Expert consensus on combined periodontal and endodontic management of multiple idiopathic cervical root resorption

doi:10.19439/j.sjos.2026.04.001

Shanghai Journal of Stomatology ›› 2026, Vol. 35 ›› Issue (4): 337-347.doi: 10.19439/j.sjos.2026.04.001

• Expert Consensus • Previous Articles Next Articles

Expert consensus on combined periodontal and endodontic management of multiple idiopathic cervical root resorption

Ran Shujun¹, Dong Jiachen², Yan Fuhua³, Yang Jian⁴, Ge Shaohua⁵, Zhao Jin⁶, Zhao Chuanjiang⁷, Pan Yihuai⁸, Zhao Lei⁹, Du Yi¹⁰, Cao Zhengguo¹¹, Huang Xiaojing¹², Tian Beimin¹³, Yu Jinhua¹⁴, Deng Hui¹⁵, Cheng Lei¹⁶, Zhu Guangxun¹⁷, Wang Li¹⁸, Sun Xiaoyu¹⁹, Chen Zhu²⁰, Huang Zhengwei¹, Song Zhongchen²

1. Department of Endodontics and Operative Dentistry;
2. Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Disease; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology. Shanghai 200011; 3. Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University. Nanjing 210008, Jiangsu Province;
4. Department of Endodontics, The Affiliated Stomatological Hospital of Nanchang University. Nanchang 330006, Jiangxi Province;
5. Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University; Shandong Key Laboratory of Oral Tissue Regeneration; Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration; Shandong Provincial Clinical Research Center for Oral Diseases. Jinan 250012, Shandong Province;
6. Department of Cariology and Endodontics, The First Affiliated Hospital of Xinjiang Medical University (The Affiliated Stomatology Hospital of Xinjiang Medical University). Urumqi 830000, Xinjiang Uygur Autonomous Region;
7. Hospital of Stomatology, Sun Yat-sen University; Guangdong Provincial Clinical Research Center of Oral Diseases. Guangzhou 510055, Guangdong Province;
8. Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University. Wenzhou 325000, Zhejiang Province;
9. State Key Laboratory of Oral Diseases; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Department of Periodontitis, West China Hospital of Stomatology, Sichuan University. Chengdu 610041, Sichuan Province;
10. Jinan Stomatological Hospital. Jinan 250001, Shandong Province;
11. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration; Key Laboratory of Oral Biomedicine Ministry of Education; Hubei Key Laboratory of Stomatology; School & Hospital of Stomatology, Wuhan University. Wuhan 430079, Hubei Province;
12. Fujian Key Laboratory of Oral Diseases & Clinical Research Center for Oral Tissue Deficiency Diseases of Fujian Province; School and Hospital of Stomatology, Fujian Medical University. Fuzhou 350002, Fujian Province;
13. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration; National Clinical Research Center for Oral Diseases; Shaanxi International Joint Research Center for Oral Diseases; Department of Periodontology, School of Stomatology, The Fourth Military Medical University. Xi'an 710032, Shaanxi Province;
14. Department of Cariology and Endodontology, The Affiliated Stomatological Hospital of Nanjing Medical University & State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases (Nanjing Medical University) & Jiangsu Province Engineering Research Center of Stomatological Translational Medicine. Nanjing 210029, Jiangsu Province;
15. Department of Periodontics, Hospital of Stomatology, Wenzhou Medical University. Wenzhou 325000, Zhejiang Province;
16. State Key Laboratory of Oral Diseases; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University. Chengdu 610041, Sichuan Province;
17. Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Wuhan 430030, Hubei Province;
18. Department of Cariology and Endodontics I, School & Hospital of Stomatology, Wuhan University; State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration; Key Laboratory of Oral Biomedicine Ministry of Education; Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University. Wuhan 430079, Hubei Province;
19. College & Hospital of Stomatology, Anhui Medical University; Key Laboratory of Oral Diseases Research of Anhui Province. Hefei 230032, Anhui Province;
20. Guiyang Stomatological Hospital (Guizhou University Stomatological Hospital). Guiyang 550002, Guizhou Province, China

