Geoffrey Sinclair Heithersay

Aim: There are few reports in the literature of multiple external invasive root resorption (EIRR) lesions in patients with systemic sclerosis (SSc), and an association between root resorption and SSc is not well established. We report the only case that comprehensively illustrates—with the combination of histopathology, cone beam computed tomography (CBCT), orthopantomograms and photography—pulpal and periodontal ligament calcifications, multiple EIRR lesions progressing over time and the sequelae of treatment. Sixteen affected teeth, documented over 14 years, are presented. Summary: A 51‐year‐old female presented for overall oral management of progressive SSc. Extraction of symptomatic teeth 16 and 26 revealed palatal EIRR. Retrospective dental record review revealed four previously extracted affected teeth. Subsequent CBCT revealed a further 10 affected teeth. Rapid EIRR progression of teeth 25 and 47 ensued and were extracted with tooth 46. Histopathology revealed ankylosis with mature bony infill of EIRR lesions, bone abutting dentine with absent cementum and pulpal and PDL calcifications. The teeth 46–47 extraction site developed stage I medication‐related osteonecrosis of the jaw secondary to denosumab use, was managed with conservative measures and resolved. Key Learning Points: Patients with SSc may display a higher prevalence of EIRR. Awareness should be raised about this potential association. Dentists treating patients with SSc should conscientiously search for these easily unnoticed, often subgingival lesions, since early management may reduce the risk of teeth succumbing to pathological fracture. However, if multiple progressive lesions present, no intervention may be appropriate due to the aggressive nature of EIRR and potential futile outcome of treatment.

Background: External cervical resorption (ECR) is a relatively rare form of tooth resorption. It is commonly classified either using two‐dimensional imaging according to the Heithersay or cone‐beam computed tomography using the Patel et al. classifications. Effective disease classification systems should provide categories that guide clinical decision‐making and support the prediction of management outcomes. This principle should apply to the classification systems for ECR. Objectives: To assess the association between Heithersay's and Patel's classification systems and the recently proposed core outcome set measures for endodontic treatment. Method: A narrative review study type was adopted due to the anticipated heterogeneity regarding clinical management. An electronic citation search of the studies by Heithersay 1999 and Patel et al. 2018 was made on 17 September, 2025 in three electronic databases (PubMed, Web of Science, and Scopus) for cohort studies that included various categories of the classifications. No language or publication date restrictions were applied. Articles were excluded when inclusion criteria were not met. Four clinical registers were searched for emerging evidence using the same criteria. The main features of the study were extracted, tabulated, and a narrative summary was made. Two authors contributed to the process independently. Results: Searches of the databases and clinical trials registers yielded six and nil studies, respectively. The identified studies originated from seven countries, were mostly set in postgraduate teaching clinics and were published within the past five years. The recall periods extended up to 10 years with all six studies using Heithersay's classification, with three also using Patel's classification. In total, 657 teeth were assessed against Heithersay's classification and 128 also assessed with Patel's. The three studies that included both classifications had relatively limited sample sizes and relatively short final recall periods. An association between Heithersay's classification with outcomes was evident; Classes I and II were associated with high rates of survival and ‘success’, and Class IV the opposite. No association was found between Patel's classification with outcomes. Conclusion: The available literature supports an association between Heithersay's classification with management outcomes for ECR. There is insufficient evidence to assess Patel's classification regarding prognostication.

An example of contrasting responses in two root fractured teeth in a 16‐year‐old male seriously injured in a hit‐and‐run motor accident is documented over a 34‐year 9‐month period. Extended non‐surgical endodontic management was necessary for one of the root‐fractured central incisors that had developed an infective marginal breakdown, and by contrast, the contralateral incisor with a diagnosis of internal surface resorption and internal tunneling resorption was carefully monitored to ultimate resolution.

