Healing of Perforating Inflammatory Root Resorption by Allogeneic Bone Marrow Mesenchymal Stromal Cells...

Perforating inflammatory root resorption (PIRR) in permanent teeth can cause extensive dentin loss, periodontal breakdown, and eventual tooth loss. Regenerative endodontic procedures (REPs) have been proposed to treat PIRR. Among them, cellular therapy based on transplantation of mesenchymal stromal cells (MSCs) has been suggested as a potential option for treating PIRR, because of their paracrine and anti-inflammatory effects during tissue repair.

A 13-year-old girl presented with a traumatized tooth #9 showing discoloration, a buccal sinus tract, 8-mm probing depth, tenderness to percussion, and nonresponse to thermal and electric tests; after unsuccessful REP. Radiography and cone-beam computed tomography (CBCT) revealed a large PIRR extending from the cervical to apical third of the root, communication with the periodontium, lateral perforation, and complete loss of buccal alveolar bone in the apical third. All of this was consistent with the presence of PIRR, pulp necrosis, and chronic apical abscess. The canal was disinfected with NaOCl, EDTA, and intracanal calcium hydroxide. Allogeneic MSCs were thawed, cultured, expanded, included in platelet-rich plasma clot, and transplanted into the canal, followed by a Biodentine coronal plug and composite restoration. The tooth was followed-up for 48 months.

The sinus tract resolved after 1 month, and buccal probing depth normalized and remained stable throughout follow-up. Radiographs and CBCT showed infilling of the resorptive defect with mineralized tissue, re-establishment of the periodontal ligament space, and buccal bone healing over 4 years. The tooth became asymptomatic and consistently responded to electric pulp testing, while responses to cold testing were variable.

This single case shows that allogeneic MSC transplantation may promote long-term healing of PIRR with pulp necrosis and chronic apical abscess in young permanent teeth. Controlled clinical studies are required to confirm the capacity of healing PIRR by MSCs.