Single-session use of mineral trioxide aggregate as an apical barrier in a case of external root resorption

Abstract

External root resorption may occur as a consequence of trauma, orthodontic treatment, bacterial infection or incomplete sealing of the root canal system (bacterial re-infection), and lead to crater formation on the resorbed apex. This would deform the root apex surface, and cause loss of apical constriction. Depending on the extent of the resorptive process, different treatment regimens have been proposed. A 34-year-old male patient presented with an intra-radicular retainer and an inadequate filling on tooth #21, as well as a radiographic image suggesting periapical bone rarefaction. After root canal retreatment, the defect was accessed coronally. The resorption area was chemo-mechanically debrided and since the apical end was very wide, a calcium sulphate matrix was made. Mineral trioxide aggregate (MTA) was used to fill the resorptive defect, and the coronal access was temporarily sealed. After 24 h, the quality of the apical seal was evaluated with the aid of an operating microscope, and then the root canal system was filled. A 12-month follow-up radiograph showed adequate repair of the resorption. Clinically, the tooth was asymptomatic. We concluded that MTA can be successfully used to avoid overextension of the filling material when treating a tooth with external resorption.