Nonsurgical Endodontic Retreatment of Advanced Inflammatory External Root Resorption Using Mineral Trioxide Aggregate Obturation

Abstract

Inflammatory external root resorption is one of the major complications after traumatic dental injury. In this case report, we describe treatment of a maxillary central incisor affected by severe, perforating external root resorption. An 18-year-old patient presented with a previously traumatized, root-filled maxillary central incisor associated with pain and sinus tract. Radiographic examination revealed periradicular lesion involving pathologic resorption of the apical region of the root and lateral root surface both mesially and distally. After removal of the root canal filling, the tooth was disinfected with intracanal triple antibiotic paste for 2 weeks. The antibiotic dressing was then removed, and the entire root canal was filled with mineral trioxide aggregate. The endodontic access cavity was restored with composite resin. After 18 months, significant osseous healing of the periradicular region and lateral periodontium had occurred with arrest of external root resorption, and no clinical symptoms were apparent.

Regenerative endodontic therapy for external inflammatory lateral resorption following traumatic dental injuries: Evidence assessment of best practices

“…Ritter et al (2004) showed that the continuation of root formation and revascularization occurs only if the root canal is bacteria-free (Saoud et al, 2016). Nonetheless, growing evidence supports the conclusion that RET can arrest EIR with dentine resorption on the lateral wall (Aggarwal & Singla, 2010;Priya et al, 2016;Santiago et al, 2015;Saoud et al, 2016;Utneja et al, 2012). Moreover, it has been shown that growth factors from the blood clot, and those embedded in dentine, are critical for the regenerative process by promoting biological healing (Galler et al, 2016;Yoshpe et al, 2020).…”

“…The first study describing the arrest of EIR with lateral root surface involvement by means of RET using TAP as intracanal medication and apical blood clot to repair apical periodontitis and pulp was published in 2012 (Miller et al, 2012 ). Subsequently, other case reports and case series have been published (Table 2 ), providing ample evidence that RET might be an efficient tool for treating and arresting EIR (Aggarwal & Singla, 2010 ; Chitsaz et al, 2021 ; Miller et al, 2012 ; Priya et al, 2016 ; Santiago et al, 2015 ; Saoud et al, 2016 ; Utneja et al, 2012 ).…”

Role of mineral trioxide aggregate in management of external root resorption

“…[ 8 ] Development of new bioactive material such as MTA makes possible other therapeutic approaches including the obturation of root canal space in complex cases of pathologic root resorption. [ 1 ]…”

Efficacy of various irrigation protocols on the removal of triple antibiotic paste

“…Various irrigating solutions have been used to remove TAP, but information is limited on this issue (Utneja et al . , Bezgin et al . , Tawfik et al .…”