A THREE STAGED INTERDISCIPLINARY APPROACH IN MANAGEMENT OF A PERFORATED TOOTH WITH COMBINED INTERNAL AND EXTERNAL RESORPTION

Root resorption is of major concern to endodontists. It is one of the common causes for root perforation which complicates endodontic treatment and often results in periodontal destruction. Proper diagnosis and an understanding of the aetiology and dynamics of the processes involved in tooth resorption is critical for effective management. Tooth resorption can have a multifactorial etiology. Traumatic injury, orthodontic treatment, bacteria, bacterial products and tissue destruction products within the root canal, periodontal treatment, local pressure and inflammation are some of the common causes for tooth resorption. Multinucleated clastic cells are responsible for destruction of bone, dentin and cementum. Usually a multidisciplinary approach is required in managing such cases. The following case report represents a surgical management of a tooth with combined internal and external resorption. The initiation and progression of the resorptive lesion has occurred due to iatrogenic errors from the previous endodontic treatment that resulted in a large perforation defect on the facial aspect of the upper left canine tooth associated with severe pain and periodontal involvement. Management of the teeth was done in three stages. The use mineral trioxide aggregate (MTA) has resulted in the repair of the resorptive defect. Periodontal surgery with regenerative procedures were carried out in the later stage. At two year followup, the tooth showed signs of healing and arrest of root resorption along with considerable bone fill. Treatment of the mutilated teeth in three stages and involvement of an interdisplinary approach have resulted in good esthetic and functional outcome.