Iranian Endodontic Journal

Abstract

Internal root resorption (IRR) is an uncommon but clinically significant condition traditionally managed with complete pulpectomy and root canal therapy. Advances in vital pulp therapy and bioactive calcium silicate–based cements have enabled conservative strategies aimed at preserving residual pulp vitality. A 33-year-old woman presented with an asymptomatic, unperforated IRR in the maxillary left lateral incisor, confirmed by periapical radiography and cone-beam computed tomography. The tooth responded positively to sensibility testing and showed healthy periapical tissues. A partial pulpectomy was performed: diseased coronal and mid-root pulp was removed, while approximately 5 mm of vital apical pulp was preserved. The resorptive cavity and root canal were bio-obturated with calcium-enriched mixture cement, which also served as a capping biomaterial for the apical pulp stump. Postoperative imaging confirmed complete filling/sealing of the resorptive defect and root canal while maintaining the apical pulp segment. At 2-year follow-up, the tooth remained functional, symptom-free, and radiographically stable, with intact lamina dura and no evidence of progressive resorption. This case demonstrates that partial pulpectomy combined with bio-obturation using an endodontic biomaterial may successfully arrest IRR and preserve apical pulp vitality in carefully selected cases. While the outcome supports the biological feasibility of this approach, further studies with larger samples and longer follow-up are required before it can be considered a routine alternative to conventional treatment.