Management of External Inflammatory Root Resorption following Tooth Autotransplantation Using a Modified Combination of Triple Antibiotics

Figure 1

Mandibular left second molar with large periapical radiolucency: (a) mandibular left second molar with inappropriate previous root canal therapy, intracanal broken instruments, large periapical radiolucency, and furcation involvement; (b) former mandibular second molar was diagnosed hopeless and thus was removed whereas the mandibular left third molar was soundly extracted, and root-end cavities were cautiously prepared, carefully sealed using calcium enriched mixture (CEM) cement, and transplanted as a replacement for the mandibular left second molar; (c) in the 3-month follow-up, relative healing of periradicular bone was evident; however, radiolucencies in the mesial periapical region and furcation persisted, and signs of external inflammatory root resorption (EIRR) appeared on the distal root; (d) after the 6-month follow-up from the first treatment session and persistence of EIRR signs, the coronal restoration was removed, root canals were prepared, canals were medicated with a new combination of triple antibiotics (PMC), and the coronal cavity was sealed with Zonalin™; (e) after 3 weeks from the previous appointment, relative bone healing and complete arrest in EIRR progression were seen. Root canals were then filled with CEM cement, and the coronal cavity was restored using amalgam; (f) in the 2-year follow-up, thorough bone healing, disappearance of periapical and furcation radiolucency, and arrest/treatment of IERR were observed.

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