Successful Orthograde Treatment of Teeth with External Inflammatory Root Resorption and Perforation Using a Tricalcium Silicate-Based Material

Abstract

One possible consequence of dentoalveolar trauma is the development of external inflammatory root resorption (EIRR), which represents an anatomic and microbiologic challenge for clinicians. This case report describes different strategies implemented for successful endodontic management of teeth with multiple EIRR lesions, highlighting the orthograde root canal filling using a tricalcium silicate-based material (Biodentine, Septodont, Saint-Maur-des-Fossés, France). A 17-year-old female patient presented with severe pain in the anterior maxillary teeth and a history of trauma. Two- and three-dimensional radiographic exams confirmed EIRR in three teeth, with a total of 11 EIRR lesions, three exhibiting communication with the root canal. Therefore, chemo-mechanical preparation complemented by ultrasonic activation of irrigants and some changes of intra-canal dressing with calcium hydroxide were performed to reduce the microbiologic load of the affected teeth as much as possible. Then, the canals were entirely filled with Biodentine to interrupt the root resorption process and strengthen the remaining root structure. A 60-month follow-up showed the disappearance of bone rarefactions and the complete repair of the 11 EIRR lesions. The favorable long-term response indicates the feasibility of using tricalcium silicate-based putty as part of orthograde endodontic treatment of teeth with EIRR and root perforations.

Clinical applications of calcium silicate‐based materials: a narrative review

“…27 Besides ex vivo and animal studies, numerous case reports describe the successful repair of root perforations with MTA [28][29][30] and other CSCs as well. 31,32 A previous systematic review and metaanalysis reported that that the use of MTA as a repair material might enhance the success rate. 33 According to a clinical study, MTA appeared to have good longterm (median 27.5 months; range 12-107 months) sealing ability in perforation repair regardless of the location, with a success rate of 86%.…”

“…In several case reports, various CSCs including MTA, 44,45 Biodentine 31,46 and CEM 47 were successfully used for the treatment of resorptions either non-surgically or surgically. In laboratory studies, various aspects were evaluated by simulating resorption cavities in teeth.…”

“…A recent systematic review including such studies reported that MTA was better than or equivalent to other tested materials in terms of tissue response 27 . Besides ex vivo and animal studies, numerous case reports describe the successful repair of root perforations with MTA 28–30 and other CSCs as well 31,32 . A previous systematic review and meta‐analysis reported that that the use of MTA as a repair material might enhance the success rate 33 .…”