Access surgery. Perforation prevention.

Care to prevent perforation during endodontic access surgery.

In: Coutinho & Paulo.

Endodontic treatment of tooth 14 with cervical perforation using MTA: clinical case report.

Introduction

Perforations are defined as mechanical or pathological communication between the root canal system and the external surface of the tooth. Accidents during endodontic treatment can arise from pathological processes, i.e. resorption and caries processes, or from iatrogenic causes during endodontic therapy, including canal morphology, error during the surgical access phase, failure during chemical mechanical preparation due to inadequate wear of the canal walls, calcifications, perforations caused by preparations for intracanal pins motivated by negligence, recklessness or inexperience on the part of the professional. Root perforations can lead to the failure of endodontic treatment and, if not detected and treated properly, due to the breakdown of the periodontium, can lead to the loss of the tooth.

Injury to the periodontium due to perforation results in the development of inflammation, destruction of periodontal fibers, bone resorption, formation of granulomatous tissue, epithelial proliferation and, finally, the development of a periodontal pocket. The ideal material for treating perforations must seal the communication pathways between the root canal system and the surrounding tissues. The material must be as biocompatible as possible with the host tissues, must not change its seal due to the presence of moisture, must be easy to handle and use, must be radiopaque to facilitate recognition on radiographs and must be insoluble in tissue fluids. MTA was developed by Mahmoud Torabinejad, a researcher and professor at Loma Linda University, California (USA), and is the most suitable material for treating root perforations, due to its sealing capacity and biocompatibility with surrounding tissues.

It comes in the form of a white or gray powder containing hydrophilic particles, the main components of which are: tricalcium silicate, tricalcium aluminate, tricalcium oxide and bismuth oxide, which is responsible for radiopacity.6 It is currently considered the most appropriate material for treating perforations, with satisfactory results.

Access surgery. Perforation prevention.