A Tale of Two Classifications 

LETTER TO THE EDITOR – Prognostication of External Cervical Resorption Based on Heithersay’s and Patel et al. Classifications: A Narrative Review

Tiago Pimentel, Shanon Patel  First published: 10 June 2026 https://doi.org/10.1111/iej.70196

There is something rather depressing about seeing this kind of academic disagreement played out in the letters section of a journal. The original article compared two classifications of external cervical resorption and concluded that the Heithersay classification currently has more evidence to support its use in prognosis than the Patel classification. That may or may not be a perfect conclusion, but the reply reads less like a neutral correction of the literature and more like an author objecting to his own classification being criticised. The tone is the usual scholarly concern: “methodological asymmetry”, “biological plausibility”, “outcome modality”, and “power limitation”. Yet beneath the polite phrasing sits the unmistakable complaint: you have preferred his system over mine, and I (Patel) am pissed.

Some of the points made in the letter may be valid. There may well be problems with sample size, follow-up, the use of periapical radiographs, and the way the evidence has been interpreted. But that is what peer review is meant to address before publication. If the original review was flawed, then the journal’s review process should have picked that up. More importantly, the proper way to establish that a classification is useful in predicting prognosis is to publish good evidence showing that it does so. It is not really enough to complain that the existing evidence is unfair, inadequate, or not designed in a way that gives the classification a fair chance. That may be true, but it still leaves us in the same place: the evidence has not yet been produced.

The most unedifying part is the sense that this is less about resorption than reputation. The final paragraph calls for better research, which is perfectly reasonable and probably all that needed to be said. Instead, the letter takes the long route through statistical underpowering, two-dimensional radiographs, classification overlap, treatment heterogeneity and conflict-of-interest innuendo, arriving at what feels like the academic equivalent of “my dad’s bigger than yours.”

For most clinicians, the issue is straightforward. If the Patel classification has prognostic value, that should be demonstrated with properly designed outcome studies. Until then, this reads less like a useful scientific debate and more like a bruised academic ego responding to being publicly marked down. Grow up Shanon.