Nonsurgical Management of Extensive Internal Root Resorption: A 48‐Month Follow‐Up Case Report

A 21‐year‐old male presented with a nonvital right maxillary central incisor with percussion sensitivity and mild mobility. Cone‐beam computed tomography (CBCT) confirmed extensive internal root resorption (IRR) involving nearly the entire root, with a buccal cortical bone defect but no perforation of the root. Nonsurgical treatment was completed in three sessions using chemomechanical preparation with ProTaper Gold and 2.5% sodium hypochlorite irrigation at each session, with an interim calcium hydroxide dressing between sessions. The calcium hydroxide was removed using 17% EDTA with EDDY sonic activation, followed by a final saline rinse. Obturation was performed using a hybrid technique: MTA Angelus in the resorptive defect and an epoxy resin sealer with warm vertical gutta‐percha condensation coronally. Clinical and radiographic follow‐ups at 6, 12, and 48 months demonstrated resolution of clinical symptoms, periapical healing, and no further progression of resorption on periapical radiographs. A follow‐up CBCT at 48 months showed healing of the buccal cortical bone defect. In this case, nonsurgical orthograde treatment, combining CBCT‐guided diagnosis, chemomechanical debridement, and hybrid bioceramic–resin obturation, was associated with clinical and radiographic healing, suggesting that a nonsurgical orthograde approach may be a feasible tooth‐preserving option for selected cases of extensive nonperforating IRR.