CLINICAL RESEARCH

Po-Yuan Jeng, DDS,* Li-Deh Lin,

Invasive Cervical DDS, PhD,*† Shu-Hui Chang,
PhD,‡ Yuan-Ling Lee, DDS,
Resorption—Distribution, PhD,*† Cheng-Ying Wang, DDS,
PhD,*† Jiiang-Huei Jeng, DDS,
Potential Predisposing Factors, PhD,*† and Yi-Ling Tsai, DDS,
PhD*†
and Clinical Characteristics

ABSTRACT
SIGNIFICANCE
Introduction: The purpose of this study was to investigate the distribution, predisposing
factors, and clinical characteristics of invasive cervical resorption (ICR). Methods: Cases with Understanding the age, sex,
ICR from 2009–2019 were collected. Clinical records and radiographs were reviewed. tooth distribution, single or
Descriptive analysis was performed in combination with univariate analysis and the Fisher multiple affected teeth,
exact test. Results: A total of 63 ICR teeth from 31 patients (14 men and 17 women) were predisposing factors, and
found. The patients’ ages ranged from 18–81 years, with a mean age of 45.77 years. Most clinical and radiographic
patients had a single ICR lesion. Among the 63 ICR teeth, maxillary anterior teeth (47.62%) characteristics of the invasive
were the most commonly affected followed by maxillary premolars (20.63%). Maxillary teeth cervical resorption in a
(76.19%) were more prone to ICR than mandibular teeth (23.81%). Most patients denied all Taiwanese population can be
major systemic diseases. The most common dental-related factors were dental/orofacial helpful for its clinical early
trauma (33.33%), periodontal treatment (26.98%), restoration/crown (17.46%), and ortho- diagnosis and further effective
dontic treatment (15.87%). Most teeth showed no percussion/palpation pain, probing depth treatment.
.3 mm, abscess formation, sinus tracts, or periapical lesions. The pulp status was mainly vital
(73.02%). The presence of percussion pain and probing depth differed significantly among
Heithersay ICR classification groups. Conclusions: ICR showed no difference in sex or age.
Maxillary anterior teeth were the most affected in a Taiwanese population. Traumatic injury,
periodontal treatment, and orthodontic treatment were the significant predisposing factors.
Furthermore, affected teeth typically lacked clinical signs and symptoms. Radiographic
examination is critical for early diagnosis. In advanced cases, deep pockets and abscess
formation were seen. These results are helpful for the diagnosis of ICR and further effective
treatment. (J Endod 2020;-:1–8.)

KEY WORDS
Dental traumatic injury; hyperparathyroidism; invasive cervical resorption; orthodontic treat-
ment; periodontal treatment; root resorption

Invasive cervical resorption (ICR) is a localized resorption process originating from the external cervical
root surface1,2. Cases of ICR have been noted after internal tooth bleaching3. The effect of bleaching on From the *School of Dentistry and
‡
periodontal tissue, dental tissue, and osteoclastic/odontoclastic cells has also been investigated. College of Public Health, National Taiwan
Although the mechanisms that trigger ICR are not entirely clear, bleaching procedures have been University, Taipei City, Taiwan; and
†
Department of Dentistry, National Taiwan
improved4; thus, ICR after bleaching is rarely reported5. However, cases with prior internal bleaching
University Hospital, Taipei City, Taiwan
account for only a low percentage of the total ICR cases6. This indicates that the etiology of ICR is
Address requests for reprints to Dr Yi-Ling
relatively complicated and requires further investigation.
Tsai, School of Dentistry and Department
The etiology of ICR remains unclear and is probably a multifactorial problem. It has been proposed of Dentistry, National Taiwan University
to be related to a developmental defect in the cementoenamel junction6. In approximately 10% of teeth, a and National Taiwan University Hospital,
gap is found between the enamel and cementum, leading to the exposure of dentin to oral soft tissue7. No 1, Changde Street, Zhongzheng Dist,
The presence of cementum and periodontal ligaments may protect the underlying dentin from root Taipei City 100, Taiwan.
E-mail address: tyl.endo@gmail.com
resorption7. Clastic cells may adhere to the exposed root dentin and initiate the resorption process. 0099-2399/$ - see front matter
Chemical or physical stimulations have also been hypothesized to damage the periodontium and trigger
Copyright © 2020 American Association
ICR. Dental trauma8, internal bleaching, orthodontic treatments9, and other surgical procedures10 are of Endodontists.
often related to ICR. Systemic diseases, such as autoimmune disorders11, varicella-zoster virus https://doi.org/10.1016/
infection12, hepatitis B virus infection13, and neuronal virus infection14, as well as the use of j.joen.2020.01.011

