Invasive Cervical Root Resorption: A Case Series and Clinical Management Protocol

Invasive cervical root resorption (ICRR) is a dynamic, multifactorial pathology affecting permanent teeth. It is characterised by a resorptive process that starts externally at the root′s cervical region and moves towards the dentin, leaving the pulp intact due to a protective layer of predentin. This study presents four clinical cases that illustrate different ICRR classifications. Case 1 involved a 2Ad lesion on Tooth 11. This was treated using a conservative surgical approach involving papilla preservation. This was followed by the removal of granulation tissue and a composite restoration. This approach achieved long‐term pulp vitality. Case 2 involved a 3Ad lesion on Tooth 21 and required a similar surgical exposure and debridement protocol, followed by a composite restoration. Despite initial success and retained vitality, endodontic therapy was required after one year. Case 3 involved a 3Ap lesion on Tooth 14 that affected the root canal system. This resorption was treated with surgical exposure, composite sealing, and orthograde root canal therapy. The case demonstrated a successful 4‐year follow‐up period until the patient was lost to further clinical observation. Case 4 showcases a 3Cp resorption on Tooth 23. Due to the extent of the resorption, the loss of hard structural tissue, and the poor overall prognosis for the tooth, the treatment of choice was extraction of the tooth followed by the placement of a bone integrated implant. The clinical management of ICRR focuses on early detection, accurate lesion classification, and timely intervention to remove resorptive tissue and restore tooth integrity while preserving pulp vitality. Surgical exposure, often involving minimally invasive pulp preservation techniques, is a critical step in providing direct access for debridement and restoration. Composite resin is commonly used to seal defects due to its biocompatibility and ease of use. In advanced cases, endodontic treatment may be necessary. In conclusion, ICRR is a challenging clinical entity due to its insidious progression, variable presentation, and multifactorial etiology. Classification systems and advanced imaging modalities, such as CBCT, are essential for diagnosis and treatment planning. Conservative surgical and restorative approaches can effectively manage lesions and preserve dental structures, emphasising the importance of personalised, minimally invasive treatment strategies in ICRR therapy.