, V. et al. Prevalence and characteristics of root resorption identified in cone-beam computed tomography scans. Journal of Endodontics, v. 49, n. 2, p. 144-154, 2023. DOI: 10.1016/j.joen.2022.11.006. Disponível em: [https://www.sciencedirect.com/science/article/pii/S0099239922007555](https://www.sciencedirect.com/science/article/pii/S0099239922007555?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
DELAISSE, J.-M. The reversal phase of the bone-remodeling cycle: cellular prerequisites for coupling resorption and formation. BoneKEy Reports, v. 3, art. 561, 2014. DOI: 10.1038/bonekey.2014.56. Disponível em: [https://www.nature.com/articles/bonekey201456](https://www.nature.com/articles/bonekey201456?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
DREWS, D.-J. et al. The interaction of two widely used endodontic irrigants, chlorhexidine and sodium hypochlorite, and its impact on the disinfection protocol during root canal treatment. Antibiotics, v. 12, n. 3, art. 589, 2023. DOI: 10.3390/antibiotics12030589. Disponível em: [https://www.mdpi.com/2079-6382/12/3/589](https://www.mdpi.com/2079-6382/12/3/589?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
DURACK, C. et al. Diagnostic accuracy of small volume cone beam computed tomography and intraoral periapical radiography for the detection of simulated external inflammatory root resorption. International Endodontic Journal, v. 44, n. 2, p. 136-147, 2011. DOI: 10.1111/j.1365-2591.2010.01819.x. Disponível em: [https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2591.2010.01819.x](https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2591.2010.01819.x?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
EFTEKHAR, L.; ASHRAF, H.; JABBARI, S. Management of invasive cervical root resorption in a mandibular canine using Biodentine as a restorative material: a case report. Iranian Endodontic Journal, v. 12, n. 3, p. 386-389, 2017. DOI: 10.22037/iej.v12i3.16668. Disponível em: [https://journals.sbmu.ac.ir/iej/article/view/16668](https://doi.org/10.22037/iej.v12i3.16668). Acesso em: 2 set. 2026.
FRANK, A. L.; TORABINEJAD, M. Diagnosis and treatment of extracanal invasive resorption. Journal of Endodontics, v. 24, n. 7, p. 500-504, 1998. DOI: 10.1016/S0099-2399(98)80056-3. Disponível em: [https://www.sciencedirect.com/science/article/abs/pii/S0099239998800563](https://www.sciencedirect.com/science/article/abs/pii/S0099239998800563?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
GÖLZ, L. et al. Hypoxia and P. gingivalis synergistically induce HIF-1 and NF-κB activation in PDL cells and periodontal diseases. Mediators of Inflammation, v. 2015, art. 438085, 2015. DOI: 10.1155/2015/438085. Disponível em: [https://onlinelibrary.wiley.com/doi/10.1155/2015/438085](https://onlinelibrary.wiley.com/doi/10.1155/2015/438085?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
GORDAN, V. V. et al. A clinical evaluation of a giomer restorative system containing surface prereacted glass ionomer filler. Journal of the American Dental Association, v. 145, n. 10, p. 1036-1043, 2014. DOI: 10.14219/jada.2014.57. Disponível em: [https://www.sciencedirect.com/science/article/pii/S0002817714601720](https://www.sciencedirect.com/science/article/pii/S0002817714601720?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
HEITHERSAY, G. S. Clinical, radiologic, and histopathologic features of invasive cervical resorption. Quintessence International, v. 30, n. 1, p. 27-37, 1999. Disponível em: https://www.quintessence-publishing.com/usa/en/article/838795/quintessence-international/1999/01/clinical-radiologic-and-histopathologic-features-of-invasive-cervical-resorption. Acesso em: 2 set. 2026.
