Nonsurgical Management of Extensive Internal Root Resorption: A 48-Month Follow-Up Case Report

A 21-year-old male presented with a nonvital right maxillary central incisor with percussion sensitivity and mild mobility. Cone-beam computed tomography (CBCT) confirmed extensive internal root resorption (IRR) involving nearly the entire root, with a buccal cortical bone defect but no perforation of the root. Nonsurgical treatment was completed in three sessions using chemomechanical preparation with ProTaper Gold and 2.5% sodium hypochlorite irrigation at each session, with an interim calcium hydroxide dressing between sessions. The calcium hydroxide was removed using 17% EDTA with EDDY sonic activation, followed by a final saline rinse. Obturation was performed using a hybrid technique: MTA Angelus in the resorptive defect and an epoxy resin sealer with warm vertical gutta-percha condensation coronally. Clinical and radiographic follow-ups at 6, 12, and 48 months demonstrated resolution of clinical symptoms, periapical healing, and no further progression of resorption on periapical radiographs. A follow-up CBCT at 48 months showed healing of the buccal cortical bone defect. In this case, nonsurgical orthograde treatment, combining CBCT-guided diagnosis, chemomechanical debridement, and hybrid bioceramic-resin obturation, was associated with clinical and radiographic healing, suggesting that a nonsurgical orthograde approach may be a feasible tooth-preserving option for selected cases of extensive nonperforating IRR.