Management of Invasive Cervical Resorption through Endodontic and Surgical Treatment – A Case Report

Aim: To present a clinical case of successful treatment of invasive cervical resorption in the right mandibular first molar. Introduction: Cervical resorption is external root resorption that often presents a significant diagnostic and therapeutic challenge. It typically originates in the cervical region of the tooth and can progress rapidly, leading to extensive structural damage if not treated promptly. Effective management often requires a multidisciplinary approach, combining endodontic treatment with surgical intervention to eliminate resorptive tissue and achive complete restoration of the affected tooth. Case report: A 50-year-old female patient was referred for endodontic treatment of the right mandibular first molar. She had spontaneous pain and a slight discomfort in that region. A retroalveolar radiograph revealed irregular radiolucent defects in the cervical region, near the cemento-enamel junction (Figure 1.). The toot responded negatively to percussion test and had a slightly delayed response to electrical pulp test. Cone beam computed tomography (CBCT) was done using field of view 5 5 and axial, sagittal, and horizontal sections were obtained that aided in the diagnosis of an external cervical resorption (Figure 2, 3, 4.). After access cavity preparation, straight line access was achieved and the canals was instrumented with a full rotation rotary file system. Obturation was completed with a one syringe calcium silicate-based sealer using single cone technique. The quality of the obturation was assessed radiographically (Figure 5.). After obturation, an incision and detachment of flap was performed following periodontal surgical principles (Figure 6a, 6b.) and the infraosseous region of the resorption was sealed with Biodentine bioceramic cement (Septodont, France), (Figure 7.). Final restoration was completed using the open sandwich technique in combination with composite materials. The one-year follow up radiograph revealed no evidence of pathological changes (Picture 8.). Discussion: A careful evaluation of CBCT images is essential for an accurate diagnosis of cervical resorption, as retroalveolar radiographs can only detect mesial and distal extensions of the lesion. CBCT provides a three-dimensional view, allowing for a more precise assessment of the resorptive defect's extent and severity, which is crucial for treatment planning. Endodontic treatment in this case was performed using a calcium silicate-based sealer and a single cone technique, both of which have demonstrated effective apical and lateral sealing properties. For the surgical management of the resorptive lesion, Biodentine was selected as the sealing material due to its excellent biocompatibility, dentin-like mechanical properties, and superior sealing ability. Clinical relevance: This case highlights the importance of early detection and precise diagnosis of external cervical resorption using CBCT imaging, as conventional radiographs may not fully reveal the extent of the lesion. A combination of endodontic, surgical and restorative approaches was necessary to manage the defect and preserve the affected tooth. The use of Biodentine for sealing the resorptive defect and calcium silicate-based obturation ensured optimal biological compatibility and long-term prognosis.