Abstract
BACKGROUND: Root resorptive defects present significant diagnostic and clinical challenges, particularly when differentiating internal root resorption (IRR) from external cervical resorption (ECR). Their irregular anatomy complicates effective debridement and increases the risk of irrigant extrusion during conventional irrigation procedures. CASE PRESENTATION: A 33-year-old female with a history of asthma presented with a chief complaint related to maxillary lateral incisor #7. Clinical examination revealed normal probing depths, absence of tenderness to percussion and palpation, no mobility, and no response to cold testing. Periapical radiography demonstrated two well-defined, balloon-shaped radiolucencies in the coronal third of the canal. CBCT revealed an extensive resorptive defect with perforation of the buccal canal wall, round internal morphology, and thinning of dentinal walls-features most consistent with ECR, although a combined IRR/ECR process could not be excluded. Because of the patient's sensitivity to the odor of sodium hypochlorite, a sealed irrigation system was employed. A dual-needle setup was used in which 5.25% NaOCl was delivered apically through a 27-gauge needle while simultaneous coronal suction via a 22-gauge needle created controlled negative pressure within a sealed chamber. This configuration allowed continuous irrigant exchange and effective debridement while minimizing extrusion risk and patient discomfort. The canal was obturated using an MTA-based sealer. At the 17-month follow-up, the tooth remained functional and asymptomatic, with radiographs showing periapical stability and no evidence of recurrent or progressive resorption. CONCLUSION: This case demonstrates that a sealed, negative-pressure irrigation technique can provide a safe and effective method for managing complex resorptive defects-particularly when patient-related limitations and diagnostic ambiguity make traditional irrigation approaches insufficient.