case_images: PMC7657415_01
case_images: (a) Preoperative clinical appearance (Buccal). (b) Preoperative clinical appearance (Palatal). (c) Preoperative peri-apical radiograph. (d) Cone beam computed tomography images in axial, sagittal, and coronal sections with 3D reconstruction. (e) Working length radiograph of 21. (f) Obturation radiograph of 21
case_images: JCD-23-102-g001.jpg
case_images: PMC7657415_01_JCD-23-102-g001.jpg
case_images: F1
case_images: Tooth 11 and 21 also showed a slight fracture of the incisal edges with slight rotation of teeth and anterior open bite indicative of the luxation injuries suffered due to trauma [Figure 1a and b]. The preoperative IOPA radiographic examination [Figure 1c] revealed an irregular, large radiolucent area in the cervical and middle third of the external root surface at the mesial aspect of 11 suggestive of ICR. Preoperative IOPA radiograph [Figure 1c] also showed pulp canal stenosis in 21. CBCT images and three-dimensional (3D) reconstructions [Figure 1d], a diagnosis of cervical external resorption of Heithersay Class IV and apical resorption in 11 was determined. Completely obliterated pulp canal with only pinpoint trace of canal and diagnosis of root canal stenosis was made in 21. Tochigi, Japan) was introduced to gain apical patency and working length was measured using an electronic apex locator (Root ZX II, J Morita, Kyoto, Japan) and confirmed radiographically [Figure 1e]. The root canal was prepared by the crown down approach using ProTaper Next rotary files to size X2 (Dentsply Maillefer, Ballaigues, Switzerland) with copious amount of 5.25% sodium hypochlorite (Chloraxid 5.25%, Cerkamed, Poland) as irrigant during instrumentation. Obturation was completed using ProTaper Next X2 gutta-percha (Dentsply Maillefer, Ballaigues, Switzerland) and AH Plus (Dentsply Maillefer Ballaigues, Switzerland) as endodontic sealer [Figure 1f].
case_images: (a) Working length radiograph of 11. (b) Incision. (c) Surgical exposure of resorption. (d) Curettage of the resorptive tissue buccally. (e) Curettage of the resorptive tissue palatally. (f) Application of 90% Tricholoroacetic acid. (g) Reconstruction of root with biodentine buccally. (h) Reconstruction of root with biodentine palatally. (i) Postoperative peri-apical radiograph. (j) 12 months follow-up clinical and radiographic images
case_images: JCD-23-102-g002.jpg
case_images: PMC7657415_01_JCD-23-102-g002.jpg
case_images: F2
case_images: In the next appointment, isolation of 11 was done with rubber dam and access cavity was prepared and the working length was checked on the radiograph [Figure 2a]. This revealed that part of the buccal bone plate was missing and exposed a small amount of inflammatory granulation tissue and the resorptive root surface [Figure 2b and c]. Curettage of the resorptive lesion and the surrounding inflamed tissue both on the mesial aspect and apical third was performed together with curette and surgical round bur [Figure 2d]. Due to the palatal extension of the resorptive defect, after giving sulcular incision, palatal flap was reflected, and complete curettage of the granulation tissue was done till a sound dentin base was revealed [Figure 2e]. The cotton pellet was then applied over the resorptive defect area with gentle pressure for about 1 min [Figure 2f]. Biodentine was contoured laterally and apically as per the external root anatomy [Figure 2g and h]. Postoperative IOPA radiograph was taken [Figure 2i]. Clinical and radiographic examinations for treated teeth [Figure 2j] revealed repair of resorption defect was successfully treated with Biodentine.