Root perforation and external root resorption.
Patient referred by a colleague with a complaint of fistula in the upper anterior gingiva, with a history of treatment with another colleague, in which the patient reported a perforation during treatment. On clinical examination, nothing noteworthy but confirmation of the main complaint. Radiographic examination revealed the causative inflammatory process in the periapical region.
In the first visit, preparation with Hypochlorite 2.5%, PUI, PDT and medication with Bio C Temp (Angelus). In the second visit, after 20 days, remission of the fistula and absence of any signs or symptoms were observed. We then opted for prior closure of the perforation with Bio C Repair (Angelus) and subsequent obturation of the root canal.
The patient was informed about the risks and alternatives in case of failure, and the next treatment would be endodontic surgery.
In: Candeiro et al. Research, Society and Development, v. 11, n. 2, e8911225474, 2022:
During the stages of endodontic treatment accidents and complications may occur, which in most cases
their resolution may represent a challenge for the clinician (Gonzalez, 1990). Root perforation is an accident characterized
by the communication between the pulp space or root canal with the periodontal tissues supporting the dental element.
This type of complication can occur due to extensive caries, root resorption or even due to the
incorrect use of drills and other endodontic instruments (Alrahabi et al, 2019).
The presence of pulpal nodules, calcifications, curved canals, operator experience and malposition
dentistry are the main predisposing factors for the occurrence of iatrogenic root perforations (Estrela et al., 2017,
2018; Evans, 2021). Iatrogenic root perforations occur in approximately 2% to 12% of endodontically treated
teeth (Tsesis et al., 2010; Tsesis & Fuss, 2006) and the prognosis in these cases depends on the size, location and
time of occurrence of the perforation (Z. Fuss & Trope, 1996). Seltzer et al. evaluated accidental root perforations in
monkeys that were treated immediately or after various time intervals. The most important factors influencing
healing were the time between perforation occurrence and closure as well as the location of the perforation (Seltzer et al.,
1970).
The treatment of root perforations requires the use of biocompatible materials that are inert or
preferably induce tissue repair. In this context, mineral trioxide aggregate (MTA) has traditionally
been considered the first choice for the repair of root perforations (Tawil et al., 2015). MTA has
biocompatibility, good sealing ability and calcium ion release, being physical and biological properties that
favor its use in cases of root perforation (Dawood et al., 2017). As disadvantages, MTA has a difficult
manipulation and insertion, besides the possibility of darkening of the dental structure.
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