Received:2026-04-24 Revised:2026-07-06 Online:2026-08-25 Published:2026-09-01

Abstract

Abstract: Multiple idiopathic cervical root resorption (MICRR) is a rare, idiopathic condition characterized by multiple resorptive lesions in the cervical region of teeth. It manifests as progressive, painless hard tissue loss, often accompanied by periodontal tissue destruction, which may ultimately lead to tooth fracture, loosening, or even exfoliation. In early stages, MICRR is typically asymptomatic and is often incidentally detected through imaging as characteristic "concave" resorptive defects in the cervical area. Currently, no specific treatment is available. The rarity, insidious nature, invasiveness and multiplicity of MICRR highlight the need for enhanced clinical awareness from both periodontal and endodontic perspectives, enabling early interdisciplinary diagnosis and coordinated intervention. Based on a review of relevant literature and expert discussion, this article aimed to improve understanding of the etiology and pathogenesis of MICRR, establish diagnostic criteria, and propose treatment and follow-up strategies, thereby providing a reference for clinicians in the early diagnosis, clinical management and prevention of MICRR.

Key words: Multiple idiopathic cervical root resorption, Classification of external resorption, Aggressive benign lesion, Periodontal-endodontic combined diagnosis and treatment, Preventive resection, Expert consensus

CLC Number:

R781

Ran Shujun, Dong Jiachen, Yan Fuhua, Yang Jian, Ge Shaohua, Zhao Jin, Zhao Chuanjiang, Pan Yihuai, Zhao Lei, Du Yi, Cao Zhengguo, Huang Xiaojing, Tian Beimin, Yu Jinhua, Deng Hui, Cheng Lei, Zhu Guangxun, Wang Li, Sun Xiaoyu, Chen Zhu, Huang Zhengwei, Song Zhongchen. Expert consensus on combined periodontal and endodontic management of multiple idiopathic cervical root resorption[J]. Shanghai Journal of Stomatology, 2026, 35(4): 337-347.

