Conservative Management of Internal Root Resorptions and a Large Periapical Lesion with Combined Nonsurgical Treatment and Decompression: A Case Report with 3 years Follow-up

Occlusal trauma is increasingly recognized as a significant contributor to pulpal inflammation, potentially leading to internal root resorption. Internal root resorption is a rare, chronic inflammatory process characterized by dentin loss within the pulp space. Typically asymptomatic, it is often discovered incidentally during radiographic examination. Managing large cyst-like periapical lesions associated with internal resorption presents challenges, particularly when nonsurgical treatments are unsuccessful. Decompression, a minimally invasive technique, has shown promising outcomes but remains underutilized. This report describes the management of a 51-year-old male presenting with multiple internal root resorption defects and a large periapical lesion in a mandibular incisor, likely caused by occlusal trauma. Nonsurgical root canal treatment combined with decompression led to complete clinical and radiographic healing at the three-year follow-up. This case highlights decompression as a conservative strategy for treating large periapical lesions and emphasizes the potential contribution of occlusal trauma to the development of internal root resorption.