Lateral perforation, above the bone margin. What should I do?
Has a perforation occurred during access surgery and is there no further bone damage above the bone margin?
The following is a guide to immediate endodontic perforation in lateral perforations treated with bioceramic materials and composite resin.
In: Fukunaga D, Barberini AF, Shimabuko DM, Morilhas C, Belardinelli B, Akabane CE. Use of mineral trioxide aggregate (MTA) in the treatment of root perforations: clinical case report. Revista de Odontologia da Universidade Cidade de São Paulo 2007 Sep-Dec; 19(3):347-53
INTRODUCTION
With the resources available to modern dentistry
, endodontic treatment has a success rate
of close to 95%, according to Grossman5 (1983); Ingle9
(1961). However, the possibility of failure exists
when there is no correct knowledge of the dental anatomy and its variations, the operative techniques,
instruments and materials used, and a
correct diagnosis is not made, leading to errors and accidents during treatment.
The installation of communications between the pulp cavity
and the periodontal tissues is the result of pathological processes such as extensive carious lesions or iatrogenic
mechanisms during endodontic
therapy (incorrect direction of trepanning, excessive dentin
wear, inadvertent use of rotary
instruments) or also in post-endodontic
restorative procedures (making intra-root retainers). (Páttaro et al.15 2004)
As far as these are concerned, professionals can minimize them
by using accurate techniques, safer instruments
that are easy to handle, and knowledge acquired through
reading, research and clinical practice.
We can minimize the consequences of these errors and
accidents by using retrofilling materials that
are restorative, sealing, inert, biocompatible, radiopaque and have good adhesion to dentin.
These materials can be amalgam, calcium hydroxide
, glass ionomer, composite resin and MTA
(Mineral Trioxide Aggregate), among others. Because
is a relatively new material on the market, MTA
has been the subject of a great deal of research into
its characteristics, behavior and indications,
even comparing it to materials commonly used today. (Ruiz et al.17 2003).
MTA was developed by Mahmoud Torabinejad, a professor and researcher at Loma University
Linda, California (USA), and its clinical indications
are pulp capping, pulpotomy (in teeth
with unformed root apexes), necrotic pulps
(in the form of an apical plug), repair of perforations
root canal, internal resorption, intracanal or through
surgical intervention, as a retro-obturator material,
in addition to stimulating the deposition of root cementum (Torabinejad and Chivian19,1999; Ruiz et al.17 2003). It has been studied for its potential to seal
between the root canal system and the external surface of the tooth.
In a study on dogs, Ford et al.4
(1995) observed the use of MTA, compared to amalgam,
in the treatment of furcation perforations. The researchers
made perforations in the floor of the pulp cavities of the teeth, where half of them were restored immediately with amalgam and MTA, and the other
half were treated, after exposure to the oral environment
for six weeks. The results were collected after four months, showing that there was cementum formation
on the MTA in 83.33%, no bacterial presence, no epithelial proliferation, and moderate inflammation
in 16.66% of the cases, when treated immediately.
In the group where the perforations were exposed to the oral
environment, cementum was formed on the MTA in
28.57%, with no bacterial presence, epithelial proliferation
in 42.85% and moderate inflammation in 28.57%
and severe in 28.57% of cases. MTA proved to be superior to amalgam in all the aspects described.
Nakata et al.13 (1998) also found that there was no bacterial penetration (Fusobacterium nucleatum) in all the teeth
in which the perforation was sealed with MTA. The same
occurred in the in vitro study carried out by Torabinejad et
al.20,21 (1995) on the bacterial penetration power
of Staphylococcus epidermidis, in which the results showed that MTA did not allow bacterial proliferation,
during the period of the experiment (ninety days).
Root perforation with bone damage
