AEGD residents Dr. Rebeca Keegan and Dr. Raquel De Mello presented a challenging clinical case at the American Association of Endodontists meeting in Boston. #AAE25 #dentistry #research

Study Title

External Invasive Root Resorption Management: A Case Report

Authors: Keegan R, De Mello, R Macedo H, Abreu R, Ibrahim G, Baig B, Kotsaitici E,Tzouma K

Institution: Eastman Institute for Oral Health, University of Rochester, NY

1. Introduction

External invasive root resorption refers to a progressive loss of cementum and dentin caused by clastic cells. It is considered a rare but aggressive form of external root resorption.

Key characteristics

• Begins on the external root surface• Often located near the cervical region of the tooth• May progress into dentin while the pulp can remain initially protected• Can eventually compromise tooth structure and lead to tooth loss

Etiology and risk factors

The exact cause is not always identifiable, but associated factors include:

• Dental trauma• Orthodontic treatment• Internal bleaching• Periodontal treatment• Surgery or restorative procedures

Clinical importance

Early diagnosis is critical because once the lesion becomes extensive it may threaten tooth survival.

2. Objective of the Study

The objective of the research was:

To present a clinical case of external invasive root resorption and describe the diagnostic process and treatment approach used to preserve the tooth.

3. Case Report

Patient

• 27 year old male

Chief complaint

• Tooth discoloration in the maxillary right central incisor (tooth #8)

Patient history

• History of dental trauma about 10 years earlier• No symptoms at the time of presentation

Clinical findings

• Visible coronal discoloration of tooth #8• Tooth sensitive to percussion• Cold test negative

These findings suggested pulpal necrosis.

Radiographic examination

Radiographs revealed:

• A resorptive defect• Lesion extending into dentin• Appearance consistent with external invasive root resorption

Diagnosis

Pulp necrosis with symptomatic apical periodontitis and external invasive root resorption.

Classification

The lesion was classified as:

Class 3 External Invasive Resorption

Meaning:• Deep invasion into dentin• Extends into the cervical third of the root• More complex treatment required

Imaging

The team used CBCT imaging to:

• Evaluate the exact size of the lesion• Determine extension of the resorption• Plan surgical access and treatment

4. Treatment

Two treatment options were presented to the patient:

1. Extraction with implant placement

2. Periodontal surgery combined with root canal treatment

The patient chose tooth preservation with surgical treatment.

Surgical Procedure

Step 1

Surgical access was performed to expose the resorptive lesion.

Step 2

All granulation tissue occupying the resorption cavity was removed.

Step 3

The defect was restored using bioceramic sealer to seal the cavity.

Endodontic Treatment

After surgical management, root canal therapy was performed.

Procedure

• Access cavity preparation• Chemomechanical preparation• Irrigation with 5 percent sodium hypochlorite• Canal obturation using gutta percha

This step was necessary because the tooth presented with pulp necrosis.

Follow Up

3 month follow up

Patient asymptomatic.

6 month follow up

CBCT imaging showed:

• Stable repair of the resorption area• No signs of continued resorption

Final Restoration

To address esthetic concerns:

• A zirconia crown was fabricated• Restoration completed about eight months after treatment

5. Results

The treatment resulted in:

• Successful removal of resorptive tissue• Stabilization of the lesion• Functional preservation of the tooth• Esthetic restoration with zirconia crown

The tooth remained asymptomatic with no progression of resorption.

6. Discussion

The authors highlight several important points.

1. Early diagnosis is essential

External invasive root resorption is difficult to detect clinically in early stages.

2. CBCT is extremely valuable

Three dimensional imaging allows accurate assessment of:

• lesion size• lesion location• extent of dentin involvement

3. Combined therapy is effective

The case shows that combining:

• surgical debridement• root canal therapy• modern restorative materials

can successfully manage advanced lesions.

4. Bioceramic materials improve outcomes

Bioceramic sealers provide:

• excellent sealing ability• biocompatibility• support for healing

7. Conclusions

The study concluded that:

• External invasive root resorption can be successfully managed with early diagnosis and appropriate intervention.• CBCT imaging improves diagnostic accuracy and treatment planning.• Surgical removal of the resorptive tissue combined with endodontic therapy can preserve teeth that might otherwise require extraction.• Modern materials such as bioceramics and zirconia restorations help achieve long term stability and esthetic success.

8. References

The poster cites key literature on root resorption including research on:

• pathogenesis of root resorption• CBCT use in endodontics• clinical management of invasive cervical resorption

These references support the diagnostic approach and treatment protocol used in this case. https://www.facebook.com/eastmandental/posts/aegd-residents-dr-rebeca-keegan-and-dr-raquel-demelo-presented-a-challenging-cli/1265521712243443/