JOE  Volume -, Number -, - 2020 Invasive Cervical Resorption 1

bisphosphonates15 have also been reported in
the literature on ICR. However, the exact
cause-and-effect association remains
uncertain.
At the early stage, ICR typically initiates
below the epithelial attachment and has no
visual signs. Therefore, ICR is detected at later
stages when destruction of the tooth structure
becomes evident. The radiographic patterns of
ICR have been investigated, and several
classifications have been established1,16. By
contrast, the clinical features of ICR lack
detailed investigation. A pink spot, vital pulp
response, periodontal pockets, and bleeding
on probing have been reported as common
clinical signs of ICR17,18. However, limited
studies have attempted to investigate whether
the symptoms and signs vary between stages
of ICR. Identifying the clinical features of ICR
could not only help clinicians in early diagnosis
but also help researchers to understand the
disease progression.
Epidemiologic studies have estimated
the prevalence of ICR as ranging from 0.02%–
0.08%1,19. In previous studies, the disease
had a wide age distribution without sex
difference, and the maxillary anterior teeth
were the most commonly affected6. However,
limited studies have been conducted in Asian
populations. This study had 2 objectives. The
first objective was to assess the distribution
and potential predisposing factors of ICR-
affected patients in a Taiwanese population.
The second objective was to investigate the
clinical features of ICR to understand its
evolution.
MATERIALS AND METHODS
Case Collection
This study was approved by the Research
Ethics Committee of National Taiwan
University Hospital, Taipei City, Taiwan. Cases
between July 2009 and June 2019 were
collected at National Taiwan University
Hospital. Patients over 10 years of age who
were diagnosed with ICR by the visiting staff
were included. The affected tooth was
required to have radiographs taken at different
angulations to confirm the location and size of
the lesion. All collected cases were screened
by 1 endodontic master student and 2 board-
certified endodontic specialists to confirm the
presence of ICR. In cases of disagreement, the
3 observers reached a consensus through
discussion.
Data Collection
After screening, Excel 2016 (Microsoft,
Redmond, WA) was used for data registration.
The clinical records and radiographs of the
confirmed cases were reviewed to gather the
2 Jeng et al.
demographic information, potential
predisposing factors, and clinical
characteristics.
The demographic data of the patients
included sex, age at which ICR was initially
diagnosed, position of the affected teeth, and
case type. The case type was defined by the
cumulated incidence of ICR-affected teeth in
the same patient at the latest follow-up. A
patient with a single ICR-affected tooth was
classified as a “single ICR case,” whereas a
patient with more than 1 ICR-affected tooth
was classified as a “multiple ICR case.”
The potential predisposing factors of the
patients were assessed using both the clinical
records and radiographs. The medical and
dental history was reviewed to identify any
relevant systemic diseases, history of dental
trauma, orthodontic treatment (Fig. 1),
periodontal treatment, or bleaching
procedures before the discovery of an ICR
lesion. Using the radiographic images, the
affected teeth were further assessed to identify
any prior restorations, root canal filling,
attrition, or extraction of neighboring teeth. The
number of missing teeth (excluding third
molars) was judged using the panoramic
radiographs with reference to the clinical
records.
Clinical parameters including
percussion or palpation tenderness,
periodontal probing depth, pulp vitality status,
abscess formation, and sinus tract tracing
were recorded. The presence of periapical
lesions, Heithersay classification, and
combination with other types of resorption
were also noted.
