Lingual resorption: root canal treatment and surgical repair
Diagnosis
Patient presented with thermal sensitivity and spontaneous pain. Examination revealed an extensive resorptive defect on the lingual aspect of tooth #23 with a corresponding 10mm periodontal pocket and pulpal involvement. The CBCT confirmed internal resorption on teeth #25 and #26 with a small portal of entry visible on the lingual of #26. The findings support a diagnosis of symptomatic irreversible pulpitis.
Challenge
The large resorption defect makes instrumentation challenging due to the highly irregular shape, often leading to extraction. In addition, the excessive gingival recession on #23 makes this less than favorable for implant therapy. After discussing these challenges the patient was motivated to preserve the tooth if possible.
Treatment
Root canal treatment was completed on tooth #23, followed by surgical repair of the lingual resorptive defect using Geristore. Access for the surgical repair on tooth #23 was facilitated due to the excessive lingual recession. At a separate appointment, root canal treatment on teeth #25 and #26 was completed using Gentlewave and the canals were sealed with Bioceramic. At the six-month-follow-up, there was excellent soft tissue healing, with resolution of the lingual gingival defect and normal probing depths.