Perforating Internal Root Resorption Treated With a Bioactive Dentin Substitute

Objectives: A mandibular lateral incisor with perforating internal root resorption and endodontic-periodontic lesion required complex treatment to preserve the tooth, heal the inflamed tissues and maintain aesthetics. This report describes the coordination of endodontic treatment, filling the internal resorption with a bioactive dentin substitute, bone grafting, fixation of the mobile tooth and coronal reshaping in achieving treatment goals.
Methods: Pulp testing of the elongated lateral incisor gave no response. Radiographic investigation showed an internal root resorption in the coronal half with perforation on the distal aspect and bone loss extending from the level of crestal bone to the apex of the tooth. An access cavity was prepared and necrotic pulp tissue extirpated. The root was filled with gutta-percha and thereafter surgically exposed with a buccal approach, revealing root perforations at the distal and buccal aspects. Cavities were filled with a bioactive dentin substitute (Biodentine, Septodont) and the root surface was covered with a bovine-derived xenograft (Bio-Oss Collagen, Geistlich Biomaterials). Splinting of the tooth served to avoid movements of the root during the healing process.
Results: A radiograph taken immediately after surgery showed the root-filled tooth with extensive lateral and periapical bone loss. Radiographs taken 5, 13, 24 and 47 months after treatment showed a continuous process of periapical healing and apposition of bone in the lateral region with no signs of external resorption. The 47-month recall showed clinically healthy and firmly adapted gingival tissues with probing depths of 2-3mm.
Conclusions: The present case report showed how a severely compromised tooth could be preserved by properly coordinated endodontic and surgical treatment procedures using a bioactive dentin substitute. Surrounding tissues tolerated the bioactive dentin substitute and the material did not evoke any clinically or radiographically observable immune reaction.