Non-Surgical Endodontic Management of Severe External Inflammatory Root Resorption in a Maxillary First Molar: A Case Report with 12-Month Follow-up

Abstract

Aims: To describe the non-surgical endodontic management of a maxillary first molar with severe, symptomatic external inflammatory root resorption in an adolescent patient, and to report the 12-month outcome. Presentation of Case: A 15-year-old boy presented with spontaneous pain and marked tenderness to percussion in the maxillary right first molar (tooth 16). A periapical radiograph showed advanced external resorption, most severe in the palatal and distobuccal roots, which had become considerably shortened. Root canal treatment was started without delay. Because the resorptive tissue was richly vascularised, controlling intracanal bleeding was difficult and time-consuming despite the short canals. After haemostasis was achieved, a dense calcium hydroxide dressing was placed in all canals. Three weeks later, the patient was almost free of symptoms, and the dressing was intact with no sign of infection. As the lesion was an external inflammatory resorption, each canal was then obturated along its full length with mineral trioxide aggregate (MTA). Discussion: Early diagnosis, elimination of the microbial stimulus, and a calcium hydroxide dressing are central to arresting inflammatory resorption. Full-length MTA obturation was chosen to seal the resorptive communications and to provide a well-sealing, biocompatible barrier in the weakened roots. Conclusion: Prompt endodontic intervention with calcium hydroxide followed by MTA obturation arrested the resorption and preserved the tooth, which remained asymptomatic and functional at the 12-month review.