Statistical Analysis
The statistical analysis was performed with R
studio version 3.6.1 (The R Foundation for
Statistical Computing, Vienna, Austria).
Descriptive analysis combined with univariate
analysis was used to assess the distribution,
potential predisposing factors, and the clinical
features of ICR. The Fisher exact test was used
to compare the clinical characteristics among
lesions with different Heithersay classes. A P
value ,.05 was considered statistically
significant.
RESULTS
Initially, 67 teeth were retrospectively
diagnosed as being affected by ICR. Four teeth
were excluded after screening by the 3
observers. Ultimately, 31 patients with a total
of 63 ICR-affected teeth were included in the
final analysis. An average of 2.03 teeth were
affected by ICR per patient.
The demographic distribution of ICR-
affected patients is summarized in Table 1.
Among the 31 patients, 14 (45.16%) were
men, whereas 17 (54.83%) were women. No
significant difference was found in sex
distribution (P . .05, exact binomial test). The
age of the patients ranged from 18–81 years,
with an average of 45.77 years (615.10 years).
The peak age group was between 50 and 59
years. The distribution among each age group
showed a marginally significant difference (P .
.05, exact multinomial test). Regarding the
case type, single ICR cases were more
common than multiple ICR cases (P , .05,
exact binomial test). More female patients were
found in the single ICR group (61.54%),
whereas more male patients were found in the
multiple ICR group (80.00%). However, no
significant difference was found between case
type and patient sex (P . .05, Fisher exact
test) or between case type and patient age (P
. .05, Wilcoxon rank sum test).
The most commonly affected teeth were
maxillary canines (20.63%) and maxillary
central incisors (15.87%). Maxillary lateral
incisors, maxillary first premolars, and
mandibular first molars were equally affected
(each 11.11%). This was followed by maxillary
second premolars (9.52%), mandibular canine
and maxillary first molars (each 4.76%), and
mandibular second molars (3.17%).
Mandibular central incisors, mandibular lateral
incisors, mandibular first premolars, maxillary
second molars, and maxillary third molars all
contributed 1 tooth (1.59%). No mandibular
second premolar or mandibular third molar
was affected by ICR in this study. The regional
distribution of ICR-affected teeth is shown in
Table 1. Maxillary anterior teeth were the most
commonly affected area followed by maxillary
premolars and mandibular molars. In the
maxilla, anterior teeth were the most
commonly affected, whereas molars were the
least commonly affected (P , .05, exact
multinomial test). By contrast, in the mandible,
molars were the most commonly affected
teeth, whereas premolars were the least
commonly affected teeth (P , .05, exact
multinomial test). Furthermore, anterior teeth
(55.56%) were more commonly affected than
premolars and molars (P , .05, exact
multinomial test). Maxillary teeth (76.19%) were
more commonly affected than mandibular
teeth (23.81%) (P , .05, exact binomial test).
The potential predisposing factors of
ICR were categorized into 2 groups: a
systemic condition and dental-related factors.
Hypertension was found in 4 patients
(12.90%). Thyroid or parathyroid disorder was
found in 3 patients (9.68%) and 11 teeth
(17.46%). Anemia was found in 2 patients
(6.45%). Diabetes was reported in 1 patient
(3.23%). Hepatitis B infection was also found in
1 patient (3.23%). No ICR cases were related
JOE  Volume -, Number -, - 2020
FIGURE 1 – A case of invasive cervical resorption related to orthodontic treatment. (A ) Soft tissue outgrowth over tooth 42 (black arrow ) was noted during dental scaling. (B ) A
periapical radiograph was taken. Cervical resorption combined with apical resorption was noted in tooth 42 (red arrow ). The tooth was asymptomatic and responded to an electric pulp
test and a cold test.

