Present status and future directions – Managing perforations

Abstract

Root perforations are severe complications and are associated with compromised endodontic treatment outcomes, especially when bacterial infection is allowed to establish. Perforations may occur due to pathological processes or treatment consequences. Various dental materials have been proposed over the years for perforation repair with varying degrees of success. The use of bioactive materials, such as mineral trioxide aggregate (MTA) and other calcium-silicate cements, promotes a favourable environment for regeneration and has been used successfully for perforation repair. This is in contrast to materials used previously that often led to unpredictable outcomes. With the increasing range of new bioactive endodontic materials available, the number of potential materials being used for repair of root perforations is growing. Though promising to date, there is little evidence to support the use of most of these new materials. The aim of this narrative review is to provide the background, clinical techniques and outcome of nonsurgical and surgical perforation repair.

Biodentine Inhibits the Initial Microbial Adhesion of Oral Microbiota In Vivo

“…A limitation using silicate cements is the long setting time of up to 3 h for MTA and approximately 45 min for Biodentine [10,38]. The presence of water is necessary for setting and there is a potential of MTA being washed out whenever there is a communication between the oral cavity and the perforation [39]. Using calcium silicates in endodontics and as a dentine replacement, discolorations of the regarding tooth may occur [40].…”

To Evaluate the Accuracy Between Two Different Electronic Apex Locators to Detect the Root Canal Perforation During Retreatment - An Ex-Vivo Study

“…(8) According to American Association of Endodontics (AAE), perforations can be defined as a mechanical or pathological communication which occurs between root canal and external surface of the tooth. (1) Pathological perforations are detected during routine clinical examination , whereas iatrogenic root perforations are generally noted during operative procedures. Endodontic therapy failure can happen from procedural operating errors at any moment during root canal treatment.…”

“…For an endodontic therapy to be successful there should not be presence of any clinical symptoms and radiological evidence which includes bone loss and non-healing lesions. If these symptoms persist the case may be considered for retreatment, the main causes of endodontic failure are: (1) 1. Incomplete removal of remnants of the pulp tissue in isthmus 2.…”

“…Reinfection and flare ups The success rates of endodontic therapy can be influenced by root perforations which is one of the most difficult procedures to deal with during retreatment. (1) Perforation can either be due to caries or resorptive process or could be iatrogenic (3-10%). Many factors contribute to the healing of these perforation sites, including the time from detection of the perforation and its closure, the size and shape of the perforation, and its location.…”

Sealing Ability of Bioactive Root-End Filling Materials in Retro Cavities Prepared with Er,Cr:YSGG Laser and Ultrasonic Techniques

“…MTA is the most commonly used root-end filling material, due to its moisture tolerance, sealing ability, marginal adaptation, bioactive characteristics [ 17 , 18 ], cementogenesis potential, and dentinogenic activity [ 18 , 19 ]. It is composed of Portland cement, with 4:1 addition of bismuth oxide.…”