Dual-phase treatment for management of apical external inflammatory root resorption with root perforation

External inflammatory root resorption (EIRR) is a destructive condition that can lead to tooth loss if not addressed promptly. This case report highlights the successful management of a 53-year-old male with EIRR and root perforation in the maxillary right central incisor. The patient presented with asymptomatic, purulent discharge and a chronic sinus tract related to the tooth. The main radiographic finding was lateral radiolucency and external resorption affecting the apical third of the root with a lateral perforation. The tooth was diagnosed as asymptomatic apical periodontitis of previous treatment with external lateral root resorption and perforation. The diagnosis was confirmed using cone-beam computed tomography. The procedure involved sealing the perforation with calcium silicate-based material, followed by surgical intervention with a xenograft and collagen membrane for guided tissue healing. At a 3-year follow-up, the tooth demonstrated stability, functional retention, and no evidence of further resorption. This case emphasizes the importance of advanced diagnostics and bioactive materials in preserving natural dentition in cases of apical EIRR with root perforation.