Endodontic Intervention for Managing External Inflammatory Root Resorption in Mandibular First Molar

Article Information

Title: Endodontic Intervention for Managing External Inflammatory Root Resorption in Mandibular First Molar

Journal: Journal of Bahria University Medical and Dental College (JBUMDC)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2022-07-01	2023-06-30
Y	2021-07-01	2022-06-30

Publisher: Bahria University, Islamabad

Country: Pakistan

Year: 2024

Volume: 14

Issue: 1

Language: English

DOI: 10.51985/JBUMDC2023268

Keywords: Calcium hydroxidePeriapical tissuesRoot resorption

Abstract

External inflammatory resorption (EIR) is the pathological destruction of external radicular structures with a multifactorial etiology. Prompt diagnosis and meticulous intervention are obligatory to retain the salvageability of the tooth and to circumvent the premature loss of permanent dentition. Infected pulpal tissues and microbial toxins are the mainstay of the persistent inflammatory response in the periodontal tissues. This provokes odontoclastic activity, precipitating radicular loss. In this report, a 17-year-old male patient reported severe pain in the mandibular right first molar. After a thorough history and examination, the case was diagnosed as inflammatory root resorption. Nonsurgical endodontic therapy was performed under rubber dam isolation. After adequate chemomechanical preparation, intracanal, non-setting calcium hydroxide was utilized to arrest the resorptive process. This case enlightens the fact that mechanical debridement alone cannot achieve the prime goal of endodontic intervention. Chemical disinfection using intracanal medicaments can magnify the outcomes by eradicating the nidus of infection.

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Research Objective

To present a case report on the management of external inflammatory root resorption (EIR) in a mandibular first molar using nonsurgical endodontic therapy.

Methodology

Case report detailing the diagnosis and treatment of a 17-year-old male patient presenting with severe pain in his mandibular right first molar. The treatment involved nonsurgical endodontic therapy, including chemomechanical preparation, irrigation with sodium hypochlorite, and intracanal medication with non-setting calcium hydroxide, followed by obturation.

Methodology Flowchart

                        graph TD;
    A["Patient presents with pain"] --> B["Diagnosis: External Inflammatory Root Resorption"];
    B --> C["Nonsurgical Endodontic Therapy"];
    C --> D["Anesthesia and Rubber Dam Isolation"];
    D --> E["Access Cavity Preparation"];
    E --> F["Canal Location and Working Length Determination"];
    F --> G["Chemomechanical Preparation"];
    G --> H["Copious Irrigation with Sodium Hypochlorite"];
    H --> I["Intracanal Medication with Calcium Hydroxide"];
    I --> J["Temporary Restoration"];
    J --> K["Recall Visit 1: Pain persists"];
    K --> L["Re-application of Intracanal Medication"];
    L --> M["Recall Visit 2: Asymptomatic"];
    M --> N["Removal of Intracanal Medication"];
    N --> O["Final Instrumentation and Obturation"];
    O --> P["Final Restoration"];
    P --> Q["Follow-up Radiographs and Clinical Evaluation"];
    Q --> R["Successful Management"];

Discussion

External inflammatory resorption is often linked to pulpal necrosis and chronic apical periodontitis. Effective management requires accurate diagnosis and timely intervention, including thorough chemomechanical preparation and the use of intracanal medicaments like calcium hydroxide to disinfect the root canal system and inhibit resorption.

Key Findings

Nonsurgical endodontic therapy, combined with intracanal calcium hydroxide medication, successfully managed external inflammatory root resorption in the mandibular first molar, leading to symptom alleviation and arrest of the resorptive process.

Conclusion

External inflammatory root resorption is a sequela of necrotic pulp and chronic apical periodontitis. Accurate diagnosis and prompt endodontic intervention, including the use of intracanal medicaments, are crucial for arresting the resorptive process, improving the prognosis, and enhancing the longevity of the tooth.

Fact Check

* Patient's age: 17 years old. (Confirmed in Case Report section)
* Date of presentation: June 5th, 2023. (Confirmed in Case Report section)
* Canal lengths for MB and ML canals: 25mm. (Confirmed in Case Report section)

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