References

[1] Harokopakis-Hajishengallis E.Physiologic root resorption in primary teeth: molecular and histological events[J]. J Oral Sci, 2007, 49(1): 1-12.
[2] Andreas JO, Andreasen FM.Root resorption following traumatic dental injuries[J]. Proc Finn Dent Soc, 1992, 88(Suppl 1): 95-114.
[3] Huang J, Walsh RM, Witherspoon DE, et al.The prevalence, characteristics, and risk factors of external cervical resorption: a retrospective practice-based study[J]. Clin Oral Investig, 2023, 27(9): 5595-5604.
[4] Machado ICP, Morais MO, Bicalho ALP, et al. Prevalence and characterization of external cervical resorption using cone beam computed tomography [J]. J Endod, 2024, 50(2): 164-172.e1.
[5] Wang N, Zhang M, Zhu J, et al.Multiple idiopathic cervical root resorption: a systematic review[J]. Oral Dis, 2023, 29(6): 2409-2422.
[6] Lin Y, Thumbigere-Math V, Kishen A, et al.Unraveling the etiology and pathogenesis of multiple cervical root resorption - a scoping review[J]. J Endod, 2025, 51(6): 674-686.
[7] Mueller E, Rony HR.Laboratory studies of an unusual case of resorption[J]. J Am Dent Assoc, 1930, 17(2): 326-334.
[8] Heithersay GS.Invasive cervical resorption: an analysis of potential predisposing factors[J]. Quintessence Int, 1999, 30(2): 83-95.
[9] Liang H, Burkes EJ, Frederiksen NL.Multiple idiopathic cervical root resorption: systematic review and report of four cases[J]. Dentomaxillofac Radiol, 2003, 32(3): 150-155.
[10] Neely AL, Gordon SC.A familial pattern of multiple idiopathic cervical root resorption in a father and son: a 22-year follow-up[J]. J Periodontol, 2007, 78(2): 367-371.
[11] Nikolidakis D, Nikou G, Meijer GJ, et al.Cervical external root resorption: 3-year follow-up of a case[J]. J Oral Sci, 2008, 50(4): 487-491.
[12] Mattar R, Pereira SA, Rodor RC, et al.External multiple invasive cervical resorption with subsequent arrest of the resorption[J]. Dent Traumatol, 2008, 24(5): 556-559.
[13] Samara E, Kelly E, Walker R, et al.Multiple idiopathic cervical root resorption: case report of an unusual presentation[J]. Spec Care Dentist, 2021, 41(1): 98-102.
[14] Coyle M, Toner M, Barry H.Multiple teeth showing invasive cervical resorption-an entity with little known histologic features[J]. J Oral Pathol Med, 2006, 35(1): 55-57.
[15] Velloso GR, de Freitas MM, Alves A, et al. Multiple external cervical root resorptions after home whitening treatment: a case report[J]. Aust Dent J, 2017, 62(4): 528-533.
[16] Macaraeg K, Lee SM, Kalra L, et al.Multiple external root resorption in a pediatric patient with familial expansile osteolysis[J]. Pediatr Dent, 2020, 42(1): 62-65.
[17] Mitchell CA, Kennedy JG, Wallace RG.Dental abnormalities associated with familial expansile osteolysis: a clinical and radiographic study[J]. Oral Surg Oral Med Oral Pathol, 1990, 70(3): 301-307.
[18] Olsen CB, Tangchaitrong K, Chippendale I, et al.Tooth root resorption associated with a familial bone dysplasia affecting mother and daughter[J]. Pediatr Dent, 1999, 21(6): 363-367.
[19] Chackartchi T, Tobias G, Mann J, et al.Dental resorption in gorham-stout syndrome[J]. Arch Clin Med Case Rep, 2022, 6: 521-523.
[20] Smith NH.Monostotic Paget's disease of the mandible presenting with progressive resorption of the teeth[J]. Oral Surg Oral Med Oral Pathol, 1978, 46(2): 246-253.
[21] Iwamatsu-Kobayashi Y, Satoh-Kuriwada S, Yamamoto T, et al.A case of multiple idiopathic external root resorption: a 6-year follow-up study[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2005, 100(6): 772-779.
[22] Thoma KH, Sosman MC, Bennett GA.An unusual case of hereditary fibrous osteodysplasia (fragilitas ossium) with replacement of dentin by osteocementum[J]. Am J Orthod Oral Surg, 1943, 29(1): C1-C30.
