Management of the apical inflammatory root resorption

Fig. 1

The diagnosis: 

Proper diagnosis of AIRR is mandatory for further management. Most common and important factor for AIRR is intracanal infection which means that either we will have necrotic or previously treated tooth. Second very common factor is periapical lesion which should be present on the x-ray. 

The shape of the apex is usually irregular or partially radiolucent. 

Fig. 2

Root length determination and preparation. 

Usually when the AIRR is present the working lenght determination can be uncertain because apical constriction is violated. In this situation clinican should find the „over apex” or „error” indication on the apex locator and perform the apical stop one millimeter shorter from that indication.  Performing control Xray with the files can be useful. 

In this kind of situations usually shaping of the apical area sholud be performed up to size 50.04 or even bigger. Often instrumentation with the hand files needs to be performed. 

Fig. 3

Obturation

After performing the apical stop procedure and irrigation protocol the apex sholud be sealed with the three calcium silicate based matherial (MTA or Biodentine). We can use Ni-Ti or steel pluggers or biomaterial cariers. 

While using the hand plugger it is important to perform proper pressure and also the good visibility is important. 

On the images you can see that the visibility of the apical part of the canal while using Prexo-M is very good. Therefore we can see the adaptation of the patherial no matter if it is MTA or Biodentine and adjust the pressure of the condensation. 

Fig. 4

Prexo-M

Fig. 5

Case: 

Treatment of the symptomatic, previously treated first mandibular moalar. Cbct examination revealed periapical lesion and AIIR in the distal root. 

The treatment of choice was NSRCRT with the TriCalcium silicate based matherial filling in the distal root.  

Fig. 6

During the single session appointment all procedures of the retreatment were performed. The old composite restoration was removed, chamber was sealed with flowable color composite. Old filling matherial was removed with rotary files.  Irrigation protocol was performed with sodium hypo, citric acid and ultrasonic activation. 

Fig. 7

Apex of the distal root was sealed with MTA material. Mesial canals and the medial part of the distal root were obturated with warm guttapercha. After the control xrays fiber post were placed.