Free Gingival Graft for External Cervical Root Resorption in a Non-Esthetic Mandibular Premolar: A Case Report

External cervical root resorption (ECRR) is an uncommon and often asymptomatic condition whose early diagnosis is challenging. When located on the buccal aspect of posterior teeth, treatment should address both lesion control and long-term periodontal stability.

A 67-year-old healthy, nonsmoking female presented with RT1 gingival recessions in the mandibular right sextant and a cervical defect on Tooth #28. Clinical and radiographic evaluation confirmed ECRR with a favorable prognosis. Treatment included a partial-thickness flap for surgical access, complete debridement of the defect, minimal osteoplasty, and restoration under rubber dam isolation. A free gingival graft harvested from the palate was placed to increase keratinized tissue and deepen the vestibule. At 3- and 15-month follow-ups, the tooth remained vital and asymptomatic, the graft showed stable integration, and radiographs demonstrated no progression of the lesion.

In non-esthetic posterior areas, a combined restorative-periodontal approach with a free gingival graft can successfully manage ECRR while enhancing keratinized tissue and supporting long-term periodontal health.