HEITHERSAY, G. S. Management of tooth resorption. Australian Dental Journal, v. 52, supl. 1, p. S105-S121, 2007. DOI: 10.1111/j.1834-7819.2007.tb00519.x. Disponível em: [https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1834-7819.2007.tb00519.x](https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1834-7819.2007.tb00519.x?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
HIRAISHI, N. et al. Interactions of boron released from surface pre-reacted glass ionomer with enamel/dentin and its effect on pH. *Scientific Reports*, v. 11, n. 1, art. 15734, 2021. DOI: 10.1038/s41598-021-95279-x. Disponível em: [https://www.nature.com/articles/s41598-021-95279-x](https://www.nature.com/articles/s41598-021-95279-x?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
IRINAKIS, E. et al. External cervical resorption: a retrospective case-control study. *Journal of Endodontics*, v. 46, n. 10, p. 1420-1427, 2020. DOI: 10.1016/j.joen.2020.05.021. Disponível em: [https://www.sciencedirect.com/science/article/pii/S0099239920303848](https://www.sciencedirect.com/science/article/pii/S0099239920303848?utm_source=chatgpt.com). Acesso em: 2 set. 2026.
KARUNAKAR, P. et al. Endodontic management of invasive cervical resorption: report of two cases. Journal of Conservative Dentistry, v. 21, n. 5, p. 578-581, 2018. DOI: 10.4103/JCD.JCD_119_18. Disponível em: https://journals.lww.com/jcde/toc/2018/21050. Acesso em: 2 set. 2026.
KOUBI, S. et al. Quantitative evaluation by glucose diffusion of microleakage in aged calcium silicate-based open-sandwich restorations. International Journal of Dentistry, v. 2012, art. 105863, 2012. DOI: 10.1155/2012/105863. Disponível em: https://onlinelibrary.wiley.com/doi/10.1155/2012/105863. Acesso em: 2 set. 2026.
LI, M. L. E. et al. Compression and hypoxia play independent roles while having combinative effects in the osteoclastogenesis induced by periodontal ligament cells. The Angle Orthodontist, v. 86, n. 1, p. 66-73, 2016. DOI: 10.2319/121414.1. Disponível em: https://angle-orthodontist.kglmeridian.com/view/journals/angl/86/1/article-p66.xml. Acesso em: 2 set. 2026.
LIN, Y. et al. Unraveling the etiology and pathogenesis of multiple cervical root resorption: a scoping review. Journal of Endodontics, v. 51, n. 6, p. 674-686, 2025. DOI: 10.1016/j.joen.2025.02.012. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0099239925001141. Acesso em: 2 set. 2026.
MARCIANO, M. A.; DUARTE, M. A. H.; CAMILLERI, J. Dental discoloration caused by bismuth oxide in MTA in the presence of sodium hypochlorite. Clinical Oral Investigations, v. 19, n. 9, p. 2201-2209, 2015. DOI: 10.1007/s00784-015-1466-8. Disponível em: https://link.springer.com/article/10.1007/s00784-015-1466-8. Acesso em: 2 set. 2026.
MARQUES JUNIOR, R. B. et al. Tooth discoloration using calcium silicate-based cements for simulated revascularization in vitro. Brazilian Dental Journal, v. 32, n. 1, p. 53-58, 2021. DOI: 10.1590/0103-6440202103700. Disponível em: https://www.scielo.br/j/bdj/a/yPzTtTvPpdjGSv5JzydXTqr/. Acesso em: 2 set. 2026.
MAVRIDOU, A. M. et al. Understanding external cervical resorption in vital teeth. Journal of Endodontics, v. 42, n. 12, p. 1737-1751, 2016. DOI: 10.1016/j.joen.2016.06.007. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0099239916303429. Acesso em: 2 set. 2026.
MAVRIDOU, A. M. et al. Descriptive analysis of factors associated with external cervical resorption. Journal of Endodontics, v. 43, n. 10, p. 1602-1610, 2017. DOI: 10.1016/j.joen.2017.05.026. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0099239917307045. Acesso em: 2 set. 2026.
