Iatrogenic perforations negatively impact the outcome of endodontic treatments. Studies on prognostic factors showed that perforations in the coronal third of the root with periodontal pocket formation have an unfavorable prognosis. A 36-year-old female was referred for endodontic evaluation of tooth #13 with a history of an iatrogenic perforation, happened 3 years ago. There was a sinus tract associated with perforation, 10 mm probing on the mesial and mesio-palatal, bleeding on probing, radiolucent lesion adjacent to the perforation and complete resorption of the interdental bone between teeth #13 and #12. After the treatment options were discussed, she chose to save the tooth. The tooth was accessed under rubber dam isolation, the perforation site was cleaned and disinfected using 0.5% sodium hypochlorite and sealed with calcium-enriched mixture cement. Eighteen months after treatment the tooth was functional and asymptomatic. The probing depths were normal without bleeding on probing. Radiographically, the interdental crestal bone formed between teeth #13 and #12. Despite all negative prognostic factors in this case (i.e., perforations in the coronal third, pocket formation, and radiolucent lesion), healing was unexpectedly achieved via non-surgical repair of the perforation. Further research on biological aspects of healing in the periodontium following iatrogenic perforations are recommended.

Citations

Citations to this article as recorded by  

• Comprehensive review of composition, properties, clinical applications, and future perspectives of calcium-enriched mixture (CEM) cement: a systematic analysis
  Saeed Asgary, Mahtab Aram, Mahta Fazlyab
  BioMedical Engineering OnLine.2024;[Epub]     CrossRef
• External Cervical Resorption: A Volumetric Analysis on Evolution of Defects over Time
  Ali Nosrat, Omid Dianat, Prashant Verma, Martin D. Levin, Jeffery B. Price, Anita Aminoshariae, Fabio Antonio Piola Rizzante
  Journal of Endodontics.2023; 49(1): 36.     CrossRef
• Comparative evaluation of mineral trioxide aggregate, endoseal, and biodentine in furcation perforation repair
  Udita Khare Baralay, Srinidhi Surya Raghavendra
  Endodontology.2022; 34(1): 22.     CrossRef
• Calcium Silicate Cements Application in Lateral Root Perforation Repair: A Case Report with 16-Month Follow-Up
  Juan G. Robledo, Pablo A. Rodríguez
  Open Journal of Stomatology.2021; 11(08): 317.     CrossRef
• Vital Pulp Therapy as a Conservative Approach for Management of Invasive Cervical Root Resorption: A Case Series
  Saeed Asgary, Mahdieh Nourzadeh, Prashant Verma, M. Lamar Hicks, Ali Nosrat
  Journal of Endodontics.2019; 45(9): 1161.     CrossRef

This article presents the successful surgical management of a failed mineral trioxide aggregate (MTA) orthograde obturation of a tooth with a history of impact trauma and perforated internal root resorption. A symptomatic maxillary lateral incisor with a history of perforation due to internal root resorption and nonsurgical repair using MTA was referred. Unintentional overfill of the defect with MTA had occurred 4 yr before the initial visit. The excess MTA had since disappeared, and a radiolucent lesion adjacent to the perforation site was evident radiographically. Surgical endodontic retreatment was performed using calcium enriched mixture (CEM) cement as a repair material. Histological examination of the lesion revealed granulation tissue with chronic inflammation, and small fragments of MTA encapsulated within fibroconnective tissue. At the one and two year follow up exams, all signs and symptoms of disease had resolved and the tooth was functional. Complete radiographic healing of the lesion was observed two years after the initial visit. This case report illustrates how the selection of an appropriate approach to treatment of a perforation can affect the long term prognosis of a tooth. In addition, extrusion of MTA into a periradicular lesion should be avoided.

Citations

Citations to this article as recorded by  

• Comprehensive review of composition, properties, clinical applications, and future perspectives of calcium-enriched mixture (CEM) cement: a systematic analysis
  Saeed Asgary, Mahtab Aram, Mahta Fazlyab
  BioMedical Engineering OnLine.2024;[Epub]     CrossRef
• The various forms of tooth resorption
  Jordan Samuel Blum
  Australian Endodontic Journal.2024; 50(2): 191.     CrossRef
• Bioceramics in Endodontics: Updates and Future Perspectives
  Xu Dong, Xin Xu
  Bioengineering.2023; 10(3): 354.     CrossRef
• Imaging techniques and various treatment modalities used in the management of internal root resorption: A systematic review
  R. S Digholkar, S D Aggarwal, P S Kurtarkar, P. B Dhatavkar, V L Neil, D N Agarwal
  Endodontology.2023; 35(2): 85.     CrossRef
• Treatment of Teeth with Root Resorptions: A Case Report and Systematic Review
  Damla Erkal, Abdullah Başoğlu, Damla Kırıcı, Nezahat Arzu Kayar, Simay Koç, Kürşat Er
  Galician Medical Journal.2023;[Epub]     CrossRef
• Effects of calcium silicate cements on neuronal conductivity
  Derya Deniz-Sungur, Mehmet Ali Onur, Esin Akbay, Gamze Tan, Fügen Daglı-Comert, Taner Cem Sayın
  Restorative Dentistry & Endodontics.2022;[Epub]     CrossRef
• Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview – part II: other clinical applications and complications
  M. Torabinejad, M. Parirokh, P. M. H. Dummer
  International Endodontic Journal.2018; 51(3): 284.     CrossRef
• Periodontal healing following non-surgical repair of an old perforation with pocket formation and oral communication
  Saeed Asgary, Prashant Verma, Ali Nosrat
  Restorative Dentistry & Endodontics.2018;[Epub]     CrossRef
• Conservative Management of Class 4 Invasive Cervical Root Resorption Using Calcium-enriched Mixture Cement
  Saeed Asgary, Ali Nosrat
  Journal of Endodontics.2016; 42(8): 1291.     CrossRef
• Importance of CBCT in the management plan of upper canine with internal resorption
  Roberto Fornara, Dario Re Cecconi
  Giornale Italiano di Endodonzia.2015; 29(2): 70.     CrossRef