Apical Barrier And Perforation Repair For Mandibular Molar Root Resorption

This case involved a mandibular second molar with combined periodontal-endodontic lesions and external cervical resorption. Based on the root canal anatomy, non-surgical approaches(apical barrier and perforation repair using iRoot BP) were performed to preserve the natural tooth. A male presented with a gingival swelling in the right posterior mandibular region persisting for two weeks. The patient reported a history of right mandibular wisdom tooth extraction. Examination of Tooth 47: Intro-oral: Percussion (+); Thermal test (No response); Mobility (I°); Buccal sinus tract; Distobuccal PD (10mm). CBCT: Distal bone loss to mid-root; Distal root resorption into pulp, mild apical resorption; Fused root with 1-2-1 canal configuration. Treatment: Ultrasonic removal of mid-root septum; Apical barrier and root perforation repair: iRoot BP; Backfilling: Thermoplastic gutta-percha; Final restoration: resin composite filling; Concurrent periodontal therapy. Using iRoot BP's superior sealing/bioactivity, we repaired the perforation by eliminating the fused root's septum to create a single enlarged canal, enabling apical barrier placement and mid-root repair despite limited second molar access. At 3-month follow-up, the tooth was stable with patient satisfaction, though persistent distal periodontal defects (10mm pocket + bone loss) may require future guided tissue regeneration despite periodontal therapy. The follow-up showed the tooth functioning normally with resolved periapical radiolucency. The results highlight the importance of comprehensive consideration of both the tooth's anatomical position and root canal morphology when developing individualized treatment plans.