🦷 Understanding External Cervical Resorption (ECR)- A Silent Condition That Can Affect Healthy Teeth
- Biraj Patel
- Jan 22, 2024
- 3 min read
Updated: Mar 22
What Is External Cervical Resorption?
External Cervical Resorption (ECR) is a condition where a tooth begins to break down from the outside, specifically at the cervical region — the area just below the gumline. The damage starts on the external root surface and may slowly progress into the dentin and pulp if left untreated.
Unlike decay caused by bacteria, ECR is a non-carious resorptive process. It’s often inflammatory in nature and can remain completely asymptomatic until it reaches an advanced stage.
What Causes ECR?
There’s no single cause of ECR, but research and clinical observation have linked it to several predisposing factors:
Dental trauma – such as a knock to the tooth, even years earlier
Orthodontic treatment – especially with heavy or prolonged forces
Internal bleaching – a cosmetic treatment for discoloured teeth
Periodontal (gum) therapy – including surgeries and deep cleanings
Systemic conditions – viral infections or autoimmune activity (rare)
Idiopathic – in many cases, no obvious cause is found
It’s important to understand that ECR can affect patients with otherwise healthy teeth and excellent oral hygiene.
Symptoms: What Do Patients Experience?
Early-stage ECR is often silent — no pain, no swelling, and no visual changes. That's why it's frequently found incidentally on routine X-rays.
As it progresses, symptoms may include:
Pink discolouration near the gumline
Sensitivity to hot, cold, or pressure
Gum tenderness or inflammation in the area
A “notch” or unusual shape at the neck of the tooth
How Is It Diagnosed?
A traditional dental X-ray may raise suspicion, but the gold standard for diagnosis is a CBCT scan (Cone Beam Computed Tomography).
This 3D scan provides:
A clear view of the extent and depth of the resorptive defect
Insight into whether the pulp (nerve) is affected
Information needed for accurate treatment planning
If you've been referred for a CBCT scan — you're in the right hands. It allows us to detect lesions that are not visible in conventional 2D X-rays.
Classification of ECR
Clinically, we often use the Heithersay classification (Class I to IV) or newer CBCT-based systems like the Patel classification, which considers lesion location, extent, and circumferential spread.
These help predict restorability and guide treatment decisions.
Can the Tooth Be Saved?
Yes — depending on the location, size, and depth of the lesion. Here are typical treatment options:
Lesion Stage | Treatment Options | Prognosis |
Mild (Superficial) | Conservative repair, monitoring | Excellent |
Moderate | Root canal + surgical access to repair defect | Good |
Advanced | Extraction may be required | Guarded |
Treatment options may include:
Surgical repair using biocompatible materials like bioceramic putty
Root canal treatment if the pulp is affected
Crown restoration after internal or external repair
Extraction, in non-restorable cases — often followed by implant planning
Why Early Diagnosis Matters
ECR is progressive, but if caught early, outcomes can be excellent. Left untreated, it can lead to:
Tooth fracture
Pulpal inflammation
Bone loss
Eventual tooth loss
Timely imaging and referral to an experienced clinician (such as an endodontist) is key to saving the tooth.
Frequently Asked Questions (FAQs)
Is ECR a cavity?No. It’s not caused by bacteria like traditional tooth decay, although bacteria may secondarily colonise the lesion.
Can I prevent it?Not always. Good oral hygiene helps, but trauma and other factors outside your control can still trigger it.
Will I need a root canal?Possibly — only if the lesion involves or threatens the pulp (nerve). A CBCT scan will help determine this.
How long does treatment take?It depends on complexity. Some cases are managed in a single visit, others require multiple appointments.
Does ECR come back?If treated properly and the cause is removed or inactive, recurrence is unlikely. But untreated ECR does progress.
Conclusion
External Cervical Resorption can be worrying when first diagnosed — especially since it often appears without symptoms. But with modern imaging and minimally invasive treatment techniques, many teeth can be saved.
If you’ve been referred for a CBCT scan, rest assured: it’s the right next step. It gives us the full picture — so we can decide how best to protect your smile.
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