MAVRIDOU, A. M. et al. A clinical approach strategy for the diagnosis, treatment and evaluation of external cervical resorption. International Endodontic Journal, v. 55, n. 4, p. 347-373, 2022. DOI: 10.1111/iej.13680. Disponível em: https://onlinelibrary.wiley.com/doi/full/10.1111/iej.13680. Acesso em: 2 set. 2026.
MIKI, S. et al. Antibacterial activity of resin composites containing surface pre-reacted glass-ionomer (S-PRG) filler. Dental Materials, v. 32, n. 9, p. 1095-1102, 2016. DOI: 10.1016/j.dental.2016.06.018. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0109564116301099. Acesso em: 2 set. 2026.
PARIROKH, M.; TORABINEJAD, M. Mineral trioxide aggregate: a comprehensive literature review - Part I: chemical, physical, and antibacterial properties. Journal of Endodontics, v. 36, n. 1, p. 16-27, 2010. DOI: 10.1016/j.joen.2009.09.006. Disponível em: https://www.sciencedirect.com/science/article/pii/S0099239909007663. Acesso em: 2 set. 2026.
KIM, J.-W. Precipitate from a combination of sodium hypochlorite and chlorhexidine. Restorative Dentistry & Endodontics, v. 37, n. 3, p. 185-186, 2012. DOI: 10.5395/rde.2012.37.3.185. Disponível em: https://rde.ac/journal/view.php?doi=10.5395%2Frde.2012.37.3.185. Acesso em: 2 set. 2026.
PATEL, K.; MANNOCCI, F.; PATEL, S. The assessment and management of external cervical resorption with periapical radiographs and cone-beam computed tomography: a clinical study. *Journal of Endodontics*, v. 42, n. 10, p. 1435-1440, 2016. DOI: 10.1016/j.joen.2016.06.014. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0099239916303697. Acesso em: 2 set. 2026.
PATEL, S. et al. Cone beam computed tomography in endodontics: a review. International Endodontic Journal, v. 48, n. 1, p. 3-15, 2015. DOI: 10.1111/iej.12270. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/iej.12270. Acesso em: 2 set. 2026.
PATEL, S. et al. External cervical resorption: a three-dimensional classification. International Endodontic Journal, v. 51, n. 2, p. 206-214, 2018a. DOI: 10.1111/iej.12824. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/iej.12824. Acesso em: 2 set. 2026.
PATEL, S. et al. External cervical resorption: part 2 - management. International Endodontic Journal, v. 51, n. 11, p. 1224-1238, 2018b. DOI: 10.1111/iej.12946. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/iej.12946. Acesso em: 2 set. 2026.
PATEL, S. et al. External cervical resorption - part 1: histopathology, distribution and presentation. International Endodontic Journal, v. 51, n. 11, p. 1205-1223, 2018c. DOI: 10.1111/iej.12942. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/iej.12942. Acesso em: 2 set. 2026.
PATEL, S.; KANAGASINGAM, S.; PITT FORD, T. External cervical resorption: a review. Journal of Endodontics, v. 35, n. 5, p. 616-625, 2009. DOI: 10.1016/j.joen.2009.01.015. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0099239909000909. Acesso em: 2 set. 2026.
PATEL, S.; SABERI, N. The ins and outs of root resorption. British Dental Journal, v. 224, n. 9, p. 691-699, 2018. DOI: 10.1038/sj.bdj.2018.352. Disponível em: https://www.nature.com/articles/sj.bdj.2018.352. Acesso em: 2 set. 2026.
RAJASEKHARAN, S. et al. Biodentine™ material characteristics and clinical applications: a review of the literature. European Archives of Paediatric Dentistry, v. 15, n. 3, p. 147-158, 2014. DOI: 10.1007/s40368-014-0114-3. Disponível em: https://link.springer.com/article/10.1007/s40368-014-0114-3. Acesso em: 2 set. 2026.
