Iatrogenic Root Perforation Research Articles

Treatment options for iatrogenic root perforation: report of three cases

Treatment options for iatrogenic root perforation: report of three cases

Iatrogenic Root Perforations: Case Report

Root perforation, a connection between the root canal system and tooth surface, is a common cause of endodontic therapy failures. Caused by pathological conditions or operative errors, it can occur during access cavities, root canal preparation, or post-preparation. A 28-year-old patient was diagnosed with a vestibular medium-sized infra-osseous perforation during root post realization. Despite no systemic disorders, the patient showed physiologic movement and was slightly sensitive to pressure. A flap surgical treatment was chosen to remove excess material and enable tissue regeneration. Biodentine® was used to prevent future discolorations. The patient underwent an intrasulcular incision, flap raised, cavity cleaned, disinfected, revised, and sealed using an anterior Schilder plugger. Root perforations are common errors caused by factors like anatomy, caries, pulp calcifications, and intracanal posts. Diagnosis is based on clinical signs, radiographic examinations, and imaging techniques. The prognosis depends on preventing bacterial infection. The ideal reparation material should stimulate bone formation, be biocompatible, maintain sealing, and not disintegrate in tissue fluid. Equivalent materials like Biodentine® offer advantages in protocol, antibacterial power, and bioactive properties. Radicular perforations, a significant dental issue, can be prevented through early management using modern techniques and clinical training, ensuring long-term success in endodontic treatments.

Management of iatrogenic root perforation using mineral trioxide aggregate as a repair material – A case report

Root perforations are one of the unsolicited complications of endodontic treatment. Early diagnosis of the defect, location of the perforation, choice of treatment materials used, host response, and practitioner’s experience are the factors responsible for the successful management of root perforations. Perforations should be managed as soon as they are diagnosed. Several materials have been used for the management of root perforations, out of which Mineral trioxide aggregate is the most commonly used repair material. This case report presents the successful non-surgical management of iatrogenic perforation; repaired, treated and sealed with MTA.

Management of root perforation and sodium hypochlorite extrusion injury

A patient was brought to A&E by their GDP who had injected sodium hypochlorite (NaOCl) through a perforation in the patient's LR4, resulting in pain, swelling and immediate formation of a large, necrotic ulcer. Within 2 days, the patient developed paraesthesia in the distribution of the right mental nerve. Antibiotics and steroids were prescribed to alleviate the acute symptoms. The perforation was repaired with mineral trioxide aggregate (MTA) and root canal treatment was completed with the aid of a microscope. Review appointments were arranged to monitor healing of the injury.CPD/Clinical Relevance: Management of iatrogenic root perforation and associated NaOCl injury is useful knowledge.

PREVALENCE OF IATROGENIC PERFORATIONS ACCORDING TO THEIR LOCATION AND AFFECTED ROOT SURFACES

Background: The location of the endodontic perforation has shown a strong correlation with the healing process and successful outcome. The aim of this study was to determine the prevalence of iatrogenic perforations according to their location and affected root surfaces. Materials and methods: Over a period of 7 years, 100 cases of iatrogenic root perforations were recorded from the digital radiographs of each case. The perforations were classified according to the following criteria: (1) perforation location – cervical, furcation, stripping, lateral, and apical (2) affected root surface. The prevalence of different types of perforation was calculated and subjected to statistical analysis. Results: Among all types of perforations, the most common are those located in the furcation area of the molars (46%), followed by lateral root perforation (35.8%). The mesial root surfaces are most often affected by iatrogenic perforations (71.9%), followed by the distal ones (21%). Conclusion: Prior to root canal treatment, it is essential to assess the morphologic conditions in the key areas prone to iatrogenic perforations.

