INTERNAL SUBSTITUTIVE PERFORATING RESORPTION: 10 YEARS OF PROSERVATION

Abstract

This study aimed to report a 10-year follow-up case of an internal substitutive perforating root resorption. A 19-years old female patient presented a considerable widening of the root canal on the periapical radiographic examination of the tooth 11. Cone beam computed tomography (CBCT) was ordered and revealed a hypodense area with irregular margins involving the entire space of the pulp cavity communicating with the periodontium. Due to the lesion characteristics, the diagnosis was of an internal substitutive perforating root resorption. Intraoral examination revealed a small pink spot on the cervical third of the buccal face. Tooth positively responded to the cold sensitivity test. There was a negative 

response to apical palpation and percussion. Coronary access and partial pulp removal were performed with 1% sodium hypochlorite (NaOCI). Due to an intense bleeding, chemomechanical preparation was not completed. Calcium hydroxide paste was used as an intracanal medication. In the next appointment, chemomechanical preparation, removal of the metaplastic and granulation tissue from the reabsorbed area, and placement of the calcium hydroxide paste, that remained for 2 months, were performed. The canal was filled with mineral trioxide aggregate and the tooth restored with glass ionomer and composite resin. After obturation, a new CBCT was performed, showing the complete filling of the root canal and resorption defect. In the 10-year follow-up tomography, the root canal was filled with the filling material, including the communication area with the periodontium, demonstrating the success of the treatment due to the stagnation of the resorption process. The use of a restorative cement for root canal filling presenting internal substitutive perforating root resorption is an alternative for these cases. Clinical, radiographic, and tomographic follow-up are essential to assess the treatments’ success.