International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2013): 6.14 | Impact Factor (2015): 6.391 Volume 5 Issue 7, July 2016 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Management of a Case of Internal Root Resorption: Case Report Mirela Marinova-Takorova 1 , Elitsa Deliverska 2 , Velislava Mazneva 3 1 Department of Conservative Dentistry, Faculty of Dental Medicine, Medical University, Sofia, Bulgaria 2 Department of Surgery, Faculty of Dental Medicine, Medical University, Sofia, Bulgaria Abstract: Internal root resorption is a pathological process, sequel of a chronic pulp inflammation. The aim of this case report is to describe the interdisciplinary treatment plan that was applied in a case of perforating internal root resorption. A 24-year-old patient presented to the clinic with complains that her front right incisor got slightly intruded two years after orthodontic treatment. The root canal system was accessed. A large zone of internal resorption with two perforating points (vetibularly and proximally) was observed in the cervical region of the incisor. The root canal was temporary filled with calcium hydroxide.The root was permanently filled with gutta-percha and a sealer till the level of the resorption area. A flap was elevated and the two perforated sites were visualized and filled with BioDentine. A composite veneer was placed in order to restore the esthetics. The success of the treatment of internal root resorption depends on the early diagnosis and initiation of endodontic treatment. In cases of perforating internal resorption a multidisciplinary approach, including endodontic treatment, surgical reconstruction of the root perforation and in some cases orthodontic extrusion should be applied. Keywords: internal rootresorption 1. Introduction Internal root resorption is a pathological process, sequel of a chronic pulp inflammation. It leads to loss of dentin, cement or even bone due to clastic cell activity. A layer of odontoblasts and predentin covers dentinand protects it [7]. Different ethiological factors could lead to damage of that layer and then odontoclasts may start resorbing dentin. Traumas, incipient or recurrent caries, heat generated during operative treatment, cracks, orthodontic treatment and idiopatic dystrophic pulpal changes are cited as ethiological factors for internal root resorption [8]. The cells responsible for the internal root resorption are muclinucleated giant cells called odontoclasts. According to somerecent theories dendric cells are precursors who could convert into odontoclaststhat move to the sites of irritation by proinflamatory cytokines and then start the resorbing process [12]. Those cells colonize the unprotected dentin. If there is no continuing irritation this process could end spontaneously and then no treatment is needed. If there is a stimulation factor present and the blood supply is sufficient they start and continue resorbing it [3, 7, 11]. The aim of this case report is to describe the interdisciplinary treatment plan that was applied in a case of perforating internal root resorption. 2. Case Report A 24-year-old patient presented to the clinic with complains that her front right incisor got slightly intruded two years after orthodontic treatment (fig. 1). There were no caries lesions or restorations on the tooth and there was no data for acute trauma. On clinical examination the tooth had a slight pinkish hue in the cervical region. There was observed slight tenderness on axial percussion and mild mobility. The marginal gingiva was swollen and there was found a periodontal pocket 4mm deep on the vestibular tooth surface on probing. The pulp test response was at 35 μA. Radiolucency in the cervical region was observed on the conventional radiographic examination using parallel technique (fig. 2). After retraction of the gingiva a small vestibular perforation with granulation tissue was seen (fig. 3). Figure 1: Initial view of patient dentition Figure 2: Preliminary X-ray examination Verbal and written conceits were taken from the patient. After the placement of a rubber dam the root canal system was accessed. The pulp was partially vital. A large zone of internal resorption was observed in the cervical region of the Paper ID: ART2016534 DOI: 10.21275/v5i7.ART2016534 1762