External Cervical Resorption Revisited: From Biological Complexity to CBCT- Guided Conservative Treatment

Abstract

External cervical resorption (ECR) remains a complex clinical entity because it is not merely a structural defect of the tooth root, but a biologically active and often silent resorptive process. In its early stages, ECR may be asymptomatic and detected incidentally during radiographic examination, while advanced lesions may compromise the pulp, periodontium, esthetics, and long-term tooth retention. The biological behavior of ECR deserves particular attention. Histopathological evidence indicates that ECR develops through penetration of resorptive tissue into cervical dentin, formation of granulation tissue, activity of multinucleated clastic cells, and extension of resorption channels within the root. At the same time, ECR may also show reparative features, including apposition or remodeling of bone-like tissue.  Therefore, ECR should be interpreted as a dynamic destructive-reparative process rather than as a simple cervical defect.