Iatrogenic apical root perforation performed during retreatment of a mandibular central incisor: A five-year follow-up case study

Abstract

Introduction: Iatrogenic root perforations occur in approximately 2% to 12% of cases involving inaccurate root canal access, attempt to locate canal orifices, instrumentation or reinstrumentation and bypassing or removal of fractured instruments. When these perforations are performed in the apical thirds, they may even lead to tooth loss due to the greater complexity of treatment. Objective: The aim of this paper was to report the occurrence of an iatrogenic apical root perforation during retreatment of a mandibular central incisor. Methods: Based on clinical and radiographic examinations, a mandibular right central incisor was diagnosed with pulp necrosis and asymptomatic apical periodontitis. Nonsurgical endodontic therapy was recommended. The final radiographic examination revealed poor endodontic treatment; for this reason, nonsurgical reintervention was the therapy of choice. The final radiograph showed apical perforation due to deviation near the apical limit. It was therefore decided that the case should be merely monitored. Results: Clinical and radiographic followups after 5 years showed the successful outcome of this decision. Conclusion: In clinical situations similar to what is shown in this case report, making the correct clinical decision, considering the characteristics of each case, is more important to long-term success than effective action.

Renovation of iatrogenic defect- A case report

“…Root canal perforation not only depicts direct damage to the root structure with mechanical weakening of the tooth but also induce insults to the periosteum, thereby potentiating entry of microorganism. 1 Successful repair of perforation depends on the ability to seal the perforation and to re-establish a healthy periodontal apparatus. The prognosis of teeth with root perforations depends on the severity of the initial damage to the periodontal tissues, the size of the perforation, the level of the perforation in relation to alveolar crest, the time lapse between perforation and repair, the adequacy of the perforation seal, the sterility of the perforation and the biocompatibility of the material used to repair at the site.…”

“…Among them perforation, is one of the most common causes of endodontic treatment failure with the incidence rate ranging from 2.3% to 12%. 1 Perforation can be defined as pathological or mechanical communication between the root canal system and the peri-radicular tissues/oral cavity and its aetiology could be pathologic, restorative, or iatrogenic. All these procedural operative errors may lead to treatment failure.…”

Frequently affected teeth by different types of iatrogenic perforations made during dental training in Bulgaria

“…Iatrogenic root perforations are accidents that occur during access ,instrumentation or attempted bypassing or removal of fractured instruments during endodontic treatment or retreatment and misaligned instruments during post-space preparation [13][14][15][16] .…”

Bioceramics in Endodontics: Updates and Future Perspectives

“…The management of root resorption can include conservative or surgical treatment, depending on the location, degree, and extent of occurrence [ 272 ] ( Figure 13 ). Root resorption and perforation appear together in many cases, and MTA used in their treatment has been reported to have satisfactory long-term results [ 273 , 274 , 275 , 276 , 277 , 278 , 279 , 280 ].…”