Hear more from Dr. Dabuleanu on the management of root perforations on CDA Oasis: bit.ly/3izxvLX ensues, healing is unlikely. In fact, it can reduce the chances of successful root canal treatment by 56%, largely due to bacterial contamination during or after treatment.3 Several key factors have been associated with pathologic sequelae and thus prognosis of the tooth.These include the site of the perforation, size of the perforation, time to repair and, more recently, the material used for the repair (see Case Study 2). (Top to bottom) Images showing perforation in search of the mesiolingual canal. The perforation was repaired with MTA and retreatment was completed. The was no periodontal pocketing associated with the perforation. References: 1. Saed S, Ashley M, Darcey J. Root perforations: aetiology, management strategies and outcomes. The hole truth. Br Dent J. 2016;220(4):171–80. 2. Kvinnsland I, Oswald R J, Halse A, Grønningsaeter AG. A clinical and roentgenological study of 55 cases of root perforation. Int Endod J. 1989;22(2):75–84. 3. Ng Y L, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int Endod J. 2011;44(7):583–609. “Since its introduction in 1993, the mineral trioxide aggregate (MTA) has revolutionized endodontics with applications such as root filling, vital pulp therapy, apical plug, perforation repair and root canal filling,” explains Dr. Dabuleanu. MTA offers multiple benefits such as a good seal and it is biocompatible. Hydroxyapatite crystals form over MTA when the material is in contact with tissue fluid. With most dental materials, the bond strength decreases significantly when in contact with moisture, but MTA requires the presence of water during setting. Therefore, cured MTA can acquire its optimal strength and produce an excellent seal in the inherently moist environment of the perforation. However, the use of MTA can have some disadvantages such as a relatively long setting time that can compromise application and possible discolouration of the tooth that can compromise esthetics, especially in patients with a high lip line. Newer, similar materials, such as Biodentine may address these handling issues. But there is little data to support the use of these materials. “The key is it’s not just about the product, it’s about having good illumination and magnification, to see the exact anatomy of that perforation you need to see the margins,” says Dr. Dabuleanu. “You need to know if you’ve got a firm base below the hole that will support the bioceramic so it doesn’t spill right out into the tissue.” Several key factors have been associated with pathologic sequelae and thus prognosis of the tooth. These include the site of the perforation, size of the perforation, time to repair and, more recently, the material used for the repair. Case Study 2 31 Issue 1 | 2023 | SupportingYour Practice
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