Root perforations: aetiology, management strategies and outcomes. The hole truth

Saed, S. Mohammed; Ashley, Martin; Darcey, James

doi:10.1038/sj.bdj.2016.132

Cited by 27 publications

(29 citation statements)

References 40 publications

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“…7 Root perforation can be managed either surgically or nonsurgically, and the choice depends upon the accessibility and visibility of the perforation area, duration and size, patient's oral hygiene, and periodontal condition. 4 In case report 1, the location of perforation was in the apical area of the root, and repair was planned surgically after obturation of canal space. Endoseal MTA was used as a sealer along with customized gutta-percha for obturation.…”

Section: Discussionmentioning

confidence: 99%

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Management of Internal Resorption with Perforation

Shekar¹,

Girija²

2018

Journal of Operative Dentistry &Amp; Endodontics

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Internal root resorption is a pathologic intraradicular process in which there is loss of dental hard tissue due to osteoclastic acti vity inside the root canal space. It is a rare lesion of permanent teeth, which might be caused due to caries, trauma, restorative procedures, etc. Because of its insidious pathology, it can extend to significant dimensions before being diagnosed and may lead to perforation to external root surface due to progressive odontoclastic activity. This article describes two case reports of surgical management of a perforating internal resorption in maxillary central incisors, managed by routine root canal treat ment, followed by repair with Biodentine and mineral trioxide aggregate (MTA). About 12 to 24 months of followup demon strated clinically asymptomatic and adequately functional tooth, with radiographic signs of healing. Care was taken to conserve the tooth structure and avoid further weakening of the already compromised tooth. A tooth deemed to have a questionable prognosis was conserved and found to demonstrate satisfactory healing with no radiographic evidence of progressive resorption.

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Section: Discussionmentioning

confidence: 99%

“…However, in cases in which a pathway between the pulp canal space and the periodontal tissues is present, root canal treatment should be followed by repair of the perforation site with a suitable sealing biomaterial. 4…”

Section: Introductionmentioning

confidence: 99%

Management of Internal Resorption with Perforation

Shekar¹,

Girija²

2018

Journal of Operative Dentistry &Amp; Endodontics

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“…However, excessive tooth loss during access preparation can make the post‐RCT restoration unfavorable and weaken the overall tooth structure. Iatrogenic perforation can greatly jeopardize the survival of the tooth due to the potential for secondary periodontal attachment loss 3–5 . Improper access to the pulp chamber blocks the straight‐line view and hence also hinders instrument access.…”

Section: Introductionmentioning

confidence: 99%

Access opening guide produced using a 3D printer (AOG‐3DP) as an effective tool in difficult cases for dental students

Choi

Jeon

Cho

et al. 2021

Journal of Dental Education

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Objectives The aim of this study was to determine the effectiveness of using an access opening guide in teaching ideal access opening shape and preventing excessive tooth loss, with a focus on predoctoral dental students. Methods Ninety teeth that were mounted in a box just below the level of the cementoenamel junction using tray resin were randomly divided into two study groups. An access opening guide produced using a 3D printer (AOG‐3DP) was designed using cone‐beam computed tomography (CBCT). The AOG‐3DP was applied in the test groups, while no aid was used in the control group. Access preparations in both groups performed by predoctoral dental students were scanned using CBCT to detect overpreparation. The preparation time and access cavity volume were evaluated. Results The mean times required for achieving access opening were 327.2 and 97.4 s in the control and AOG‐3DP groups, respectively, for premolars, and 547.4 and 104.5 s for molars. The mean volumes for premolars and molars differed from the ideal cavities by 38.1 and 72.2 mm3, respectively, in the control group, and by −2.0 and −8.7 mm3 the AOG‐3DP group. Conclusions Using the AOG‐3DP significantly reduced the access opening time for premolars and molars. However, there is a limitation in that CBCT DICOM images must be converted to stereolithographic .stl files in order to be printed via 3D technology. This requires additional preclinical treatment time for imaging and subsequent printing. It could be considered that this can be a useful method in difficult cases.

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“…Numerous reports have been published on how to handle or avoid a perforation, but less is known about the rate of these unexpected incidents in endodontics. Perforations have been estimated to account for up to 10% of all failed endodontic cases [2]. The estimates vary, however, depending on the definition of a perforation and the tooth type evaluated.…”

Section: Introductionmentioning

confidence: 99%

Accidental perforations during root canal treatment: an 8-year nationwide perspective on healthcare malpractice claims

Vehkalahti

Swanljung

2020

Clin Oral Invest

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Objectives To assess occurrence and its variation over time of serious accidental perforations during endodontic treatment and the fate of perforated teeth by tooth type and characteristics of patients and dentists. Materials and methods Data, based on patient documents on healthcare malpractice claims, comprised all endodontic injuries (n = 970) verified by the Patient Insurance Centre in Finland in 2002-2006 and 2011-2013. Two specialists in endodontics scrutinized the documents. Accidental perforations were recorded by location (tooth type, chamber/canals) and dichotomized as avoidable (could have been avoided by following good clinical practice) or unavoidable (normal treatment-related risks). Fate of perforation cases was recorded as treatment discontinued, root canal(s) filled, or tooth extracted. Background information included patients' and dentists' sex and age and the service sector. Statistical evaluation used Chi-square tests. Results Serious accidental perforations comprised 29% of all verified injuries. Most perforations were judged as avoidable: 93% in patients aged below 35 years, 87% when located in the pulp chamber or in molars (84%); 70% of all perforations and 75% of those in molars resulted in tooth extraction. The overall rate of serious accidental perforations was 17.6 cases per 100,000 endodontic patients per year. Conclusions The rate of serious accidental perforations increased over time. The majority was in molars and resulted in tooth extraction. Clinical relevance Accidental perforations comprise almost a third of serious injuries during root canal treatment. However, four of five perforations could be avoided by following good clinical practice. Therefore, training is needed before adopting new working equipment and methods.

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Root perforations: aetiology, management strategies and outcomes. The hole truth

Cited by 27 publications

References 40 publications

Management of Internal Resorption with Perforation

Management of Internal Resorption with Perforation

Access opening guide produced using a 3D printer (AOG‐3DP) as an effective tool in difficult cases for dental students

Accidental perforations during root canal treatment: an 8-year nationwide perspective on healthcare malpractice claims

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