The objective of this work is displaying a successful treatment for an internal resorption case under operating microscope using bioceramic material.

Periapical radiograph showed radiolucent lesion representing large internal resorption of the root. The respective defect was obturated using endoscquence bioceramic material follow up at the month 18 after treatment revealed no abnormal finings clinically and radiographically.

New generations bioceramics have many advantages that internal root resorption cases can benefit from. The use of operating microscope helps to apply obturating materials with precision. However, long term study on a large sample is required in future studies.

Internal resorption of the root is an inflammatory process that starts inside the pulp and results in dentin loss and potential cementum invasion[1]. Internal resorption can lead to perforation of the root if it progresses. Vital tissues apical to the resorptive area are required for the process of internal resorption to be active[2]. In its classical representation radiographically, the resorptive defect can be seen as round radiolucency with symmetrical enlargement of the canal space[3]. Internal resorption represents one of the treatment challenges in endodontics; therefore, many previous studies have been conducted on this subject, including case reports[4-7].

Endodontic treatment success relies on sufficient root canal system instrumentation, disinfection and obturation[8]. In general, bioceramics have demonstrated favorable physicochemical properties. Moreover, new generation bioceramics have improved on some of existing drawbacks of previous materials[9]. Promising results can be expected from the bioceramics due the antibacterial and anti-biofilm characteristics in addition to the biocompatible nature of the material[10]. This study aims to demonstrate a comprehensive management solution for internal root resorption with the use of a bioceramic material based as an obturation material for the resorptive defect.

The diagnosis was previously treated tooth, with symptomatic apical periodontitis. Planned treatment included endodontic retreatment and final restoration.

The patient was seen at the month 18 after treatment for evaluation. The patient had no complaints. Clinical examination showed no abnormal findings. Teeth 11 and 21 responded normally to percussion and palpation with no mobility detected. Periapical Radiographs showed no abnormalities as seen in Figure 1D.

Internal resorption of the root poses an endodontics treatment challenge for various reasons. The irregular nature of the resorptive lesion and the possible perforation externally of the root surface are among the factors of difficulty in these situations[11]. However, salvaging a functional tooth remains one of the main objectives of endodontic treatment. The utilization of new materials with favorable properties can be beneficial in these cases.

Various studies have examined the characteristics of bicoeramics and the potential advantages of these materials[12,13]. Bioceramics are bio-inert, biocompatible, and non-toxic[14]. In addition, a previous study found similar sealing capability when evaluating Endosequence Bioceramic Root Repair Material Putty and Mineral Trioxide Aggregate[15]. A new generation of bioceramics have been reported to be clinical used for treatment of internal resorption that cause perforations. In a previous study[16], bioceramic sealer was utilized for management of perforating internal resorption in chamber/coronal canal region.

Microscope-improved visualization is one of the advantages of using magnification[17]. Using the operating microscope throughout the course of treatment in this case was helpful in visualizing and precisely applying the material to the resorptive defect. Obtaining cone beam computed tomography (CBCT) is valuable in identifying the perforation in the internal root resorption[18]. In this case, CBCT image preoperatively could be beneficial for determining the size and the extension of the resorptive lesion prior treatment. Furthermore, the use of bioceramic sealer instead of the resin based sealer could be advantageous in such case.

A combination of correct diagnosis and proper management is important for the success of root canal treatment. The use of an operating microscope, bioceramics, and coronal seal after endodontic treatment can be important for treating internal root resorption. However, future studies with representative samples are required to evaluate long-term outcomes.

Internal resorption represents one of many endodontic treatment challenges. The use of a new generation of bioceramics in such cases has potential benefits that can add to overall treatment success. Further studies are required to evaluate the outcomes.