Nonsurgical Management of Apical Root Perforation Using Mineral Trioxide Aggregate

Abstract

This study illustrates a conservative approach to nonsurgical management of apical root perforation in maxillary first molars. A patient was referred for retreatment of a maxillary left first molar. Her chief complaint was dull pain while biting in her maxillary left first molar. Periapical radiography showed radiolucency related to the mesiobuccal root and overextended gutta-percha through a perforation in the apical part of the distobuccal root. A CBCT scan was acquired and revealed the location and size of the apical perforation. The clinical examination showed that the tooth has been endodontically treated and the canals were filled, tender to percussion and palpation. Thus, the nonsurgical root canal retreatment was done and the perforation site was repaired by using mineral trioxide aggregate (MTA). At the one-year follow-up, after the management of apical root perforation, we observed periapical tissue healing and no pain due to percussion and palpation, without any clinical/radiological signs or symptoms. The prognosis of this case has a higher success rate with the development of new materials such as MTA. The MTA not only can seal the site of the perforation but also has the ability to induce calcification. Many factors can contribute to the success rate of perforated cases, including time, size, and location of the perforation. With the use of this material and good tools like a microscope, there are those with having higher chances of repair and eventually higher success rates.

Surgical and Non-surgical Repair of Iatrogenic and Carious Perforation using Biodentine: A Case Report

“…According to the glossary of endodontic terms, root perforation is defined as the mechanical or pathological communication between the root canal system and the external tooth surface. 6 Accidental root perforations occur in approximately 2% -12% of endodontically treated teeth 7 which may occur during access cavity opening, root canal preparation during post preparation, or during retreatment which was the major cause of iatrogenic perforation in the second case. Diagnosis of root perforation can be through clinical and imaging examination.…”

Perawatan non bedah pada perforasi koronal iatrogenik gigi insisivus sentral kanan atas menggunakan mineral trioksida agregat: Laporan kasus

“…9 MTA memiliki kandungan kalsium silikat yang dapat melepaskan kalsium sehingga dapat meningkatkan kemampuan penutupan perforasi dengan mendorong pembentukan dan perbaikan jaringan baru. 15 Kemampuan penutupan perforasi berhubungan dengan perawatan saluran akar yang akan dilakukan sehingga dengan adanya bahan penutupan perforasi yang adekuat, prognosis perawatan saluran akar mengalami peningkatan. 6 Berdasarkan 12 tinjauan sistematis, 72,5% mengalami keberhasilan untuk perawatan non bedah endodontik pada perforasi akar sedangkan jika menggunakan MTA sebagai bahan penutupan perforasi dapat meningkatkan angka keberhasilan perawatan sebesar 80,9%.…”

Clinical Properties and Efficacy of MTA VS Biodentine VS GIC in Repairing Root Perforations

“…Arandi and Thabet (2021) support biodentine by claiming that it has a good clinical efficacy when it comes to pulp capping [17]. According to Alzahrani and Alghamdi (2021), MTA contributed to tissue healing without pain due to palpation and percussion [18]. Aldayri et al (2019, P.10) roots for MTA in the sense that it can be utilized in "furcal perforated-pulpotomized primary molars" as a repair material [19].…”