Lateral Root Perforation Research Articles

Extrusion of debris during retreatment using various nickel-titanium files in teeth with simulated lateral root perforation.

To investigate the influence of various nickel-titanium (Ni-Ti) files on debris extrusion during the retreatment of teeth with simulated lateral root perforation, focusing on root resorption. Sixty human mandibular premolar teeth were divided into groups with and without perforation and further subdivided based on the retreatment technique. Lateral root perforations were created in one group (Group 1), while the other group had no perforations (Group 2). Two retreatment techniques were compared: Remover (RE)+One RECI (OR) and ProTaper Universal Retreatment (PTUR)+WaveOne Gold (WOG). The weight of the extruded debris was determined. The time of both retreatment procedures was measured. Statistical analyses were performed using a two-way analysis of variance (ANOVA) test (P < 0.05). Teeth with simulated lateral root perforation exhibited higher extrusion of debris during retreatment. In both groups, RE+OR files led to more extruded debris than PTUR+WOG files. However, this difference was statistically significant in Group 2 (P < 0.001). Compared to PTUR+WOG files, RE+OR files showed a statistically significant longer time to remove obturation material (P < 0.001). Perforated teeth exhibited significantly higher debris extrusion. While both file systems demonstrated similar debris extrusion in perforated teeth, the RE+OR files significantly increased debris extrusion in non-perforated teeth compared to the PTUR+WOG files.

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.

REPETITIVE REGENERATIVE ENDODONTIC PROTOCOL TREATMENT FOR MATURE TEETH WITH DENS INVAGINATUS AND SEVERE PERFORATED INTERNAL ROOT RESORPTION: A CASE REPORT WITH 24-MONTH FOLLOW-UP

The association of internal root resorption (IRR) with dens invaginatus is an extremely rare finding, and its incidence may be underestimated, adding to the difficulty of endodontic treatment. A 9-year-old boy was admitted with complaints of swelling and pain. Radiological examination revealed closed apex Oehlers type II dens invaginatus and severe IRR, as well as apical third of two lateral root perforation and lesion. Calcium hydroxide applied in the regenerative endodontic protocol (REP) as intracanal medicament. Differently, bleeding was achieved by irritating the lateral perforation area. However, the tooth showed spontaneous pain and sensitivity to percussion after 2 months. The same REP was performed, but a triple antibiotic paste was used as the intracanal medicament. After 2 years, the tooth was asymptomatic, and radiographic examination revealed the decrease was cared on the previous resorption sites, and one of the openings on the lateral root surface had closed.

Calcium Silicate Cements Application in Lateral Root Perforation Repair: A Case Report with 16-Month Follow-Up

Lateral root perforations are unfortunate procedures during endodontic treatment and often lead to tooth extraction. Conditioning factors such as time, size, location, inappropriate disinfection and sealing, are indispensable to achieve acceptable long-term outcomes. Calcium silicate cements are bioactive materials used for perforation repair. They can be set in moist environments such as blood, saliva and dentinal fluid making them a reliable material for clinical applications. This case report describes the treatment and repair after a 16-month follow-up of a lateral root perforation of the maxillary lateral incisor.

The Response of the Pulp-Dentine Complex, PDL, and Bone to Three Calcium Silicate-Based Cements: A Histological Study in an Animal Rat Model

Objective The aim of this study was to histologically examine the tissue reaction of three different calcium silicate cements in the closure of perforations in rat incisor teeth. Material and Methods. An experimental lateral root perforation with pulp exposure was performed in 32 lower incisors of 16 male Wistar albino rats. They were randomly assigned into three test groups (each including eight teeth) that were filled either by Biodentine (BD) or MicroMega mineral trioxide aggregate (MM-MTA) or EndoSequence root repair material putty (ESRRM putty), besides eight unperforated incisors from the other four rats (control group). The inflammatory response and healing process were evaluated histologically and scored after one and four weeks. Differences among groups were tested by Kruskal–Wallis tests at P ≤ 0.05. Results In the first week, BD produced more inflammatory response in the pulpal (score 3) than other materials (score 2). Only ESRRM putty showed odontoblast-like cells in 50%, 25% dentine-like deposit, 25% evidence of bone deposition in the drilling site (score 2), and minimum periodontal ligament (PDL) necrosis and disorganization (25%, score 2). After one month, all groups had healthy pulpal tissue, but 25% of ESRRM putty retained score 1 inflammatory response, and 50% of the BD case had an incomplete palisading odontoblast layer (score 3). A thick and regular dentine bridge deposition was seen in the ESRRM putty group in comparison with MM-MTA and BD cases. The cortical plate healing in all ESRRM putty samples was complete (score 3), while an incomplete closure was seen in MM-MTA and BD groups (score 2). Both the MM-MTA and ESRRM putty groups had fully organized PDL (score 2), while in 50% of BD cases, a necrotizing area and disorganized PDL with inflammatory cells infiltration were still present. Statistically significant differences in the scores of any histologic parameters among the three tested materials were observed neither in the 1st nor in the 4th weeks of the experimental period. Conclusion Better tissue compatibility and repair of pulpal and periodontal tissue have been detected after lateral perforation in the root of rat incisors when treated with ESRRM putty than MM-MTA and BD. However, the difference was not significant.

