Surgical and Nonsurgical Endodontic Treatment of a Patient with Vitamin D-resistant Rickets and Extraoral Sinus Tract: A Case Report.

Abstract

Vitamin D-resistant rickets is a rare genetic disorder that significantly impacts oral health, causing characteristic dental manifestations including enlarged pulp chambers, spontaneous pulp necrosis, and frequent periapical infections. This case report describes the comprehensive endodontic management of a 32-year-old female with vitamin D-resistant rickets who presented with spontaneous pulp necrosis, periapical pathosis, and an extraoral sinus tract in multiple mandibular anterior teeth. Clinical examination, radiographic assessment, and vitality testing were performed. Initial nonsurgical root canal treatment was completed on teeth #22, #25, and #26, followed by aspiration. When no healing was observed at recall, surgical endodontic treatment with guided tissue regeneration was completed on teeth #24-26. Twelve-month post-treatment evaluation demonstrated complete symptom resolution, sinus tract closure, and radiographic evidence of osseous regeneration. Patients with vitamin D-resistant rickets present unique challenges for endodontic treatment due to impaired hard tissue mineralization and healing capacity. This case report demonstrates that adults with vitamin D-resistant rickets can achieve favorable endodontic outcomes, both surgically and nonsurgically.