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Figure 4: Management of internal replacement root resorption with root perforation, using both warm gutta-percha and MTA for root canal filling (tooth 36). (a) Preoperative intraoral radiograph of the first left lower molar showing an enlargement associated with a fuzzy appearance of pulp chamber and the first third of the root canal. (b), (c), and (d) Sagittal, coronal, and axial CBCT cross-sections confirm the enlargement of pulp space and the abnormal apposition of dentin/bone-like hard tissue. (e) After chemomechanical and ultrasonic removal of pathological soft and hard tissues, the mesial canals and the 2/3rd of the distal root were filled with warm compacted gutta percha, leaving free the resorbed area. (f) Peroperative clinical view of the MTA material placed in the resorbed area and (g) the immediate X-ray to assess the quality of the root canal obturation. (h) Periapical X-ray: control of treatment at one year. Note the absence of periapical disease and the healthy appearance of the furcation facing the resorbed area filled with MTA.