Introduction: A radicular perforation caused by an inflammatory internal root resorption was present in a maxillary lateral incisor.
Methods: The root canal preparation was completed with hand files and thorough irrigation. Calcium hydroxide was placed as a temporary dressing for 10 days. At the second visit, the root canal with resorption lacuna was filled with warm vertical compaction of gutta-percha. The coronal access was restored with composite resin. A surgical flap was elevated to repair the resorption defect with gray mineral trioxide aggregate. The bony defect adjacent to the perforated lesion was filled with Unigraft (Unicare Biomedical, Laguna Hills, CA).
Results: The tooth was in function with satisfactory clinical and radiographic results after 48 months.
Conclusions: According to the long term results of this case, successful sealing of a perforating defect is possible with mineral trioxide aggregate.