Combined therapy of mineral trioxide aggregate and guided tissue regeneration in the treatment of external root resorption and an associated osseous defect

Background: The treatment of external root resorption and associated periodontal defects can be challenging to the most astute clinician. In this case report, a multidisciplinary approach was performed to treat a maxillary central incisor that presented with a sinus tract. An amalgam restoration had been placed approximately 10 years earlier to repair an area of external root resorption. Methods: A full-thickness mucoperiosteal flap was reflected from teeth #8 to #9. Following degranulation of the area, an amalgam restoration was found on the distal root surface of tooth #8. A 2-wall osseous lesion was also associated with the distal surface of #8. The amalgam was removed and the defect was restored with mineral trioxide aggregate (MTA). The root surface was chemically conditioned with tetracycline, and the osseous defect was grafted with decalcified freeze-dried bone allograft (DFDBA) and a calcium sulfate barrier. Results: An 8 mm gain in clinical attachment,, as well as an increase in radiodensity, was noted on the distal surface of tooth #8 at 15 months postsurgery. The patient was also asymptomatic, with no clinical signs of inflammation present. Conclusions: A combined approach utilizing MTA for root surface repair, and DFDBA and calcium sulfate to address an associated osseous lesion, appears to be a viable modality in the treatment of chronic endodontic/periodontal lesions.