Nonsurgical Endodontic Management of Nonperforating Internal Root Resorption in a Maxillary Central Incisor: A Case Report with a 4-Year Follow-Up.

Internal root resorption (IRR) commonly occurs as a single oval-shaped defect radiographically; however, variation like bilocular IRR defect is rarely reported in the literature. This case report presents a 28-year-old male patient who reported with pain of dull nature, in his front upper tooth for the past 1 week. He reported with a history of trauma 8 years back. Clinical findings indicated the maxillary left central incisor with a crown, tender to percussion and palpation, no swelling, mobility, or pockets were noted. A tentative diagnosis of symptomatic apical periodontitis was made. The diagnosis was confirmed through careful, clinical, and radiographic examination, including the use of cone-beam computed tomography for detailed morphology. Radiographic examination revealed an oval-shaped radiolucency in the midroot region of tooth #21. The bilocular nature of the IRR defect was revealed in the different views of the CBCT. Given the challenges in cleaning, shaping, disinfecting, and obturating, the IRR defect, a specialized endodontic approach, was employed. The use of passive ultrasonic irrigation (PUI) for canal disinfection and hybrid technique of obturation with bioceramic sealer led to the reinforcing the IRR defect, and the successful outcome has a 4-year follow-up.