ENDODONTIC MANAGEMENT OF CALCIFIC METAMORPHOSIS IN MAXILLARY CENTRAL INCISOR: A CASE REPORT

Calcific metamorphosis is a pulpal reaction to dental trauma where the root canal gets obliterated by the deposition of hard tissue within the root canal space. Calcified root canal possesses a great challenge to the endodontist as negotiating such canal is very much difficult and tiring job along with risk of iatrogenic root perforation. Negotiation of root canal during endodontic treatment is very much crucial for its success as it could affect the cleaning, shaping, disinfection and finally 3 dimensional obturation of the root canal. This case report demonstrates the clinical management of maxillary central incisor with calcified canal in a 28 years old female patient with a history of trauma 2 years back. The preoperative radiograph shows complete obliteration of the canal up to coronal 2/3rd of the root canal along with widening of the periodontal ligament space. The only way to locate and negotiate such calcified canal was to remove the calcified pulp tissue from the canal while staying centered within the root during negotiation. Control radiograph was taken to rule out any deviation from the root’s centre during negotiation. Once the calcified tissue from the coronal 3rd of the root was removed using fine ultrasonic instruments, a #08 C+ file in a watch winding motion along with alternate use of 5.25% sodium hypochlorite and 17% EDTA was then used to negotiate the remainder of the canal. After negotiation of the calcified canal of tooth #21, it was then successfully cleaned, shaped and obturated till the apical terminus.

Multidisciplinary treatment approach of a large periapical cyst with an iatrogenic root perforation: Three year follow-up

The undesired complications of endodontic treatment are iatrogenic root perforations. Mineral trioxide aggregate (MTA) is widely used to seal perforations because of its biocompatibility and sealability property. Radicular cysts are the most commonly occurring cystic lesions in the oral cavity. In this present case report, a multidisciplinary approach involving the expertise of endodontist and oral surgeon successfully manages the surgical treatment of a large-infected cyst combined with a root perforation associated with maxillary central and lateral incisors.

Management of iatrogenic root perforation with grade II furcation involvement through guided tissue regeneration technique: A case with comprehensive review of clinical literature

The aim of this case report was to describe a successful repair of a long-standing furcal and coronal root perforation with grade II furcation involvement in the mesiolingual canal of a lower first molar. A 41-year-old male patient reported with the chief complaint of mild intermittent pain and pus discharge from mandibular left first molar for 1 year. Upon clinical and radiographic examination, a pulpal diagnosis of previously initiated therapy with root perforation was made. In addition, the tooth had a periapical diagnosis of chronic apical abscess, as well as a primary endodontic and secondary periodontal lesion with grade II furcation involvement. Root canal treatment and surgical repair of the perforation and furcation involvement with Mineral Trioxide Aggregate and bone graft was done. Recall examination after 2 years showed no evidence of periodontal breakdown. The patient was asymptomatic, and favorable bone regeneration and periodontal healing were seen on the radiograph. A literature review was also conducted to assess the factors affecting the prognosis of perforation repair in molars. Long-standing cervical root and furcal perforations readily lead to persistent endo-perio lesions and have been found to have the worst prognosis. A biocompatible sealing of the perforation site along with periodontal regeneration effectively enhances the longevity of such teeth. Though there are very few case reports that advocated the use of guided tissue regeneration for periodontal regeneration, nevertheless it has proven to be a reliable technique to improve the prognosis for crestal level and furcal root perforations.

Subcutaneous Craniofacial Emphysema Following Endodontic Treatment: Case Report with Literature Review

Subcutaneous emphysema is a well-known and recognized complication in oral surgery, due to high pressure rotating instrument use, mostly related to impacted tooth surgery. Although root canal treatment in endodontic therapy is considered as a safe and standard procedure, affected by a low incidence of complication, subcutaneous emphysema due to the choice of mechanical tools or as a consequence of the use of air stream to dry the operating field should be considered as a potential cause. The air can spread through soft tissue from the apex or from an iatrogenic root perforation, suddenly leading to this unusual complication. It is very important for a dental practitioner to promptly identify the adverse event and to know how to manage this situation. We report a case of a 57-year-old woman with immediate subcutaneous cervicofacial emphysema after root canal therapy of the right inferior second premolar and its management. A brief review of the literature is also displayed.

