Long-term outcome of combined orthograde and surgical management of perforating internal root resorption using a bioceramic repair material: an eight-year CBCT-documented case report.

BACKGROUND: Perforating internal root resorption (IRR) represents a rare and challenging endodontic condition that may require a combined nonsurgical and surgical approach for effective management. METHODS: A 24-year-old female presented with pain on biting and discoloration of the maxillary right lateral incisor. Cone-beam computed tomography (CBCT) confirmed perforating IRR associated with apical periodontitis. Initial non-surgical disinfection was performed using calcium hydroxide as an intracanal medicament. Persistent intracanal exudation necessitated surgical intervention under an operating microscope, during which the defect was sealed with EndoSequence Root Repair Material (ERRM) Putty and covered with a bone graft. Final obturation was completed using a hydraulic condensation technique with a bioceramic sealer. RESULTS: At the eight-year follow-up, the tooth remained functional and asymptomatic. Both periapical radiographs and CBCT imaging demonstrated complete osseous healing and restoration of normal trabecular bone pattern. CONCLUSION: This case illustrates that perforating IRR may be successfully managed using a combined non-surgical and surgical approach guided by CBCT and supported by bioactive bioceramic materials, with stable clinical and radiographic outcomes documented over an eight-year follow-up period.