Bio-obturation Repair of Extensive External Root Resorption in Neglected Avulsed Teeth: A Case Report

Tooth avulsion represents a severe dental injury, and prognosis depends on extraoral time and storage. Its major complications include ankylosis and external inflammatory root resorption. We report a 14-year-old female who presented with pain in her upper incisors one year after avulsion of teeth 11 and 21, replanted after 60 minutes in dry cloth and splinted for four months without follow-up. Clinical and radiographic examinations were consistent with severe external inflammatory root resorption in the teeth #11, 12, 21, and 22. Given her age and unsuitability for implants, staged endodontic therapy was performed over four months. Canals were prepared under rubber dam isolation, irrigated with 17% EDTA and 5.25% sodium hypochlorite with ultrasonic activation, and dressed with non-setting calcium hydroxide. Dressing was refreshed at sequential visits until resorption stabilized. Final obturation used calcium-enriched mixture (CEM) cement at perforations and gutta-percha in remaining canal spaces, and AH-26 sealer was used as sealant. Our treatment arrested resorption and preserved function, though the long-term risk of ankylosis remains high. This case report underscores the need for immediate replantation, physiologic storage media, and timely endodontic intervention to mitigate complications. Close monitoring remains vital for maintaining aesthetics and function in growing patients.