Idiopathic Multiple External Root Resorption: A Rare Case Report

Idiopathic multiple external root resorption (IMERR) is a rare condition characterized by progressive root resorption without identifiable local or systemic etiology. This report describes a case of IMERR associated with metabolic abnormalities, highlighting diagnostic challenges and management considerations. A 28-year-old female presented with a history of mobility in the left mandibular central incisor, which fractured and left a residual root. Clinical examination revealed mild gingival swelling and mobility of the adjacent lateral incisor. Radiographs showed reduced alveolar bone density in the anterior maxilla and mandible, with multiple teeth exhibiting external root resorption. Laboratory findings included elevated alkaline phosphatase, decreased serum magnesium, zinc, and iron, alongside increased phosphorus. Her medical history encompassed osteoporosis and surgically treated right foot osteomyelitis. Systemic disorders (hyperparathyroidism, autoimmune diseases) and local factors (trauma, infection) were excluded. IMERR remains poorly understood, with limited evidence linking it to metabolic imbalances. This case highlights concurrent osteoporosis and trace element deficiencies, suggesting potential systemic contributions to dysregulated bone/tooth metabolism. Elevated ALP and phosphorus levels may indicate altered bone turnover, though causality is unproven. No direct link between IMERR and osteomyelitis was observed. This case underscores IMERR's diagnostic complexity and potential metabolic associations. Clinicians should prioritize systemic evaluations in patients with unexplained root resorption, particularly those with metabolic comorbidities. Early radiographic surveillance and interdisciplinary care are essential to minimize tooth loss and address underlying metabolic disturbances.