Vital root resection with regenerative retrograde vital pulp therapy: A case report.

Abstract

Background: Vital root resection is a surgical procedure that involves the selective removal of a root of a multi-rooted tooth to preserve the remaining tooth structure and pulp, maintaining the vitality and function of the tooth. When combined with regenerative retrograde vital pulp therapy (rVPT), it may offer a less invasive and more cost-effective alternative to traditional root resection methods. The purpose of this article is to report the techniques and outcomes of vital root resection and rVPT for the periodontally involved fractured mesiobuccal (MB) root in a maxillary first molar.

Methods: This case report describes the treatment of a 56-year-old patient with a chief complaint of swelling and pain in her upper right quadrant and with the periodontally involved MB root of tooth #3 using vital root resection combined with rVPT. Tooth #3 was diagnosed as normal pulp and acute periodontal abscess with a suspected root fracture in the MB root. Upon root fracture detection, root resection and rVPT with amnion-chorion membrane and bioceramic material were performed, followed by guided tissue regeneration.

Results: Tooth #3 remained asymptomatic with confirmed osseous healing at 6 months, and gingival recession on the adjacent distobuccal root was successfully treated via connective tissue graft. Tooth #3 remained vital at 18 months without clinical and radiographic signs and symptoms.

Conclusions: This case report highlights the potential of vital root resection using rVPT as a less invasive treatment modality that may preserve the tooth's vitality and function, offering a cost-effective alternative to more traditional methods.

Key points: The preservation of tooth function and vitality may be achieved through vital root resection combined with regenerative retrograde vital pulp therapy. Regenerative retrograde vital pulp therapy may be performed using a bioactive scaffold and bioceramic material. This biologically oriented approach may provide a less invasive and more cost-effective alternative to traditional root resection methods that require orthograde endodontic therapy followed by a permanent full-coverage restoration.

Plain language summary: This case report presents a minimally invasive dental procedure to preserve tooth function and vitality. A 56-year-old patient reported swelling and pain in the upper right part of her mouth. Examination of tooth #3 revealed an acute gum infection and a likely root fracture in one of the roots. The treatment involved vital root resection, which removes only the damaged root, and regenerative pulp therapy to enhance healing. The regenerative pulp therapy used bioactive materials, including an amnion-chorion membrane and bioceramics, to support tissue regeneration. After 6 months, the patient showed successful bone healing, and gum recession around the treated area was corrected with a connective tissue graft. At the 18-month follow-up, the tooth remained vital and free of symptoms, with no signs of further infection or damage. This case highlights the potential of combining vital root resection and regenerative pulp therapy as a less invasive, cost-effective alternative to traditional methods, allowing the tooth to be preserved while maintaining its natural function.