Rafael Fernández-Grisales, Ana María Vallejo-Hernández, Carlos Humberto Quiceno-Bermúdez, Diego Tobón-Calle, Luis Gonzalo Álvarez, Néstor Ríos-Osorio
European Endodontic Journal - 2026;11(3):117-128
Objective: This retrospective cohort study aimed to (i) determine the prevalence of external cervical resorption (ECR) in a Colombian subpopulation; (ii) assess the long-term impact of treatment on tooth survival, success and failure according to ECR reactivation monitored by digital periapical radiography (DPR) and cone-beam computed tomography (CBCT); and (iii) identify possible predictive factors influencing treatment success. Methods: The DPR and CBCT images of 5934 patients (2745 females and 3189 males) collected between January 2012 and October 2017 were examined for ECR lesions. Only teeth treated surgically via an external approach and followed for a minimum of 2 years were included in the outcome analysis. Lesions were classified using the Heithersay and Patel systems. Survival and recurrence were analysed using the Kaplan-Meier estimates and Cox proportional hazards regression model (P <= .05). Results: The prevalence of ECR was 1.5% (94 patients, 97 teeth), with rates of 0.67% in females and 0.91% in males (P >= .05). Eighty-one patients each contributed 1 tooth to the outcome analysis. The overall survival rate was 77.8% at a median follow-up of 5.6 years. The overall success rates were 61.7% by DPR and 49.3% by CBCT, with no significant difference between methods (P >= .05). Lower ECR severity was associated with higher success in both classification systems. Furthermore, trauma, bruxism, and the use of Biodentine(R) were significantly associated with either the reactivation or non-reactivation of ECR lesions. Conclusion: The prevalence of ECR was low in this Colombian subpopulation, predominantly affecting maxillary and mandibular incisors, as well as maxillary canines. The CBCT was more sensitive than DPR for detecting ECR reactivation. Both survival and long-term treatment success were higher when ECR severity was lower. Notably, the critical time points for survival and reactivation were 2 and 3 years post-treatment, respectively.