The varicella zoster virus as an aetiological agent for endodontic disease is not a well-recognised entity despite several published case reports. While advances in DNA molecular analysis techniques (PCR) have contributed to the current understanding of the potential role of the varicella zoster virus in the initiation and progression of endodontic disease, a review indicates a need for ongoing research. Case reports are presented of two female patients with a history of herpes zoster who developed pulp necrosis, with one patient progressing to apical periodontitis. Both patients received non-surgical endodontic therapy, followed by intra-coronal bleaching in one of the patients due to tooth discolouration which developed during the prodromal and acute phases of the herpes zoster infection. Clinical and radiographic examinations at 23 and 22 years, respectively, showed the affected teeth to be retained in an asymptomatic and aesthetically satisfactory state with no radiographic evidence of apical pathosis.

Dentine dysplasia type 1 is a rare and complex dental anomaly. Our aim was to conduct a morphometric assessment of a dentinal dysplasia type 1c (DD1c) caries‐free mandibular second molar, extracted due to symptomatic apical periodontitis. Controls consisted of five intact mandibular second molars. Micro‐computed tomography analysis showed that the DD1c volume % for enamel, dentine/cementum and pulp chamber fell in the 0.36th, 99.97th and 0.09th percentiles of the control teeth (P < 0.01). It also revealed an extremely complicated root canal system in the DD1c tooth with a varying degree of dentine mineralisation and aberrant dentine deposition in the pulp chamber. A crack extending from the external tooth surface to the pulp chamber was identified as a potential site for microbial invasion. Clinical implications include preventive measures and early intervention in reversible pulpitis. Conclusion: Micro‐CT imaging can be useful in establishing post‐extraction diagnosis of cracks and phenomic characterisation of tooth anomalies.

Background: Tooth discolouration could occur due to bacterial contamination in traumatized teeth. Hydrogen peroxide is the commonly used bleaching agent. However, due to concerns over safety, alternative bleaching regimes such as sodium perborate (S) and thiourea‐hydrogen peroxide (T) have been investigated.Methods: Apices resected and pulp extirpated 99 premolars were divided into two groups. Group 1 and 2 was injected with blood and blood/bacteria, stored anaerobically for 35 days. The two groups were treated by bleaching with water, S or T. Teeth were rebleached after 7 days. Colourimetric evaluation was assessed using digital imaging, CasMatch standardization and CIE L*a*b colour system preoperatively, 35 days of staining and 7 and 14 of bleaching. A linear mixed model with fixed effects of time, group and bleach was used to examine colour difference.Results: Blood‐stained teeth were significantly redder and darker on day 35 compared with blood/bacteria‐stained teeth. After bleaching, blood‐stained teeth retained significant redness compared with blood/bacteria‐stained teeth using either S or T. T produced a significantly whiter shade in both the groups after 14 days.Conclusions: Blood‐stained teeth were significantly darker and red compared with blood/bacteria‐stained teeth. T bleaching regime was more effective than S.

The purpose of the study is to document a rare case of a peripheral odontogenic fibroma with associated cervical and coronal tooth resorption in a 38 year old woman. Histopathological features are described, the clinical management outlined and follow‐up observations over 27 years detailed. The exophytic firm lesion, coral pink in appearance, located on the labial aspect of a maxillary right lateral incisor was excised, fixed in formalin and prepared for histological evaluation. The resorption cavity and adjacent soft tissue were treated by the topical application of trichloroacetic acid prior to restoration with a glass‐ionomer cement and subsequent root canal treatment. Histologically, the body of the lesion was characterized by the presence of odontogenic epithelium embedded in a mature fibrous stroma. Areas of dystrophic calcification could also be identified. The features were consistent with a diagnosis of a peripheral odontogenic fibroma. The clinical result of treatment assessed 27 years postoperatively showed no evidence of recurrence of the peripheral odontogenic fibroma. External cervical and coronal tooth resorption can, on rare occasions, prove to be a clinical feature associated with peripheral odontogenic fibroma. Treatment of the tumour mass and the resorptive lesion can provide a successful outcome.