Management of invasive cervical resorption using a surgical approach followed by an internal approach after 2 months due to pulpal involvement

Invasive cervical resorption (ICR) is an aggressive and invasive form of external tooth resorption that commences in the cervical region which can be managed using either a nonsurgical, surgical or a combination of nonsurgical and surgical approach. The restoration of resorptive defects having a coronal and radicular extent can be challenging as a single material cannot be used to restore the entire defect. This case presented with Heithersay's Class 3 ICR lesion in tooth #12, which was managed initially using a surgical approach and restoration of ICR defect with a combination of resin modified glass ionomer cement, composite resin and mineral trioxide aggregate (MTA). However, the patient presented with pulpal symptoms 2 months later which warranted a root canal therapy. An internal approach was then used to debride and remove remnant fibro-osseous tissue. The defect was then repaired with MTA. A 1 year follow-up demonstrated adequate periapical healing and no pathologic changes around the restored resorptive defect.