PMC9831804_01
Clinical photographs, radiographs, and histopathological microphotographs of our case. (A) Preoperative periapical radiograph. (B-E) Cone-beam computed tomography showed that the invasive cervical root resorption (ICRR) lesion created a big perforation in the entire mid-root of tooth 35 and resorbed the covering buccal cortical plate as well. (F) The ICRR defect after mechanical debridement. Root canal space could be easily observed. (G) The defect cavity was repaired with calcium-enriched mixture (CEM) endodontic biomaterial. (H) Periapical radiograph after root canal filling and root perforation repair showed a three-dimensional filling/sealing of the defect. However, the radiograph clearly showed an unfilled portion of the pulp in the most coronal part of the root canal system. (I-J) Histopathological views of the removed tissue specimen with hematoxylin-eosin staining showed resorptive dentine pieces with dentinal tubule structures and resorptive lacuna with associated multinucleate odontoclast cells. (K) A clinical photograph at the 1-year recall showed no discoloration of the tooth crown and (L) a normal periodontal probing depth (= 2 mm). (M) One-year recall periapical radiograph showed an arrested resorptive process and normal periapical area of tooth 35.
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A class 4 ICRR was accidentally detected in tooth 35 during routine radiographic examinations of a 27-year-old female patient (Fig. 1A). CBCT demonstrated a huge perforation on the buccal aspect which was not covered with the jaw bone (Fig. 1B-E). Then using an ultrasonic retro-tip, the apical/coronal fragments of the root canal were prepared (Fig. 1F). BioniqueDent, Tehran, Iran) cement were mixed/inserted in the root canal space/resorptive defect (Fig. 1G). Before suturing, a periapical radiograph showed an optimum filling/sealing of the root canal walls (Fig. 1H). Histopathological evaluations of the removed tissues showed a chronic inflammatory cell infiltrate, resorptive dentine pieces with dentinal tubule structures, as well as resorptive lacuna with several large multinucleate odontoclast cells (Fig. 1I-J). At one-year recall, clinical examination revealed an asymptomatic/functional tooth with a normal periodontal probing depth on the midbuccal area (Fig. 1K-L), and radiographic examination showed an arrested resorptive process and normal periapical area (Fig. 1M).