Penatalaksanaan Perawatan Saluran Akar pada Fraktur Gigi 21 disertai Perforasi

Root canal treatment aims to maintain the condition of the teeth in order to keep them functioning. In practice, the treatment procedure does not always run smoothly, the operator can face undesirable conditions that can affect the prognosis of treatment. A common procedural error during root canal treatment is a lateral root perforation which must be treated immediately to avoid further damage. The success of the perforation treatment is determined by the materials used. One of the bicompatible materials to seal lateral perforations using MTA (mineral trioxide aggregate). Successful root canal treatment affects treatment outcomes, so proper restoration is required to reduce the risk of marginal leakage. The choice of final restoration in post-root canal treatment depends on the amount of remaining tooth structure, horizontal pressure and chewing load. For post-root canal treatment anterior teeth with intact marginal edges, direct restoration can be performed using composite resin

Chronic iatrogenic lateral root perforation with open apex

Chronic iatrogenic lateral root perforation with open apex

TITLE - MINERAL TRI-OXIDE AGGREGATE (MTA) FOR THE REPAIR OF PERIAPICAL TISSUES IN A PATIENT WITH SELF INFLICTED INJURIES: CASE REPORT

AbstractInjury to anterior teeth is a relatively common event. Dentists regularly deal with management of dental trauma and restoration of fractured teeth. Hence the treatment approach and medicaments that assures the biologically acceptable healing and improve long term success rate are of potential value and should be considered.A big cystic lesion, which is unable to heal non-surgically, heals well with use of Mineral Trioxide Aggregate (MTA Angelus) by surgical approach. Results of clinical trials have recommended the use of MTA as the most suitable root end filling material.This article presents the case report of management of big cystic lesion along with the lateral root perforation with maxillary left central incisor. Root canal treatment was followed by the resection of root end of tooth in question at the level of perforation and sealed with MTA. 12 month's follow up radiograph showed completely healed Cystic lesion.

Comparison of cone-beam computed tomography with intraoral photostimulable phosphor imaging plate for diagnosis of endodontic complications: a simulation study

The objective of this study was to compare the sensitivity and reliability of cone-beam computed tomography (CBCT) and intraoral photostimulable phosphor (PSP) imaging plate for diagnosis of endodontic complications. Seventy-two human mandibular teeth were used, including 24 incisors/canines, 24 premolars, and 24 molars. Three images were taken from each group of teeth with intraoral PSP, CBCT-NewTom, and CBCT-ProMax. The sensitivity of PSP, CBCT-NewTom, and CBCT-ProMax was 76.39%, 80.56%, and 94.44% for detecting cast post deviation; 98.61%, 100%, and 100% for external root resorption; 86.11%, 31.94%, and 36.11% for fractured file; and 66.67%, 90.28%, and 86.11% for lateral root perforation respectively. The intertechnique reliability (kappa statistics) was 58.4% for the 2 CBCT techniques, 20.1% and 18.8% for CBCT-NewTom and CBCT-ProMax versus PSP respectively. Given strengths and weaknesses of the techniques as well as the cost, CBCT is recommended as a complementary but not routinely used diagnostic method for endodontic complications not usually detected by conventional methods.

