Clinical case of a rarely diagnosed tooth root internal resorption

The article presents a clinical case of tooth root internal resorption which resulted in root canal perforation. The treatment of internal resorption is rather challenging to the dentists. It may occur as a result of pulpitis, which in its turn might be caused by dental trauma, periodontal infection, orthodontic treatment and teeth whitening in case the patient’s dental status is not taken into consideration and possible complications are not considered and prevented in advance. Though the resorptive process mechanism is to some extent investigated, its etiology still remains unclear. Internal resorption is mainly observed in anterior teeth, as they are more often exposed to trauma. However, it can also be found in posterior teeth as a result of tooth decay.
Successful treatment outcome is conditioned by early diagnosis, cause elimination and proper treatment of resorptive tooth.
The peculiarity of present clinical case is that the progression of root internal resorption led to root canal perforation resulted in connection between root canal and periodont resulting in periodontitis. However, conventional treatment cannot be used for this kind of periodontitis; additional materials and methods are required to control the process and achieve a favorable outcome. In this case, as in case of external resorption, the choice of treatment strategy is due to a number of factors, such as the location and size of the lesion, as well as presence or absence of pulpo-periodontal communication.
Within the framework of this clinical case several research methods, such as periapical X-ray, cone beam computed tomography, determination of gingival crevicular fluid quantity and pH were used to diagnose pathology, to plan and implement the treatment. During the treatment different materials and endodontic instruments were used, among which mineral trioxide aggregate is worth mentioning. The latter is considered to be biocompatible material used in complicated cases of endodontic treatment, particularly in presence of root canal perforation. In this clinic case the use of mineral trioxide aggregate was completely justified as there was a wall perforation in the middle third of the root canal i.e. in the mesio-vestibular part.