Implant Rehabilitation of Internal Root Resorption after Dental Trauma

Internal root resorption is a result of complex interaction of resorbing and inflammatory cells which are responsible for progressive destruction of intraradicular dentin along the middle and apical thirds of the canal walls due to osteoclastic action. It is a rare phenomenon that can manifest through a slow or rapid progression. If the IRR is extensive and the prognosis of endodontic treatment questionable, extraction of the tooth with socket preservation is recommended so that further complications can be avoided. After tooth extraction, a series of processes take place including scarring of the alveoli, with an inevitable three-dimensional loss of alveolar bone. Over the years many different techinques of socket preservation and socket grafting have been used, preserving the socket from collapse during normal healing process. A 20-year old female patient was referred by the endodontist to the Department of Oral Surgery, School of Dental Medicine, University of Zagreb because of a progressive internal root resorption of upper right lateral incisor and upper left central incisor. She reported trauma in the area of upper incisors in her childhood during playing with peers but without any further consequences until now. After analysing few different solutions, the patient agreed to have her teeth extracted with socket preservation and after healing period of 6 months for the implants to be placed in the extracted site. Dental implants (4.0 mm/12 mm for central incisor; 3.3 mm/12 mm for lateral incisor) were inserted in the positions of the missing teeth. The implants were loaded after 6 months with individual CAD/CAM made zirconia abutments with CAD/CAM made temporary acrylic crowns mainly for emergence profile modelling. Two lithium-disilicate crowns, supported with individual CAD/CAM zirconia abutments served as final restoration.