RAMEZANALI, F. et al. In vitro microleakage of mineral trioxide aggregate, calcium-enriched mixture cement and Biodentine intra-orifice barriers. Iranian Endodontic Journal, v. 12, n. 2, p. 211-215, 2017. DOI: 10.22037/iej.2017.41. Disponível em: https://journals.sbmu.ac.ir/iej/article/view/13717. Acesso em: 2 set. 2026.
RATHI, S. R. et al. Conservative treatment of invasive cervical resorption using mineral trioxide aggregate (MTA) and fiber-reinforced composite: a case report. Cureus, v. 17, n. 6, e85487, 2025. DOI: 10.7759/cureus.85487. Disponível em: https://www.cureus.com/articles/358550-conservative-treatment-of-invasive-cervical-resorption-using-mineral-trioxide-aggregate-mta-and-fiber-reinforced-composite-a-case-report. Acesso em: 2 set. 2026.
RODRÍGUEZ, G. et al. Influence of cone-beam computed tomography in clinical decision making among specialists. Journal of Endodontics, v. 43, n. 2, p. 194-199, 2017. DOI: 10.1016/j.joen.2016.10.012. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0099239916307397. Acesso em: 2 set. 2026.
ROMBOUTS, C. et al. Pulp vascularization during tooth development, regeneration, and therapy. Journal of Dental Research, v. 96, n. 2, p. 137-144, 2017. DOI: 10.1177/0022034516671688. Disponível em: https://journals.sagepub.com/doi/10.1177/0022034516671688. Acesso em: 2 set. 2026.
ROTONDI, O.; WALDON, P. A.; KIM, S. G. The disease process, diagnosis and treatment of invasive cervical resorption: a review. Dentistry Journal, v. 8, n. 3, art. 64, 2020. DOI: 10.3390/dj8030064. Disponível em: https://www.mdpi.com/2304-6767/8/3/64. Acesso em: 2 set. 2026.
SCHWARTZ, R. S.; ROBBINS, J. W.; RINDLER, E. Management of invasive cervical resorption: observations from three private practices and a report of three cases. Journal of Endodontics, v. 36, n. 10, p. 1721-1730, 2010. DOI: 10.1016/j.joen.2010.06.011. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0099239910005145. Acesso em: 2 set. 2026.
TAMILSELVAM, S.; DIVYANAND, M.; NEELAKANTAN, P. Biocompatibility of a conventional glass ionomer, ceramic reinforced glass ionomer, giomer and resin composite to fibroblasts: in vitro study. Journal of Clinical Pediatric Dentistry, v. 37, n. 4, p. 403-406, 2013. DOI: 10.17796/jcpd.37.4.98h23631v8734478. Disponível em: https://www.jocpd.com/articles/10.17796/jcpd.37.4.98h23631v8734478. Acesso em: 2 set. 2026.
TOMÁS-CATALÁ, C. J. et al. Biocompatibility of new pulp-capping materials NeoMTA Plus, MTA Repair HP, and Biodentine on human dental pulp stem cells. Journal of Endodontics, v. 44, n. 1, p. 126-132, 2018. DOI: 10.1016/j.joen.2017.07.017. Disponível em: https://www.sciencedirect.com/science/article/pii/S0099239917309068. Acesso em: 2 set. 2026.
TROPE, M. Root resorption due to dental trauma. Endodontic Topics, v. 1, n. 1, p. 79-100, 2002. DOI: 10.1034/j.1601-1546.2002.10106.x. Disponível em: https://onlinelibrary.wiley.com/doi/10.1034/j.1601-1546.2002.10106.x. Acesso em: 2 set. 2026.
YAN, P. et al. Effect of BioAggregate on differentiation of human periodontal ligament fibroblasts. International Endodontic Journal, v. 43, n. 12, p. 1116-1121, 2010. DOI: 10.1111/j.1365-2591.2010.01786.x. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2591.2010.01786.x. Acesso em: 2 set. 2026.