Evaluation of Selected Properties of Mineral Trioxide Aggregate Sealer Cement

IntroductionThe addition of a water-soluble polymer to mineral trioxide aggregate (MTA), which to date has been used primarily to seal lateral root perforations and as a root-end filling material, resulted in material that is suitable for use as an endodontic sealer. MethodsMTA was mixed with water at powder/liquid ratios of 4 and 3.33 and an addition of 2 μL to 20 μL of water-soluble polymer. The materials were tested for flow and film thickness, and the optimal quantity of polymer required to conform to EN ISO 6876 Section 4.3.1, 4.3.4 (2002) was determined. The resultant MTA sealer was tested for radiopacity using methods suggested by ISO 6876 (2002) using pulp canal sealer (PCS) as control. The effect of polymer addition on the hydration characteristics of the MTA and calcium silicate cement was evaluated by assessing paste microstructure under the scanning electron microscope after 30 days and by collecting 50 quantitative analyses of the hydration products and plotting the data as atomic ratios. Plots of Al/Ca versus Si/Ca and S/Ca and Al/Ca were drawn. ResultsHigh additions of polymer were required for the flow and film thickness of MTA to conform to ISO 6876 (2002). The resultant cement sealer had a lower radiopacity than PCS but greater than the 3-mm thickness of Al specified by the international standard. The addition of polymer did not modify the hydration mechanism of MTA. ConclusionsThe addition of a water-soluble polymer to MTA did not alter the hydration characteristics of the material and resulted in a material with improved properties suitable for use as endodontic sealer cement.

The Combination of a Mineral Trioxide Aggregate and an Adhesive Restorative Approach to Treat a Crown-root Fracture Coupled with Lateral Root Perforation in a Mandibular Second Molar: A Case Report

The current paper describes a modified treatment procedure for a traumatized mandibular left second molar resulting in a crown-root fracture and root perforation with the fracture line below the gingival attachment and alveolar bone crest. After the mobile crown-root fragment was extracted, the root perforation was obturated with mineral trioxide aggregate (MTA), and the subgingival defect was directly repaired with polyacid-modified resin composites (Ionosite Baseline). A 24-month recall showed no evidence of periodontal inflammation and no adverse symptoms, and the treated tooth exhibited good healing and normal function.

Contemporary management of lateral root perforation diagnosed with the aid of dental computed tomography

Lateral root perforation unnoticed during post-space preparation, and followed by post cementation, can subsequently be challenging to diagnose in the labio-lingual plane due to the two-dimensional nature of conventional radiography. This paper demonstrates the application of a recently developed three-dimensional imaging system, cone beam computed tomography, in the diagnosis of iatrogenic root perforation. A clinical case is reported where labial post perforation in a maxillary central incisor occurring 15 years previously presented with a sinus tract and radiolucent lesion. Non-surgical retreatment and perforation repair using mineral trioxide aggregate was performed with the aid of an operating microscope. The sinus tract resolved with radiographic evidence of healing at 1-year recall.

Reaction of the Lateral Periodontium of Dogs’ Teeth to Contaminated and Noncontaminated Perforations Filled with Mineral Trioxide Aggregate

It has been shown that the mineral trioxide aggregate (MTA) used to seal lateral/furcal perforations stimulates the deposition of newly formed cementum. Nevertheless, when the site of the perforation is contaminated, the healing process might occur under less favorable conditions. This study evaluated the repair healing process of noncontaminated and contaminated lateral perforations filled with MTA and the effect of previously filling the contaminated perforations with a bactericidal agent. Thirty lateral root perforations were prepared in endodontically treated dog's teeth, thus forming 3 groups with 10 specimens each. In group 1 the perforations were immediately sealed with MTA. In group 2 the perforations were left open for 7 days and thereafter sealed with MTA. In group 3 the perforations were left open for 7 days, filled temporarily with a calcium hydroxide-based paste for 14 days, and then sealed with MTA. The animals were killed after 90 days, and the pieces were prepared for histomorphologic and histomicrobiologic evaluations. The statistical analysis showed that group 1 had significantly better repair than groups 2 (P < .05) and 3 (P < .05), which validates the superior results obtained when MTA was immediately used to seal root perforations. Groups 2 and 3 had statistically similar repair to each other (P > .05). There were a larger number of cases of complete or partial biologic seal in group 1 compared with the contaminated groups. It might be concluded that the lateral root perforations sealed with MTA after contamination presented worse repair than the noncontaminated, immediately sealed perforations. The temporary filling with a bactericidal agent (calcium hydroxide-based paste) did not improve the repair of perforations exposed to contamination, and the contaminated groups presented similar results to each other.

Treatment of lateral root perforation with mineral trioxide aggregate: a case report

Root perforations are undesired complications of endodontic treatment which result in loss of integrity of the root and further destruction of the adjacent periodontal tissues. In recent literature mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair. In this case iatrogenic perforation was observed in a maxillary central incisor. It was not possible to reach the perforation from the access cavity due to the angulation and excessive bleeding even though the root canal was filled with calcium hydroxide paste between appointments. Therefore, surgical intervention was preferred. After the root canal was filled with gutta percha and AH plus, the perforation site was subsequently sealed with MTA. The restoration was made with strip crown and composite resin. The symptoms were ceased and the results were satisfactory after 15 months follow-up.

