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Case Reports
. 2023 Jul 18;10(7):1236.
doi: 10.3390/children10071236.

External Inflammatory Root Resorption in Traumatized Immature Incisors: MTA Plug or Revitalization? A Case Series

Tchilalo Boukpessi  1   2   3 , Leslie Cottreel  1   4 , Kerstin M Galler  5
Affiliations
Case Reports

External Inflammatory Root Resorption in Traumatized Immature Incisors: MTA Plug or Revitalization? A Case Series

Tchilalo Boukpessi et al. Children (Basel). .

Abstract

Introduction: External inflammatory root resorption (EIRR) in immature permanent teeth is a common complication after severe dental trauma. The management of this condition requires thorough disinfection of the root canal in order to arrest the resorptive process. However, current guidelines regarding the recommended treatment of EIRR following traumatic dental injuries vary, mainly in regard to the type of intracanal medication and its retention time in the root canal system. The objective of this case series was to present both the apical barrier technique (MTA plug) and revitalization procedures as valid treatment options in immature teeth with EIRR.

Methods: Four cases of post-traumatic immature teeth diagnosed with pulp necrosis and EIRR, with or without apical periodontitis, were treated either by an MTA plug (two teeth) or revitalization (two teeth). Cases were followed between 12 and 24 months.

Results: Both treatment methods were efficient in arresting EIRR and enabled bone healing. After revitalization, partial root maturation was observed.

Conclusion: Whereas the key to achieve periodontal healing in cases of EIRR is thorough disinfection of the root canal, both a subsequent MTA plug as well as revitalization may represent adequate treatment methods. An additional benefit lies in the potential of revitalization to promote further root maturation through hard tissue apposition.

Keywords: MTA plug; case series; dental trauma; immature teeth; pulp necrosis; revitalization.

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Conflict of interest statement

TB has a collaboration between university and Septodont. LC and KMG declare no conflict of interest.

Figures

Figure 1
Figure 1
Second session of revitalization, clinical images. (A) Removal of CH intracanal dressing. (B) Bleeding was provoked up to 2 mm below the gingival margin. (C) Placement of a collagen matrix to cover the blood clot. (D) Application of hydraulic calcium silicate onto the collagenous matrix. (E) Placement of the temporary material.
Figure 2
Figure 2
Case 1: Apexification with MTA plug. (A) Preoperative intraoral radiograph of teeth 11 and 21 presenting apical lesion and EIRR. (B–E) Sagittal, frontal, and axial CBCT images show the presence of resorption on all aspects of teeth 11 and 21. (F) Postoperative radiograph after MTA plug and filling with gutta-percha. The root canal filling was performed 1 week after the placement of MTA. At the 12-month follow-up, resorption lacunae were arrested, and complete bone healing was observed on periapical radiographs (G) and CBCT images (H,I).
Figure 3
Figure 3
Case 2. (A) Periapical radiograph reveals a wide-open apex on tooth 11 and the presence of a periapical radiolucency and multiple radicular resorption lacunae. (B) The presence of a periapical radiolucency and relevant bone loss around the tooth are observed on CBCT sagittal images. The clinical protocol for an MTA plug was performed. (C) Temporary intracanal dressing with CH before MTA plug in (D). (E) At the 3-month follow-up, the periapical radiograph showed resolution of the periapical inflammation and an arrested resorption process. (F) At the 12-month follow-up, the resorption was arrested, and complete bone healing can be observed on the periapical radiograph.
Figure 4
Figure 4
Case 3: Revitalization treatment of tooth 21 after avulsion and replantation. (A) The periapical radiograph reveals a wide-open apex and the presence of a periapical radiolucency and multiple radicular resorption lacunae. (B–D) CBCT images show external root resorption on different aspects of the root, without root perforation. (E) Post-operative periapical radiograph after revitalization. (F) Six-month follow-up radiograph shows a decrease in the apical radiolucency, an increase in root length, and a decrease in apical foramen size. (G–J) On the periapical radiograph and on CBCT images, the periapical lesion still decreased, the resorption was stopped, and the apex was closed when compared with previous radiographs.
Figure 5
Figure 5
Case 4: MTA plug after failure of revitalization. (A,B) A periapical radiograph revealing multiple resorption lacunae on the distal side of tooth 21, a wide-open apex, and a periapical radiolucency. (C,D) CBCT revealed that even though there were multiple lacunae, no perforation of the root walls was visible. (E) Revitalization procedure. (F) Failure noted due to no decrease in the periapical radiolucency. (G) MTA plug. (H) Obturation with gutta-percha. (I,J) Follow-up sessions for respective months and 1 year. Increase in root length and apical closure (J).
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