Selective preservation of the apical pulp vitality during surgical management of perforating root resorption: a case report with 1-year CBCT follow-up
Year: 2026
Type: article
Study design: Case Report
Abstract: Background Perforating internal root resorption (IRR) is conventionally managed by complete pulpectomy and root canal treatment. Preservation of the remaining apical pulp tissue has not, to the best of our knowledge, been previously reported. Case presentation: A healthy 27-year-old woman presented with an asymptomatic maxillary left central incisor in which IRR was detected during routine radiographic examination. The tooth responded positively to cold and electric pulp sensibility tests. Cone-beam computed tomography (CBCT) confirmed a perforating lesion involving the buccal and distal root surfaces. After declining conventional root canal treatment, the patient consented to an alternative one-step surgical procedure. The coronal root canal and internal resorptive cavity were retrogradely prepared, after which the coronal root canal was sealed with calcium-enriched mixture (CEM) cement. At the same time, the preserved apical pulp stump underwent shallow pulpotomy and direct pulp capping with the same biomaterial. At the 1-year follow-up, the tooth remained asymptomatic. Periapical radiography and CBCT demonstrated complete mineralized tissue fill of the resorptive cavity and formation of a cortical bony bridge across the buccal perforation. Conclusions This case suggests that selective preservation of healthy apical pulp tissue may be biologically feasible in carefully selected cases of perforating IRR. However, conventional root canal treatment remains the standard of care. Further clinical studies are warranted. Clinical trial registration Not applicable.
Source: BMC Oral Health
Author: Saeed Asgary
Language: English
Subfield: Oral Surgery
Field: Dentistry
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,190
OpenAlex ID: W7203685414