Mineral Trioxide Aggregate Repair of Lateral Root Perforations

This study was conducted to observe the healing process of intentional lateral root perforation repaired with mineral trioxide aggregate (MTA). Forty-eight root canals of dogs' teeth were instrumented and filled. After partial removal of the filling, an intentional perforation was made with a bur in the lateral area of the root. The perforations were repaired with MTA or Sealapex (control group). Histological analysis occurred 30 and 180 days after treatment. Results showed no inflammation and deposition of cementum over MTA in the majority of the specimens. In the 180-day period, Sealapex exhibited chronic inflammation in all the specimens and slight deposition of cementum over the material in only three cases. In conclusion, MTA exhibited better results than the control group.

Endodontic miscellany: Endo-ortho management of subgingival transversely fractured tooth

Endodontic-orthodontic treatment may become necessary to save teeth with advanced caries, traumatic destruction of clinical crown, lateral root perforation, external or internal rsorption near the alveolar crest or overzealous tooth preparation. With such treatment these teeth may not offer sound tooth structure on which to place a restoration. Lengthening the clinical crown by removing supporting bone to expose sound tooth structure or eliminate the existing periodontal defect is the solution usually recommended. Forced orthodontic eruption in conjunction with endodontic, periodontal & restorative therapy is an alternative.

Detection and measurement of endodontic root perforations using a newly designed apex-locating handpiece.

Access openings and lateral root perforations were prepared in 40 single-rooted extracted teeth. The distance to the perforations was measured visually and then with the Tri Auto ZX. The electronic device was used first in its apex-locating function and then in conjunction with its automatic reverse mechanism. On average, the electronically measured length was slightly shorter than the visually measured length (P < 0.05). When the automatic reverse mechanism was used, the values registered were either consistent with or slightly different (+/- 0.5 mm) from the electronically measured length (P > 0.05). The results of this study revealed that the Tri Auto ZX detected and measured endodontic root perforations within a range of clinically acceptable variations.

Mapping of sugar and amino acid availability in soil around roots with bacterial sensors of sucrose and tryptophan

We developed a technique to map the availability of sugars and amino acids along live roots in an intact soil-root matrix with native microbial soil flora and fauna present. It will allow us to study interactions between root exudates and soil microorganisms at the fine spatial scale necessary to evaluate mechanisms of nitrogen cycling in the rhizosphere. Erwinia herbicola 299R harboring a promoterless ice nucleation reporter gene, driven by either of two nutrient-responsive promoters, was used as a biosensor. Strain 299RTice exhibits tryptophan-dependent ice nucleation activity, while strain 299R(p61RYice) expresses ice nucleation activity proportional to sucrose concentration in its environment. Both biosensors exhibited up to 100-fold differences in ice nucleation activity in response to varying substrate abundance in culture. The biosensors were introduced into the rhizosphere of the annual grass Avena barbata and, as a control, into bulk soil. Neither strain exhibited significant ice nucleation activity in the bulk soil. Both tryptophan and sucrose were detected in the rhizosphere, but they showed different spatial patterns. Tryptophan was apparently most abundant in soil around roots 12 to 16 cm from the tip, while sucrose was most abundant in soil near the root tip. The largest numbers of bacteria (determined by acridine orange staining and direct microscopy) occurred near root sections with the highest apparent sucrose or tryptophan exudation. High sucrose availability at the root tip is consistent with leakage of photosynthate from immature, rapidly growing root tissues, while tryptophan loss from older root sections may result from lateral root perforation of the root epidermis.

Sealing ability of several restorative materials used for repair of lateral root perforations

Amalgam, IRM, Vitremer, Bisfil, and Ana Norm Liner were evaluated for repair of experimentally induced lateral perforations. Eighty-five sound, mandibular, and maxillary molars, extracted for periodontal reasons, were selected for this study. The sample teeth were randomly divided in five groups with 15 specimens each. Ten teeth were used as control groups. After the perforations were filled with the above-mentioned materials, the teeth were immersed in a 2% methylene blue solution for 48 h, sectioned, and dye penetration was measured. The results indicated that Bisfil 2 B provided a significantly better seal than the other materials.

Treatment of stripping perforations

Strippings are problems that are frequent on thin and concave roots. Treatment and prognosis differ from that of a lateral root perforation because of the size, oval shape, and thin edges of the striping. We propose a two-step technique: an endodontic phase in which the root canal system is sealed with gutta-percha overflowing through the stripping perforation and a surgical second step that will allow elimination of this excess.