to herpes virus infection, arthritis, autoimmune Twenty-two patients (70.97%) and 42 teeth The more common dental-related
disease, or the use of bisphosphonates, (66.67%) were not related to any of the factors of ICR-affected teeth were a history of
although they were reported in the literature. systemic diseases under investigation. dental or orofacial trauma (33.33%), prior
periodontal treatment (26.98%), restoration/
crown (17.46%), orthodontic treatment
TABLE 1 - Demographic Distribution and Tooth Distribution among Patients and Teeth with Invasive Cervical Resorption
(15.87%), extraction of a neighboring tooth
(ICR)
(7.94%), more than 3 missing teeth (8.20%),
Classification Number of patients (%) Number of teeth (%) P value moderate to severe attrition (3.17%), external
tooth bleaching (1.59%), and root canal
Demographic distribution
perforation (1.59%). No tooth had a history of
of ICR patients
Sex distribution internal tooth bleaching. However, univariate
Male 14 (45.16) .720* analysis of dental-related factors found that
Female 17 (54.84) ICR-affected teeth occurred more often in
Age distribution teeth without a history of dental or orofacial
10–19 y 1 (3.23) .066† trauma, without previous periodontal
20–29 y 5 (16.13) treatment, without restoration/crown, without
30–39 y 6 (19.35) orthodontic treatment, without extraction of a
40–49 y 5 (16.13) neighboring tooth, without more than 3
50–59 y 8 (25.81)
missing teeth, without moderate to severe
60–69 y 4 (12.90)
attrition, and without external tooth bleaching
70–79 y 1 (3.23)
801 y 1 (3.23) (all P , .05).
Number of affected The main reasons for the discovery of
teeth per patient ICR among the 31 patients were a chief
Single ICR cases 5 (16.13) ,.001* complaint of symptoms (48.39%) and clinical/
Multiple ICR cases 26 (83.87) radiographic findings (51.61%). Further
Distribution of ICR-affected teeth univariate analysis of the clinical
Dental arch characteristics showed that ICR was more
Maxillary teeth 48 (76.19) .001* commonly noted in teeth without percussion
Mandibular teeth 15 (23.81)
pain, without palpation pain, with vital pulp
Tooth type
response, and without formation of an
Anterior teeth 35 (55.56) .002†
Premolars 14 (22.22) abscess and/or sinus tract (all P , .05)
Molars 14 (22.22) (Table 2). The ICR-affected teeth had probing
Maxillary teeth depths of both 3 mm and .3 mm (P . .05).
Maxillary anterior teeth 30 (62.50) ,.001† When sinus tracts were present, they were
Maxillary premolars 13 (27.08) most commonly traced toward the resorption
Maxillary molars 5 (10.42) cavity (75%, P . .05). Radiographically, ICR-
Mandibular teeth affected teeth mainly exhibited no periapical
Mandibular anterior teeth 5 (33.33) .043† lesions (88.89%, P , .05). Four teeth (6.35%)
Mandibular premolars 1 (6.67)
exhibited ICR in combination with other types
Mandibular molars 9 (60.00)
of resorption, including apical resorption,
*Exact binomial test. internal resorption, and replacement
†
Exact multinomial test. resorption.

