Restor Dent Endod.  2014 May;39(2):137-142.

Surgical management of a failed internal root resorption treatment: a histological and clinical report

• Asgary S
• Eghbal MJ
• Mehrdad L
• Kheirieh S
• Nosrat A

Abstract

This article presents the successful surgical management of a failed mineral trioxide aggregate (MTA) orthograde obturation of a tooth with a history of impact trauma and perforated internal root resorption. A symptomatic maxillary lateral incisor with a history of perforation due to internal root resorption and nonsurgical repair using MTA was referred. Unintentional overfill of the defect with MTA had occurred 4 yr before the initial visit. The excess MTA had since disappeared, and a radiolucent lesion adjacent to the perforation site was evident radiographically. Surgical endodontic retreatment was performed using calcium enriched mixture (CEM) cement as a repair material. Histological examination of the lesion revealed granulation tissue with chronic inflammation, and small fragments of MTA encapsulated within fibroconnective tissue. At the one and two year follow up exams, all signs and symptoms of disease had resolved and the tooth was functional. Complete radiographic healing of the lesion was observed two years after the initial visit. This case report illustrates how the selection of an appropriate approach to treatment of a perforation can affect the long term prognosis of a tooth. In addition, extrusion of MTA into a periradicular lesion should be avoided.

Keyword

Calcium enriched mixture; CEM cement; Extrusion; Mineral trioxide aggregate; Perforation; Root resorption

MeSH Terms

Calcium
Follow-Up Studies
Granulation Tissue
Incisor
Inflammation
Prognosis
Retreatment
Root Resorption*
Tooth
Pemetrexed
Calcium

Figure

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  Figure 1 (a) Immediate postoperative periapical x-ray of orthograde MTA perforation repair (- 4 years before the surgical retreatment), extruded MTA was evident; (b) Preoperative periapical x-ray of the lateral incisor tooth shows complete resorption of extruded MTA and a lateral lesion adjacent to perforation site after 4 years; (c) Clinical photograph shows localized inflammation and swelling.

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  Figure 2 (a) Intra-radicular and bony defect after curettage of the lesion; (b) Using an ultrasonic retrotip in a coronoapical direction the apical portion of root canal was instrumented; (c) The canal was shaped and cleaned; (d) Filling and sealing of the apical portion of the root canal as well as the intra-radicular defect using calcium enriched mixture (CEM) cement was verified radiographically.

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  Figure 3 (a) Photomicrograph shows granulation tissue with chronic inflammatory cells (H&E staining, Mag. ×200); (b) A macrophage containing phagocyte particles (H&E staining, Mag. ×1,000); (c) A multinucleated giant cell (H&E staining, Mag. ×1,000); (d) Fragments of MTA of different sizes were seen (H&E staining, Mag. ×200); (e) A higher magnification of an MTA fragment which is encapsulated within fibrous connective tissue (H&E staining, Mag. ×1,000).

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  Figure 4 (a) Clinical photograph shows uninflamed overlying soft tissues; (b) Recall radiograph after one year; (c) Recall radiograph after two years revealed bony healing as well as establishment of PDL.

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