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28 March 2023

External cervical resorption: relationships between classification, treatment, and outcomes


The purpose of this study was to identify possible associations between classification, treatment, and one-year outcome of external cervical resorption (ECR) lesions using the Heithersay and Patel systems. The performance of the Patel 3-dimensional classification system was also evaluated.


A chart review identified 142 cases of ECR over a twelve-year period. Information regarding demographics, predisposing factors, lesion classification, treatment, and outcomes was collected and analyzed. Inter- and intra-observer reliability analyses were conducted for both classification systems.


There were 72 cases with at least one year of follow-up. 70% of these cases survived. Treatment recommendations were correlated with both Heithersay and Patel classification. There were no correlations found between one-year outcome and either classification or treatment done. The weighted reliability analysis showed substantial agreement in both classification systems for both inter- and intra-observer agreement. There was a significant association between the two systems, however, the Heithersay system tended to underestimate the apical extent of the lesion.


Periodic review of ECR lesions presents as a viable treatment option, at least for one year after diagnosis. The Patel 3-D classification system is at least as effective as the Heithersay system and should be used in future ECR prognosis studies. Further long-term outcome assessments are still needed.

Schuyler DeLuca, DDS, Andrew Choi, DDS , Sarah Pagni, PhD, MPH, Elinor Alon, DMD - Published: March 15, 2023DOI:https://doi.org/10.1016/j.joen.2023.03.005

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