JOE  Volume -, Number -, - 2020 Invasive Cervical Resorption 3

TABLE 2 - Clinical and Radiographic Findings among 63 Teeth Affected by Invasive Cervical Resorption
Clinical and radiographic findings
Clinical examination
Tenderness to percussion
Tenderness to palpation
Probing depth .3 mm
Pulp vitality status
Vital
Necrotic
Previously initiated or treated
Abscess formation
Sinus tract formation*
Origin of sinus tract*
Around the resorption cavity
Around the periapical area
Radiographic examination
Presence of a periapical lesion
Combined with apical resorption
Combined with internal resorption
Combined with ankylosis
*Eleven teeth exhibited sinus tract formation, 1 of which exhibited 2 sinus tracts simultaneously. One sinus tract was traced
to the root apex, whereas the other was traced to the resorption cavity. Thus, 12 sinus tracts were analyzed to determine
their origin.
Table 3 compares the clinical
characteristics among Heithersay classes of
ICR. Only a probing depth .3 mm differed
significantly between Heithersay classes I and
II. The percussion test and probing depth
differed significantly between Heithersay class I
and classes III and IV. No significance
difference was found between class II and
classes III and IV.
DISCUSSION
To the best of our knowledge, this was the first
epidemiologic study on ICR in an Asian
population. The results showed that ICR has a
wide age distribution without a significant sex
difference, which is in agreement with previous
studies1,6. Sex and age seemed to have little
effect on the development of this disease.
Notably, the multiple ICR cases were mainly
men, whereas single ICR cases were mainly
women.
TABLE 3 - Comparison of Clinical and Radiographic Features among Heithersay Classes
Class I (18 teeth),
Tenderness to percussion*
Tenderness to palpation
Probing depth .3 mm*†
Vital pulp response 15 (83.33)
Abscess formation
Presence of sinus tract
Presence of periapical lesion
*Statistically significant difference between class I and classes III and IV (P , .05).
†
Statistically significant difference between class I and class II (P , .05).
4 Jeng et al.
completely healthy and denied all major
systemic diseases.
Number (%) of affected teeth Hormones, cytokines, and growth
factors play a crucial role in osteoclast/
13 (20.63) odontoclast regulation including parathyroid
8 (12.70) hormone; thyroid hormone; 1,25-
32 (50.79) dihydroxyvitamin D3; and estrogen21.
Orthodontic studies have shown that
46 (73.02) hyperparathyroidism22, hypophosphatemia23,
11 (17.46)
and the administration of thyroxine24 may
6 (9.52)
influence bone remodeling and root resorption.
12 (19.05)
11 (17.46) A previous study reported a rare familial
pattern of multiple ICR in which most family
9 (75) members had hypothyroidism and received
3 (25) hormone replacement therapy when they were
young25. In this study, 3 patients (9.68%) and
7 (11.11) 11 teeth (17.46%) had a history of thyroid or
2 (3.17) parathyroid disorder. One female patient with
1 (1.59) multiple ICR did not know that she had
1 (1.59)
hyperparathyroidism until her blood samples
were analyzed. A prospective study can be
performed in the future to analyze the blood
samples of ICR-affected patients.
Dental and orofacial trauma was the
most prominent dental-related factor in the
Regarding the distribution of affected
present study. Because it can damage the
teeth, maxillary anterior teeth were the most
cementum, periodontal ligament, and the
commonly affected (30/63, 47.69%) in the
surrounding alveolar bone, dental trauma is a
current study. However, this percentage was
common cause of transient apical breakdown,
slightly lower than in previous studies. A
external replacement resorption, external
possible reason might be that the etiologic
inflammatory resorption, and internal
factors of ICR differ according to population,
resorption26,27. Previous studies have shown
leading to various patterns of affected teeth. In
that 28.5% of ICR-affected teeth had a history
addition, maxillary teeth were more commonly
of dental trauma6. Orofacial trauma was also
affected than mandibular teeth. This could be
included in our study, and we found that
explained by maxillary teeth being more prone
traumatic history was prominent regardless of
to dental trauma20.
the tooth position. Anterior teeth were
Because the etiology of ICR was
commonly affected by dental trauma, whereas
unclear, a thorough investigation of the
posterior teeth were commonly affected by
systemic conditions and dental-related factors
orofacial trauma. These posterior teeth
of ICR was conducted in this study. Previous
probably suffered great mechanical impact,
case reports have suggested that autoimmune
although they typically showed no obvious
disorder11, varicella-zoster virus12, hepatitis B
signs of tooth fracture or luxation. Because the
virus13, neuronal virus14, and the use of
cementoenamel junction is not always
bisphosphonates15 could be related to the
contiguous, cervical dentin is prone to
development of ICR. However, our results
colonization by activated clastic cells. Trauma
showed that patients with ICR rarely had these
may alter the microstructure of the tooth
diseases. In fact, many patients were
surface, which probably facilitates the
attachment of clastic cells.
Periodontal treatment was the second
most common dental-related factor in this
Class II (15 teeth), Classes III and IV study; however, whether it leads to ICR is
n (%) n (%) (30 teeth), n (%) unclear. Cementum is commonly regarded as
1 (5.56) 3 (20.00) 9 (30.00) an antiresorptive barrier for dentin. Scaling and
0 (0.00) 1 (6.67) 7 (23.33) root planing result in the removal of cementum
3 (16.67) 11 (73.33) 18 (60.00) regardless of the instrument used28,29, leading
8 (53.33) 23 (76.67) to the exposure of dentinal tubules. In severe
1 (5.56) 4 (26.67) 7 (23.33) cases, pulpitis, tooth hypersensitivity, and
1 (5.56) 4 (26.67) 6 (20.00)
other complications have been reported30,31.
0 (0.00) 3 (20.00) 4 (13.33)
In addition, the microbial stimulation and host
inflammatory response in periodontitis may
promote osteoclast activity, resulting in
JOE  Volume -, Number -, - 2020
FIGURE 2 – A case of multiple teeth affected by ICR with a history of dental trauma and new lesions that developed during and after treatment. (A ) A panoramic radiograph taken at the
initial visit (October 6, 2015). Multiple ICR lesions over teeth 15, 14, 13, 22, 23, 24, 27, 28, 46, and 47 were noted. (B ) On March 22, 2016, cone-beam computed tomographic
radiographs showed typical ICR lesions over teeth 14 distal, 14 mesial, 12 distal, and 28 mesial. (C ) A panoramic radiograph revealing new ICR lesions over teeth 11 and 13 (October
29, 2019). Some teeth with severe ICR involvement (teeth 21, 22, 23, 24, and 27) during this period were extracted and replaced using implant therapy.

