Root perforations: a review of diagnosis, prognosis and materials

Abstract

Root perforation results in the communication between root canal walls and periodontal space (external tooth surface). It is commonly caused by an operative procedural accident or pathological alteration (such as extensive dental caries, and external or internal inflammatory root resorption). Different factors may predispose to this communication, such as the presence of pulp stones, calcification, resorptions, tooth malposition (unusual inclination in the arch, tipping or rotation), an extra-coronal restoration or intracanal posts. The diagnosis of dental pulp and/or periapical tissue previous to root perforation is an important predictor of prognosis (including such issues as clinically healthy pulp, inflamed or infected pulp, primary or secondary infection, and presence or absence of intracanal post). Clinical and imaging exams are necessary to identify root perforation. Cone-beam computed tomography constitutes an important resource for the diagnosis and prognosis of this clinical condition. Clinical factors influencing the prognosis and healing of root perforations include its treatment timeline, extent and location. A small root perforation, sealed immediately and apical to the crest bone and epithelial attachment, presents with a better prognosis. The three most widely recommended materials to seal root perforations have been calcium hydroxide, mineral trioxide aggregate and calcium silicate cements. This review aimed to discuss contemporary therapeutic alternatives to treat root canal perforations. Accordingly, the essential aspects for repairing this deleterious tissue injury will be addressed, including its diagnosis, prognosis, and a discussion about the materials actually suggested to seal root canal perforation.

In Vitro Effect of Putty Calcium Silicate Materials on Human Periodontal Ligament Stem Cells

“…In our daily practice, it is common to find in some problematic cases with lesions such as external or internal resorption, iatrogenic perforations, or periapical lesions that have a doubtful prognosis especially when there is a radiolucent area adjacent to the perforation site, and therefore it is necessary to perform apical surgery with a retrograde root filling [1,2].…”

Anatomical danger zone reconsidered: a micro‐CT study on dentine thickness in mandibular molars

“…Midroot perforations are normally caused by over-instrumentation on an already thin dentinal wall, which may seriously compromise the outcome of root canal treatment (Estrela et al 2018). These perforations have been related historically to the distal area of mesial roots in mandibular molars, and thus, Abou-Rass et al (1980) introduced the concept of the 'danger zone' (DZ) in the early 1980s.…”

A 16-year-old boy with chronic discharging sinus on upper left lateral incisor tooth

“…changed color in the tooth crown), radiographic diagnosis, conventional and cone beam computed tomography, light microscopy and electron microscopy. 25,34 Radiographically, it appears as a round-to-oval radiolucency with uniform density and symmetrical enlargement of the pulp space. The margins are smooth and clearly defined with distortion of the original root canal outline and the original canal shape is lost at the site of resorption.…”

“…[23][24] Calcium hydroxide also used as an intracanal medicament and a favorable result was achieved in the present and previous studies. [25][26] Repair with mineral trioxide aggregate Dr. Hossain: In the case when resorptive defect was seen on the apical part of the root canal with perforation of the root, this can be repaired by mineral trioxide aggregate because it is biocompatible, has superior sealing ability, induces osteogenesis and cementogenesis as well as well tolerated in the periapical tissue. [27][28][29] Furthermore, when used as a root end filling material in the absence of infection, it also helps to regeneration of the periodontium.…”