Title : Non surgical and surgical repair of pathologic and iatrogenic perforations
Abstract:
In recent years in Endodontics there has been a true explosion of new technologies, new instruments and new materials, which made predictable many procedures that before were considered impossible or just made by chance. The most important revolutions have been the introduction of the surgical operating microscope, the CBCT and the MTA, a revolutionary material which is extremely biocompatible, hydrophilic, and capable to stimulate healing processes and osteogenesis. Many studies demonstrated the growth of cementum, periodontal ligament and bone adjacent to MTA when used to seal perforations as well as a retrofilling material in surgical endodontics. For all the above mentioned characteristics, MTA can be considered the material of choice both in surgical endodontics (as a retrofilling material) and in nonsurgical endodontics (in direct pulp capping, to repair perforations, for the apical barrier technique in treatment of open apices). The diagnosis of a perforation today can be confirmed thanks to the CBCT and the nonsurgical repair can have a longterm success when treated under magnifications and when sealed with bioceramic material like MTA. Perforations are pathologic or iatrogenic communications between the root canal system and the attachment apparatus. The clinician must be particularly concerned about avoiding perforations of the tooth during endodontic therapy, since a perforation will necessitate additional treatment. The perforation creates an “additional” portal of exit in the root canal system.
The prognosis of a perforation is influenced by several factors: Level: Coronal, middle or apical one third, Location: buccal, lingual, mesial or distal, Size and shape and Time.
The time is one of the most crucial factors, and once identified, the perforarion must be sealed as quickly as possible, since periodontal involvement arising from the perforation can become irreversible with time. If a perforation occurs, the tooth does not necessarily require surgery, intentional replantation, or extraction; in fact, it can be treated successfully in a conservative manner and continue to function like the perforation was never done. Today, there is no reason to believe that the tooth will be lost prematurely because of this complication.