JOE  Volume -, Number -, - 2020 Invasive Cervical Resorption 5

alveolar bone loss. A slight possibility exists
that osteoclasts adhere to the exposed dentin
surface after periodontal treatment.
Orthodontic treatment has been
suggested as a potential cause of ICR.
Heithersay1 stated that ICR was mainly
detected after the completion of orthodontic
treatment. However, recent case reports have
shown signs of ICR development during the
treatment process32. The constant
orthodontic force may stimulate clastic cells,
particularly at the pressure side. In the present
study, 15.87% of teeth with ICR had a history
of orthodontic treatment (Fig. 1), suggesting
orthodontic treatment as a possible factor of
ICR. Mavridou et al6 reported that 45.7% of
ICR was related to orthodontics. These results
indicate that orthodontic treatment is the more
critical predisposing factor of ICR in Europe,
whereas in a Taiwanese population trauma
accounted for a greater portion. This difference
may be affected by the popularity of
orthodontics in different countries as well as
the modality of treatment. Because craniofacial
patterns differ between Asian and white
patients33 and the perception of esthetics
varies according to culture and race34,
treatment methods and needs vary on a case
by case basis. In the future, treatment details
such as the movement method, movement
distance, and treatment duration should be
investigated to determine their combined effect
on the treatment outcome.
Historically, ICR has occasionally
developed after internal tooth bleaching3.
Hydrogen peroxide is able to diffuse through
the dentinal tubules35, producing free radicals,
which react with the periodontal tissue and
participate in osteoclast differentiation and
activation36. In this study, no tooth had
undergone internal bleaching; however, 1
tooth had a history of external bleaching. This
is probably because of the improvement of
internal bleaching procedures. The extraction
of neighboring teeth has also been pointed out
as a cause of ICR37, but in our study this was
the case for only 5 teeth (7.94%). Playing a
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teeth. J Endod 2016;42:1737–51.
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wind instrument and malocclusion have also
been reported38,39. In addition, half of the
cases had complaints of tissue swelling, pain
on biting, or tooth sensitivity. Another half had
altered tooth appearance or random
radiographic findings. Most teeth appeared
normal, but occasionally pink cervical
discoloration was noted. In 1 of our cases, the
cervical third of the crown was resorbed and
occupied by gingival tissue (Fig. 1).
Limited studies have investigated the
clinical signs and symptoms of ICR among
different ICR classes. We found that most ICR-
affected teeth showed no obvious symptoms
or signs. However, as the resorption advanced
to a later stage, pain on percussion and
palpation was observed. Regarding the
probing depth, Heithersay class I lesions
mostly showed a probing depth 3 mm, but
class II to IV lesions often had pockets .3
mm1. The lesion causes localized bony
destruction as it progresses apically.
Furthermore, most teeth with ICR showed a
positive pulp response because a thin
resorption-resistant dentin layer typically
covers the outer surface of the pulp chamber2.
When ICR invades the dental pulp followed by
microorganisms, pulp vitality may diminish.
Abscess formation was detected in
approximately 25% of teeth with Heithersay
class II to IV lesions. These abscesses were
typically found at the gingival level, whereas
sinus tracts were traced toward the resorbed
cavity. The overlying mucosa appeared
erythematous, swollen, and with discomfort to
palpation. Some patients reported a history of
spontaneous, throbbing pain that later
subsided. The reason for abscess formation is
probably bacterial accumulation in the pocket
inducing a severe inflammatory response. By
contrast, without bacterial contamination,
abscesses might not be seen even in
Heithersay class IV lesions.
Radiographically, ICR-affected teeth
typically showed no periapical lesions, and
most teeth remained vital. Notably, in some
affected teeth, apical resorption, internal
resorption, and ankylosis were detected.
These situations are related to the causes of
resorption. In addition, multiple ICR-affected
teeth in the same patient were not always
detected simultaneously; rather, new lesions
later developed in teeth that previously had no
obvious signs of ICR. This successive
appearing phenomenon was found in 1 of our
representative cases (Fig. 2) and also reports
by other researchers25,40,41. We suggest that
in patients with ICR, radiographs should be
taken periodically to ensure early detection of
new ICR lesions and to improve treatment
outcomes. Periapical radiographs for anterior
teeth and horizontal bitewings for posterior
teeth can provide more accurate information.
Furthermore, because ICR is mainly
asymptomatic, clinicians should be familiar
with the radiographic patterns of ICR and be
alert to any possible anomalies in routine
practice.
CONCLUSIONS
In a Taiwanese population, ICR had a wide age
distribution, with the peak between 50 and 59
years. Maxillary anterior teeth were the most
commonly affected. Traumatic injury,
periodontal treatment, and orthodontic
treatment were significant predisposing factors
for teeth with ICR. Endocrine disorders are
probably related to ICR. Furthermore, the
affected teeth were typically absent of clinical
signs and symptoms; thus, careful
radiographic examination is critical for
diagnosis. Regular radiographic follow-up
should be performed for early detection of new
ICR lesions in these patients.
ACKNOWLEDGMENTS
Supported by National Taiwan University
Hospital, Taiwan (grant nos. 107-S003875,
108-004156 and 109-S4632).
The authors deny any conflicts of
interest related to this study.
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