Spontaneous repair of iatrogenic root perforation by an orthodontic miniscrew: A case report

Background and OverviewOrthodontic miniscrews have become popular tools for providing temporary anchorage during orthodontic treatment. Although they are easy to insert, damage to the periodontal ligament or dental root during insertion is an unfavorable iatrogenic complication. Root perforation during miniscrew insertion in human teeth has been reported in a few articles. In this article, the authors describe the spontaneous repair of an iatrogenic root perforation in a mandibular first molar that occurred during insertion of an orthodontic miniscrew in a young girl undergoing orthodontic treatment. Case DescriptionA 15-year-old girl with malocclusion was undergoing orthodontic treatment when the mesial root of her mandibular right first molar was damaged by an orthodontic miniscrew. The miniscrew and corresponding bracket were immediately removed to avoid any unnecessary forces on the tooth. Because the pulp remained vital without any additional damage and infection for 6 months, orthodontic treatment was resumed and completed in 9 months without any pulp damage or unfavorable symptoms. Serial periapical radiographs and cone-beam computed tomographic images showed that the injured area was surrounded by reparative tissue without any apical lesion. Conclusions and Practical ImplicationsThe findings of this case suggest that immediate removal of unnecessary forces provides an environment for spontaneous repair in cases of iatrogenic root perforation by orthodontic miniscrews, even when the damage involves the pulp. If force stimulation is avoided for a certain period, which was 6 months in this case, it may be possible to complete the orthodontic treatment without unfavorable symptoms.

Evaluation of Stress Distributions in Mandibular Molar Teeth with Different Iatrogenic Root Perforations Repaired with Biodentine or Mineral Trioxide Aggregate: A Finite Element Analysis Study

IntroductionIn this study, finite element analysis was used to evaluate the stress distributions in simulated mandibular molar teeth with various iatrogenic root perforation types after reparation with Biodentine (Septodont, Saint-Maur-des-Fossés, France) or mineral trioxide aggregate (MTA). MethodsAn extracted human mandibular molar tooth was scanned using a micro–computed tomographic device, and a 3-dimensional solid model was created. Then, 3 different iatrogenic perforation types (furcation perforation [FP], strip perforation [SP], and post drill perforation [PDP]) and 2 different repair materials (MTA and Biodentine [BD]) were simulated on the model. In addition, a sound tooth (ST) model (control) and a model left unrepaired for each type of perforation were created; then, access cavities were restored using resin composite, except for the sound tooth model. Consequently, a total of 10 experimental models were designed. An oblique force of 300 N angled at 45° to the occlusal plane was simulated. Evaluations of von Mises stress were performed in the perforated regions. ResultsMaximum von Mises stress values were 7.76 MPa for ST/corresponding to the FP region, 8.48 MPa for ST/corresponding to the SP region, 14.20 MPa for ST/corresponding to the PDP region, 10.89 MPa for FP /MTA, 7.65 MPa for FP/BD, 14.67 MPa for FP/unrepaired, 15.92 MPa for SP/MTA, 15.82 MPa for SP/BD, 21.95 MPa for SP/unrepaired, 10.20 MPa for PDP/MTA, 9.17 MPa for PDP/BD, and 17.86 MPa for PDP/unrepaired. ConclusionsThe results of this finite element analysis indicated that BD models showed lower maximum von Mises stress values than the MTA models, and SPs exposed higher stress concentrations in root perforation regions than FPs and PDPs. The use of MTA and BD may reduce the risk of potentially harmful stress in root perforation regions.

A Contemporary Treatment of an Iatrogenic Root Perforation: A Case Report

Pulp canal calcification is 1 of the possible outcomes after certain types of dental trauma. This can make endodontic treatment more challenging should it become necessary. Because of the increased degree of difficulty, sometimes procedural incidents do occur during root canal treatment. This case report demonstrates an unusual clinical presentation of a root perforation and missed canal, which had undergone calcification as a result of trauma some years earlier. A contemporary approach to treatment involved a combination of treating the biological complication of the calcified canal combined with surgical repair of the iatrogenic complication of a perforation using modern imaging techniques and materials.

The 2780-nm Er,Cr:YSGG laser in endodontic treatment of teeth with iatrogenic root perforations: technique description and case series

The 2780-nm Er,Cr:YSGG laser in endodontic treatment of teeth with iatrogenic root perforations: technique description and case series

Endodontic and Surgical Management of Iatrogenic Root Injury Caused by Orthodontic Miniscrew Placement: A Case Report.

One of the potential serious complications, associated with the inter-radicular placement of an orthodontic miniscrew, is root injury. This article reports the endodontic and surgical treatments of an iatrogenic root perforation in a mandibular first molar caused by the placement of an orthodontic miniscrew anchorage. The 24-month follow-up showed a successful treatment outcome.

