Conservative Management of Class 4 Invasive Cervical Root Resorption Using Calcium-enriched Mixture Cement

Area of Science:

• Endodontics
• Dental Traumatology
• Regenerative Dentistry

Background:

• Class 4 invasive cervical root resorption (ICRR) poses a significant treatment challenge in endodontics.
• Current management typically involves non-treatment or extraction, offering limited conservative options.

Observation:

• A case report details the management of a 28-year-old female with class 4 ICRR in tooth #26, presenting with root perforation, bone loss, and a periapical lesion.
• Clinical examination revealed a 6mm probing depth with bleeding and percussion sensitivity.

Findings:

• A conservative endodontic approach involved chemomechanical preparation followed by obturation with calcium-enriched mixture (CEM) cement.
• No mechanical removal of the resorptive lacuna was performed.
• After 24 months, the tooth remained functional and asymptomatic, with reduced probing depths, no bleeding, no resorption progression, and evidence of bone and periapical healing.

Implications:

• CEM cement may offer a viable alternative for treating otherwise non-treatable teeth with class 4 ICRR.
• This conservative strategy preserves the natural tooth, avoiding extraction.
• Further research into CEM cement for complex root resorption cases is warranted.