Nonsurgical Management of External Root Resorption in a Maxillary Central Incisor Using Sequential Calcium Hydroxide Dressings Followed by MTA Obturation: A Case Report

Abstract

Background: External root resorption is a pathological process characterised by the loss of dental hard tissues from the external root surface. It encompasses different entities with distinct aetiologies, clinical presentations and treatment requirements. The diagnosis and management of external root resorption can be challenging, particularly when the resorptive defect is evaluated using conventional two-dimensional radiography. Calcium hydroxide has traditionally been used as an intracanal medicament in the management of inflammatory root resorption because of its antimicrobial properties and a highly alkaline environment.  Mineral trioxide aggregate (MTA), owing to its biocompatibility and sealing properties, has also been used in the management of resorptive defects. Case Presentation: A 39-year-old female patient reported to the Department of Conservative Dentistry and Endodontics, D.A. Pandu Memorial R.V. Dental College and Hospital, Bengaluru, with a chief complaint of severe pain in the maxillary anterior region and pain on biting. Intraoral examination revealed existing composite restorations in relation to teeth 11 and 21. Tooth 21 was non-responsive to electric pulp testing and was tender to percussion, whereas periodontal probing revealed normal probing depths. A periapical radiograph demonstrated radiographic features suggestive of external root resorption associated with tooth 21. There was no reported history of trauma. CBCT examination was not performed. Following nonsurgical endodontic treatment, calcium hydroxide was used as an intracanal medicament and was replaced during a total of three dressing appointments. After clinical and radiographic monitoring, the root canal was definitively obturated with mineral trioxide aggregate. At the one-month follow-up, the patient was asymptomatic and the radiograph demonstrated satisfactory obturation with no apparent radiographic progression of the previously identified resorptive defect. Conclusion: Within the limitations of the available follow-up, sequential calcium hydroxide intracanal medication followed by MTA obturation resulted in resolution of clinical symptoms and no apparent radiographic progression of the resorptive defect at one month. Longer-term clinical and radiographic follow-up is required to determine whether the resorptive process remains stable.