[23] Hughes AE, Ralston SH, Marken J, et al.Mutations in TNFRSF11A, affecting the signal peptide of RANK, cause familial expansile osteolysis[J]. Nat Genet, 2000, 24(1): 45-48.
[24] Ralston SH.Juvenile Paget's disease, familial expansile osteolysis and other genetic osteolytic disorders[J]. Best Pract Res Clin Rheumatol, 2008, 22(1): 101-111.
[25] Arroyo-Bote S, Bucchi C, Manzanares MC.External cervical resorption: a new oral manifestation of systemic sclerosis[J]. J Endod, 2017, 43(10): 1740-1743.
[26] Elmatary A, Longridge N, Jarad F.Is external cervical resorption an established manifestation of systemic sclerosis? a case report[J]. J Endod, 2023, 49(7): 915-919.
[27] Journo JE, Woodmansey KF, Walsh RM.Scleroderma and multiple teeth with invasive cervical resorption: is there a connection?[J]. Gen Dent, 2022, 70(2): 41-44.
[28] Dobros K, Myciński P, Borowy P, et al.Multiple invasive cervical resorption and celiac disease: a case report[J]. Quintessence Int, 2018, 49(5): 407-412.
[29] Jabali AH.Management of multiple idiopathic root resorption in a rheumatoid arthritis patient: a case report with 4-year follow-up[J]. J Contemp Dent Pract, 2022, 23(6): 652-658.
[30] Allanore Y, Simms R, Distler O, et al.Systemic sclerosis[J]. Nat Rev Dis Primers, 2015, 1: 15002.
[31] Auluck A, Pai KM, Shetty C, et al.Mandibular resorption in progressive systemic sclerosis: a report of three cases[J]. Dentomaxillofac Radiol, 2005, 34(6): 384-386.
[32] Siao-Pin S, Damian LO, Muntean LM, et al.Acroosteolysis in systemic sclerosis: an insight into hypoxia-related pathogenesis[J]. Exp Ther Med, 2016, 12(5): 3459-3463.
[33] Liu Y, Du H, Wang Y, et al.Osteoprotegerin-knockout mice developed early onset root resorption[J]. J Endod, 2016, 42(10): 1516-1522.
[34] Wang Z, McCauley LK. Osteoclasts and odontoclasts: signaling pathways to development and disease[J]. Oral Dis, 2011, 17(2): 129-142.
[35] Friedrich RE, Scheuer HA.Sequential loss of mandibular permanent incisors in Noonan syndrome[J]. In Vivo, 2022, 36(2): 1021-1029.
[36] Moskow BS.Periodontal manifestations of hyperoxaluria and oxalosis[J]. J Periodontol, 1989, 60(5): 271-278.
[37] Edwards PC, McVaney T. External cervical root resorption involving multiple maxillary teeth in a patient with hereditary hemorrhagic telangiectasia[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2005, 100(5): 585-591.
[38] Neely AL, Thumbigere-Math V, Somerman MJ, et al.A familial pattern of multiple idiopathic cervical root resorption with a 30-year follow-up[J]. J Periodontol, 2016, 87(4): 426-433.
[39] Wang YM, Ruan WY, Chi DD, et al.Clinical and genetic analysis of multiple idiopathic cervical root resorption[J]. Chin J Dent Res, 2024, 27(1): 89-99.
[40] Muromachi K, Hosomichi K, Park H, et al.Identification of candidate genes of familial multiple idiopathic cervical root resorption[J]. J Endod, 2023, 49(11): 1537-1547.
[41] Qin W, Gao J, Ma S, et al.Multiple cervical root resorption involving 22 teeth: a case with potential genetic predisposition[J]. J Endod, 2022, 48(12): 1526-1532.
[42] Llavayol M, Pons M, Ballester ML, et al.Multiple cervical root resorption in a young adult female previously treated with chemotherapy: a case report[J]. J Endod, 2019, 45(3): 349-353.
[43] Merrick D, Duncan HF, Bolas A, et al.Multiple external cervical resorption lesions in patient with graft versus host disease treated with systemic bleomycin: a case report[J]. J Endod, 2024, 50(5): 674-679.
[44] Kumar V, Chawla A, Kaur A.Multiple idiopathic cervical root resorptions in patients with hepatitis B virus infection[J]. J Endod, 2018, 44(10): 1575-1577.
[45] von Arx T, Schawalder P, Ackermann M, et al. Human and feline invasive cervical resorptions: the missing link?-presentation of four cases[J]. J Endod, 2009, 35(6): 904-913.
