Apicoectomy of Perforated Root Canal Using Bioceramic Cement and Photodynamic Therapy

Abstract

Root perforation is a common endodontic accident. Its management depends mainly on root canal disinfection and sealing the perforation area by preventing any communication with the periodontium to prevent recontamination. A patient was referred to treat root perforation due to a previous treatment of tooth #22. The diagnosis was symptomatic periapical periodontitis, and the treatment plan was to retreat the root canal of #22 and make a surgical intervention (apicoectomy) associated with antimicrobial photodynamic therapy as a complementary technique. Five mineral oxides (5MO) cement was used as a root-end filling material. The procedures were performed in two sessions and controlled in two visits (after 30 days and 12 months). A bone neoformation was observed at the periapical area of tooth #22. 5MO bioceramic cement was effective in inducing the repair of the periapical lesion and had the ability to seal the exposed periapical area of the tooth. Its success depended mainly on root canal and surgical site disinfection.

Endodontic Perforation Closure by Five Mineral Oxides Silicate-Based Cement with/without Collagen Sponge Matrix

“…It was stated in the literature that the adequate disinfection of the root canal system and the sealing site, associated with the sealing ability of 5MO bioceramic cement results in satisfactory clinical and radiographic healing [18].…”

“…The silicate-based cement sealing should be associated with root canal disinfection to guarantee the success of the root canal treatment in perforated [ 26 ] or immature teeth [ 18 ]. MTA presented a satisfactory antibacterial effect over some facultative bacteria, but no effect over strict anaerobic bacteria [ 27 ].…”

“…It was stated in the literature that the adequate disinfection of the root canal system and the sealing site, associated with the sealing ability of 5MO bioceramic cement results in satisfactory clinical and radiographic healing [ 18 ]. This disinfection was achieved in the current case report by the antimicrobial action of sodium hypochlorite as endodontic irrigant [ 29 , 30 ] and calcium hydroxide as a dressing [ 31 ].…”

“…Other factors play a major role in healing, and preventing the lesion progression is the matrix metalloproteinases deactivation and endotoxins (LPS and LTA) detoxification, and this may be achieved by the irrigation of the root canal system by sodium hypochlorite [ 30 , 32 ], besides the sealing ability of the 5MO cement [ 18 ] and the good biocompatibility, osteoconductivity, and osteoinductivity of silicate-based cements [ 33 ].…”

“…Five mineral oxides “5MO” is a new repair silicate-based cement, derived from Portland cement, developed to treat all endodontic complications and accidents (patent). As a capping material, it is effective as Ca(OH) 2 (Dycal) [ 15 ] and MTA [ 16 ] and as a root-end filling material in apicoectomy [ 17 , 18 ].…”