External Root Resorption In A Maxillary Left Central Incisor

This report describes the management of the maxillary left central incisor with external root resorption. A combined nonsurgical-surgical approach was employed. Six-month follow-up demonstrated reduced radiolucency and symptom resolution. A 16-year-old male presented with a 2-day history of gingival swelling and pain around the maxillary left central incisor. The tooth had a history of trauma 7 years prior, treated with resin restoration. Clinical examination revealed #9 discoloration and no response to vitality testing. Radiographic and CBCT imaging identified external root resorption at the middle-third of the distal root, accompanied by a periapical radiolucency. A diagnosis of chronic apical periodontitis with external root resorption .Treatment involved initial root canal treatment followed by surgical intervention under microscopy. Bioceramic material sealing of the perforation site were performed. The root canal was subsequently obturated, and the coronal defect restored with composite resin. At the 6-month follow-up, reduced periapical radiolucency and resolution of symptoms were observed. The resorption likely originated from trauma-induced damage to the cementum and epithelial root sheath, disrupting the RANKL/OPG balance. Surgical repair was prioritized due to the size and location of the perforation and communication with the periodontium. Bioceramics provided effective sealing, minimizing bacterial leakage. The case highlights the critical role of CBCT in diagnosing complex resorption, the efficacy of bioceramics in sealing defects, and the importance of integrated treatment strategies for trauma-induced root pathology.