[46] Chen X, Yu X, Yan K, et al.Multiple idiopathic cervical root resorption involving all permanent teeth[J]. Aust Endod J, 2020, 46(2): 263-271.
[47] Darcey J, Qualtrough A.Resorption: part 1. pathology, classification and aetiology[J]. Br Dent J, 2013, 214(9): 439-451.
[48] Feller L, Khammissa RA, Thomadakis G, et al.Apical external root resorption and repair in orthodontic tooth movement: biological events[J]. Biomed Res Int, 2016: 4864195.
[49] Kimura R, Anan H, Matsumoto A, et al.Dental root resorption and repair: histology and histometry during physiological drift of rat molars[J]. J Periodontal Res, 2003, 38(5): 525-532.
[50] Mavridou AM, Hauben E, Wevers M, et al.Understanding external cervical resorption in vital teeth[J]. J Endod, 2016, 42(12): 1737-1751.
[51] Tyrovola JB, Spyropoulos MN, Makou M, et al.Root resorption and the OPG/RANKL/RANK system: a mini review[J]. J Oral Sci, 2008, 50(4): 367-376.
[52] Nakao A, Kajiya H, Fukushima H, et al.PTHrP induces Notch signaling in periodontal ligament cells[J]. J Dent Res, 2009, 88(6): 551-556.
[53] Patel S, Mavridou AM, Lambrechts P, et al.External cervical resorption-part 1: histopathology, distribution and presentation[J]. Int Endod J, 2018, 51(11): 1205-1223.
[54] Wu J, Lin LY, Yang J, et al.Multiple idiopathic cervical root resorption: a case report[J]. Int Endod J, 2016, 49(2): 189-202.
[55] George DI Jr, Miller RL.Idiopathic resorption of teeth. a report of three cases[J]. Am J Orthod, 1986, 89(1): 13-20.
[56] Moody GH, Muir KF.Multiple idiopathic root resorption. a case report and discussion of pathogenesis[J]. J Clin Periodontol, 1991, 18(8): 577-580.
[57] Mikušková K, Vaňuga P, Adamicová K, et al.Multiple idiopathic external cervical root resorption in patient treated continuously with denosumab: a case report[J]. BMC Oral Health, 2022, 22(1): 129.
[58] An SY, Kim CM, Sung CH, et al.Peripheral ossifying fibroma arising from the maxillary bucco-palatal gingiva in an elderly male patient: a rare case report[J]. J Korean Assoc Oral Maxillofac Surg, 2024, 50(5): 292-296.
[59] Alfred Xavier S, Yazhini PK.Peripheral ossifying fibroma: a case report[J]. Cureus, 2024, 16(5): e59749.
[60] Goldberg F, De Silvio A, Dreyer C.Radiographic assessment of simulated external root resorption cavities in maxillary incisors[J]. Endod Dent Traumatol, 1998, 14(3): 133-136.
[61] Tronstad L.Root resorption-etiology, terminology and clinical manifestations[J]. Endod Dent Traumatol, 1988, 4(6): 241-252.
[62] Patel S, Foschi F, Mannocci F, et al.External cervical resorption: a three-dimensional classification[J]. Int Endod J, 2018, 51(2): 206-214.
[63] Dare S, Bajaj P, Shirbhate U.The management of peripheral ossifying fibroma: a case presentation[J]. Cureus, 2024, 16(10): e70818.
[64] Parsegian K, Arce RM, Angelov N.Surgical periodontal management of peripheral ossifying fibroma: a series of three cases[J]. Case Rep Dent, 2024: 3683561.
[65] Gu W, Li S, Hu S, et al.Epulis: a narrative review of epidemiology, clinical features, pathogenesis, and management[J]. Oral Health Prev Dent, 2025, 23: 507-524.
[66] Heithersay GS.Clinical, radiologic, and histopathologic features of invasive cervical resorption[J]. Quintessence Int, 1999, 30(1): 27-37.
[67] Jeng PY, Chang SH, Wang CY, et al.Surgical repair of external cervical resorption-prognosis and prognostic factors[J]. J Dent Sci, 2024, 19(1): 377-386.
[68] Sahin Mantı A, Ulusoy Ö.An evaluation of the fracture resistance of teeth with simulated external cervical resorption cavities categorized using three-dimensional classification[J]. J Clin Med, 2024, 13(8): 2159.

Expert consensus on combined periodontal and endodontic management of multiple idiopathic cervical root resorption

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