• computed tomography;
  • cone-beam;
  • external cervical resorption;
  • micro-focus;
  • wind instruments

Gunst V, Huybrechts B, De Almeida Neves A, Bergmans L, Van Meerbeek B, Lambrechts P. Playing wind instruments as a potential aetiologic cofactor in external cervical resorption: two case reports. International Endodontic Journal 44, 268–282, 2011.


Aim  To present two cases of external cervical resorption (ECR) on maxillary incisors, in which the primary aetiologic factor is suggested to be pressure trauma by frequently playing wind instruments.

Summary  The exact aetiological spectrum of ECR is still poorly understood. For resorption to occur, a defect in the cementum layer (trigger) is a likely prerequisite. Whilst the mechanism for continuation (stimulus) is still unclear, knowledge of potential predisposing factors is important in assessing patients at risk. Pressure generated by playing wind instruments could present an aetiological factor in ECR because it affects the cervical region of the root surface. The cases that are presented may confirm this hypothesis and the extent of resorption defects is shown by cone-beam computer tomography (CT) and micro-focus CT imaging techniques.

Key learning points 

  •  The repetitive forces generated by playing wind instruments could be compared to excessive, longstanding, orthodontic forces and therefore may initiate and stimulate ECR.
  •  Music teachers as well as general dental practitioners should be aware of the potential impact of playing wind instruments on the orofacial structures.
  •  If possible, a protective mouth guard should be fabricated and used whilst practicing.
  •  Cone-beam CT analysis is useful for the clinical diagnosis and treatment planning of ECR.
  •  Micro-focus CT analysis does reveal the extent and complexity of an ECR defect ex vivo.