Conventional endodontic treatment followed by surgical repair of resorptive defect.
Diagnosis
Patient with intermittent pain on the lower left side. Examination revealed what appeared to be extensive external resorption on #18 near the pulp, with lingering pain to cold and pain on percussion consistent with a symptomatic irreversible pulpitis. CBCT showed the defect to be on the mesiolingual aspect, just above the crestal bone and involving the pulp. As the patient was already missing #19, he desired to save the tooth. Prognosis: questionable.
Challenge
Due to the pulpal involvement of the resorption, hemostasis and field isolation can be difficult. The location of the defect on the lingual aspect also make surgical correction and restoration difficult.
Treatment
Root canal treatment was completed and a permanent core was placed to seal the defect internally. This was followed by flap surgery, during which the defect was fully repaired with Geristore. A full coverage restoration, with margin replacement on the Geristore, was recommended.