Improved single visit management of old infected iatrogenic root perforations using Biodentine®

Aim: The aim of this retrospective observational case series study was to evaluate the middle term outcomes on endodontic management of old infected iatrogenic root perforations using Biodentine. The treatments were always concluded in a single visit, without previous medication with calcium hydroxide. Our goal was to facilitate this kind of treatments and to make them more reproducible and manageable even for a general practitioner or a student. Methodology and methods: Between January 2011 and June 2016, 51 patients with old infected root perforations have been enrolled. All the treatments were performed using Biodentine in a single visit. Infected root perforation repair was performed by supervised dental students (39%) or a qualified endodontist (61%), employing surgical microscope magnification during treatments. After the treatment, the 51 patients were monitored for 18—64 months. We used clinical and radiographic examinations. Results: Of 51 examined teeth, 48 (94%) were classified as healed. The time, the size and the location of the perforations did not have a significant effect on the outcome. We proved the ineffectiveness of the null hypothesis. According to this latter, the single visit treatment of old infected perforations with Biodentine was inadequate. Conclusions: In single visit treatments, Biodentine seems to provide a biocompatible and effective seal in acidic environment, in accidental root perforations, even if the treatment is performed by an inexperienced operator and regardless of the location, the size and the time of occurrence of the perforation.

Improved single visit management of old infected iatrogenic root perforations using Biodentine®

AimThe aim of this retrospective observational case series study was to evaluate the middle term outcomes on endodontic management of old infected iatrogenic root perforations using Biodentine. The treatments were always concluded in a single visit, without previous medication with calcium hydroxide. Our goal was to facilitate this kind of treatments and to make them more reproducible and manageable even for a general practitioner or a student. Methodology and methodsBetween January 2011 and June 2016, 51 patients with old infected root perforations have been enrolled. All the treatments were performed using Biodentine in a single visit. Infected root perforation repair was performed by supervised dental students (39%) or a qualified endodontist (61%), employing surgical microscope magnification during treatments. After the treatment, the 51 patients were monitored for 18–64 months. We used clinical and radiographic examinations. ResultsOf 51 examined teeth, 48 (94%) were classified as healed. The time, the size and the location of the perforations did not have a significant effect on the outcome. We proved the ineffectiveness of the null hypothesis. According to this latter, the single visit treatment of old infected perforations with Biodentine was inadequate. ConclusionsIn single visit treatments, Biodentine seems to provide a biocompatible and effective seal in acidic environment, in accidental root perforations, even if the treatment is performed by an inexperienced operator and regardless of the location, the size and the time of occurrence of the perforation.

Posibile implicaţii ale tratamentelor endodontice în aspergiloza sinusurilor maxilare

The host immune system is not so active against Aspergillum sp. due to the anatomical location of maxillary antrum that facilitates the fungal multiplication. At least 10% of chronic sinusitis are actually infections with Aspergillum, mainly developing the clinical feature of maxillary aspergilloma. Though the terminal respiratory airways are the main access portal of the mycotic infection, the oro-antral fistulas, dental extractions, iatrogenic root perforations which also involve the mucousa of the alveolar ridge might be additional risk factors. It seems that the root canal overfillings may develop a maxillary sinus aspergillosis since zinc from the in sinusal cavity extruded sealers plays the role of a growth factor for Aspergillus. Accordingly, a chronic sinusitis with purulent secretions, refractory to conventional treatment and associated with a foreign body identified on radiographs as root filling material might be suspected as maxillary sinus aspergilossis.

MANAGEMENT OF IATROGENIC ROOT PERFORATION IN TOOTH WITH OBLITERATED PULP CANAL- A CASE REPORT.

MANAGEMENT OF IATROGENIC ROOT PERFORATION IN TOOTH WITH OBLITERATED PULP CANAL- A CASE REPORT.

Chronic iatrogenic lateral root perforation with open apex

Chronic iatrogenic lateral root perforation with open apex

Management of iatrogenic root perforation with pulp canal obliteration

Iatrogenic root perforations, which may have serious implications, occur in approximately 2-12% of endodontically treated teeth. Successful management of root perforations is dependent on early diagnosis of the defect, location of the perforation, choice of treatment, materials used, host response, and the experience of the practitioner. This report presents the successful management of an iatrogenic perforation in a tooth with radiographic evidence of pulp canal obliteration.