Management of External Root Resorption: A Case Report

INTRODUCTION

External root resorption is a pathological condition characterized by the progressive loss of dental root structure due to various factors. It affects both primary and permanent dentition and can lead to significant functional and aesthetic consequences.^1,2

External root resorption can be attributed to a range of factors. Trauma, such as dental injury or orthodontic treatment, is a common cause, as it disrupts the protective layers surrounding the tooth root. Orthodontic forces, if excessive or prolonged, can also induce resorption. Additionally, certain inflammatory conditions, such as periodontal disease, cysts, or tumors, may contribute to root resorption. Systemic factors, including genetic predisposition and certain medical conditions, can increase the susceptibility to resorption.^4,10

This article aims to present a clinical case depicting external root resorption and its management with the use of MTA as material of choice.

CASE REPORT

A 48 years old male patient reported to the department of Conservative dentistry and Endodontics with the chief complaint of broken tooth in the upper left tooth region since 6-7months. The patient gave a history of root canal treatment being initiated for the same tooth 1 month back. Clinical Examination revealed temporary restoration irt 24. Radiographic finding revealed previously initiated root canal treatment with external root resorption.

After complete examination, a treatment plan for non-surgical root canal treatment irt 24 followed by MTA plug and fiber post and core were made.

On the first visit, temporary restoration was removed and working length determination was done using apex locator. Following working length determination, cleaning, and shaping of root canal system was done using a crown down technique using 2.5% NaOCl and normal saline as irrigating solutions. The canal was dried were paper points and MTA was mixed as per manufacturer’s instructions and a apical plug of 3-4mm was made for both buccal and lingual canal. After the plug was made, a wet cotton gauze was placed and provisional restoration was given. The patient was recalled after 1 day and the temporary restoration was removed and the set of MTA was verified.

The lingual canal was then enlarged using peeso reamers to receive a fiber post and the buccal canal was obturated. Fiber post try was done for the lingual canal followed by its cementation and core build up. Tooth preparation was then done and indirect putty impression was recorded for the fabrication of prosthesis. Once the prosthesis was fabricated, it was cemented using glass ionomer cement.

DISCUSSION

External root resorption is a challenging condition that can compromise the integrity and stability of affected teeth. External root resorption may present with various clinical manifestations, depending on the severity and location of the resorptive process. In early stages, patients are often asymptomatic, and the condition may only be detected during routine dental examinations. As the resorption progresses, symptoms such as tooth sensitivity, pain, and mobility may develop.^3,5,6

The management of external root resorption depends on several factors, including the extent of resorption, patient age, and overall dental health. In cases of mild to moderate resorption, regular monitoring with radiographic evaluations may be sufficient. However, active treatment is often necessary to preserve tooth function and aesthetics.^7,8,11

Non-surgical approaches involve identifying and addressing the underlying cause, such as treating periodontal disease or removing a source of trauma. In some cases, placing a protective barrier, such as a biocompatible material, over the resorptive defect can help prevent further progression.⁹

Severe cases of external root resorption may require surgical intervention. Various techniques, including root canal therapy, root resection, or extraction, may be employed based on the individual circumstances.¹²

This case report described the use of MTA aa a barrier to prevent further progression of the defect.

Traditional treatment options for external root resorption have limitations in terms of sealing the resorptive defect and promoting repair. However, the use of mineral trioxide aggregate (MTA) as a plug has emerged as a promising treatment approach.¹³

MTA is a biocompatible material with excellent sealing properties and biocompatible characteristics. The placement of an MTA plug in the resorptive defect can effectively seal the area, preventing bacterial infiltration and promoting the regeneration of periapical tissues. MTA promotes the formation of a mineralized tissue barrier, thereby preventing further resorptive activity and facilitating the repair process. Moreover, MTA exhibits antimicrobial properties, reducing the risk of infection.¹⁶

In a study by Pace et al. (2019), a significant reduction in the size of external root resorption defects was observed after the placement of MTA plugs.¹⁴ Another study by Yu et al. (2017) reported successful healing of invasive cervical resorption lesions using MTA plugs with a high success rate.¹⁵ Additionally, a systematic review by Patel and Sayed (2016) demonstrated favorable outcomes with MTA plugs in the treatment of external root resorption.¹⁶

CONCLUSION

External root resorption is a multifactorial condition that can significantly impact dental health. Understanding its causes, mechanisms, clinical manifestations, and management strategies is crucial for timely diagnosis and appropriate treatment.) The use of MTA plugs as a treatment approach for external root resorption holds significant promise. The biocompatibility, sealing ability, and potential for tissue regeneration make MTA an ideal material for managing these challenging cases. Further research and long-term follow-up studies are necessary to establish standardized protocols and optimize the use of MTA plugs in the management of external root resorption.

REFERENCES