This case study delves into an uncommon occurrence of internal root resorption (IRR), an inflammatory variant with perforation of root, in the left central incisor, which seems to have a prevalence ranging from 0.01% to 1%. The patient presented with pain in the upper left front tooth, leading to a diagnosis of pulpal necrosis with symptomatic apical periodontitis. The initial phase involved identifying the three-dimensional overview of resorption and perforation using cone-beam computed tomography and nonsurgical root canal treatment utilizing orthograde mineral trioxide aggregate (MTA) placement and thermoplasticized obturation technique, aided by sonic-irrigation, and intracanal medicament under magnification. In the later phase, based on the clinical and radiographical evaluation and addressing the complexities of the perforative resorptive lesion, surgical approach needed to be performed. A 6-month follow-up revealed the arrest of IRR and a satisfactory overall outcome. This case report discusses the etiology, prevalence, clinical decision-making, and therapeutic management of IRR.