A recent case study published in the Case Reports in Dentistry suggested that decision-making could be improved in the case of root canal perforation by using the cone beam computed tomography (CBCT) scan and other modern technologies.
Root perforation results in communication between the root canal system and the external tooth surface. When completing the last steps of the endodontic therapeutic protocol, all care must be taken to avoid accidents that may risk losing teeth. In clinical practice, pathological perforations are frequent. Iatrogenic root perforations may occur at any time in root canal treatment, during access cavity opening, root canal preparation, or post preparation. All these procedural operative errors may lead to treatment failure This study describes a conservative approach to surgical management of root canal perforation in maxillary lateral incisors.
A patient was referred for retreatment of a maxillary lateral incisor. Her chief complaint was discomfort in the buccal mucosa. Periapical radiography showed radiopaque material consistent with sealing material inside the root canal. A CBCT scan was acquired and revealed a gutta-percha cone outside the root canal, from the middle third to beyond the root apex. The imaging examination showed that the pulp cavity had not been affected.
Thus, the researchers took the clinical alternative of surgically managing the perforation by sealing with MTA, thereby avoiding endodontic treatment, and followed up with only clinical and radiographic control.
At the two-year follow-up, after the surgical procedure to remove the extruded filling material, the researchers observed bone tissue formation and positive response to pulp tests, without any clinical signs or symptoms. Root perforation is considered an unpleasant error in an operative procedure. Once a perforation is properly diagnosed, located, and sealed with biomaterial, a favorable prognosis is often achieved. MTA offered good sealing of the perforation, with promising results.
Thus, the researchers concluded that decision-making using the CBCT scan enabled us to adopt a conservative approach and favored more reliable treatment predictability.
Reference:
A Conservative Approach to Surgical Management of Root Canal Perforation by Régis Augusto Aleixo Alves et al. published in the Case Reports in Dentistry.
https://doi.org/10.1155/2021/6633617