Furcal area and root canal perforations treatment – case series report and literature review

Krystyna Pietrzycka

Abstract


Introduction: Perforation is a pathological connection between the root canal system and the external surface of the tooth that can occur unintentionally during pulp chamber preparation. The consequence of this complication is inflammation and destruction of the periodontal tissues. Therefore, it is essential to seal the perforation to avoid tooth loss. Among different bioactive materials, mineral trioxide aggregate (MTA) and Biodentine (BD) ensure a favorable prognosis in therapeutic dental procedures due to their healing properties.
Materials and methods: The present case series report describes successful treatments of different sizes, locations, and immediate and mediated perforations.
Results: Clinical and radiographic follow-up showed asymptomatic teeth without discomfort, swelling, fistula, or radiolucency in the furcal area.
Conclusion: Mineral trioxide aggregate and BD can be successfully used as a biocompatible material for the repair of furcal and root canal perforations.

Keywords


perforation, pulp chamber, MTA, Biodentine, root canal treatment

Full Text:

PDF

References


Pietrzycka K, Radwanski M, Hardan L, Bourgi R, Mancino D, Haikel Y, et al. The Assessment of Quality of the Root Canal Filling and the Number of Visits Needed for Completing Primary Root Canal Treatment by Operators with Different Experience. Bioengineering (Basel) 2022;9(9):468. doi: 10.3390/bioengineering9090468.

Estrela C, Pécora JD, Estrela CRA, Guedes OA, Silva BSF, Soares CJ, et al. Common Operative Procedural Errors and Clinical Factors Associated with Root Canal Treatment. Braz Dent J 2017;28(2):179-90. doi: 10.1590/0103-6440201702451.

Tsesis I, Fuss Z. Diagnosis and Treatment of Accidental Root Perforations. Endod Top 2006;13:95-107. doi: 10.1111/j.1601-1546.2006.00213.x.

Fuss Z, Trope M. Root Perforations: Classification and Treatment Choices Based on Prognostic Factors. Endod Dent Traumatol 1996;12(6):255-64. doi: 10.1111/j.1600-9657.1996.tb00524.x.

Sarao SK, Berlin-Broner Y, Levin L. Occurrence and Risk Factors of Dental Root Perforations: A Systematic Review. Int Dent J 2021;71(2):96-105. doi: 10.1111/idj.12602.

Askerbeyli Örs S, Aksel H, Küçükkaya Eren S, Serper A. Effect of Perforation Size and Furcal Lesion on Stress Distribution in Mandibular Molars: A Finite Element Analysis. Int Endod J 2019;52(3):377-84. doi: 10.1111/iej.13013.

Glossary of Endodontic Terms. 10th ed. Chicago: American Association of Endodontists; 2020.

Olcay K, Ataoglu H, Belli S. Evaluation of Related Factors in the Failure of Endodontically Treated Teeth: A Cross-Sectional Study. J Endod 2018:44(1):38-45. doi: 10.1016/j.joen.2017.08.029.

Clauder T. Present Status and Future Directions – Managing Perforations. Int Endod J 2022;55 Suppl 4:872-91. doi: 10.1111/iej.13748.

Estrela C, Decurcio D de A, Rossi-Fedele G, Silva JA, Guedes OA, Borges ÁH. Root perforations: a review of diagnosis, prognosis and materials. Braz Oral Res 2018;32(Suppl 1):e73. doi: 10.1590/1807-3107bor-2018.vol32.0073.

Saed SM, Ashley MP, Darcey J. Root Perforations: Aetiology, Management Strategies and Outcomes. The Hole Truth. Br Dent J 2016;220(4):171-80. doi: 10.1038/sj.bdj.2016.132.

Löst C. Quality Guidelines for Endodontic Treatment: Consensus Report of the European Society of Endodontology. Int Endod J 2006;39(12):921-30.

Beavers RA, Bergenholtz G, Cox CF. Periodontal Wound Healing Following Intentional Root Perforations in Permaent Teeth of Macaca Mulatta. Int Endod J 1986;19(1):36-44. doi: 10.1111/j.1365-2591.1986.tb00888.x.

Pietrzycka K, Pawlicka H. Treatment of internal inflammatory root resorption – based on own observations. J Stoma 2015;68(3):367-79. doi: 10.5604/00114553.1165619.

Pietrzycka K, Pawlicka H. Clinical Aspects of Pulp Stones: A Case Report Series. Dent Med Probl 2020;57(2):213-20. doi: 10.17219/dmp/117944.

Palatyńska-Ulatowska A, Pietrzycka K, Koprowicz A. Denticles of the pulp chamber – diagnostics and management. Case studies. Pomeranian J Life Sci 2019;65(2):29-36. doi: 10.21164/pomjlifesci.580.

Torabinejad M, Watson TF, Pitt Ford TR. Sealing Ability of a Mineral Trioxide Aggregate When Used as a Root End Filling Material. J Endod 1993;19(12):591-5. doi: 10.1016/S0099-2399(06)80271-2.

Nakata TT, Bae KS, Baumgartner JC. Perforation Repair Comparing Mineral Trioxide Aggregate and Amalgam Using an Anaerobic Bacterial Leakage Model. J Endod 1998;24(3):184-6. doi: 10.1016/S0099-2399(98)80180-5.

Lee SJ, Monsef M, Torabinejad M. Sealing Ability of a Mineral Trioxide Aggregate for Repair of Lateral Root Perforations. J Endod 1993;19(11):541-4. doi: 10.1016/S0099-2399(06)81282-3.

Daoudi M, Saunders W. In Vitro Evaluation of Furcal Perforation Repair Using Mineral Trioxide Aggregate or Resin Modified Glass Ionomer Cement with and without the Use of the Operating Microscope. J Endod 2002;28(7):512-5. doi: 10.1097/00004770-200207000-00006.

Hardy I, Liewehr F, Joyce A, Agee K, Pashley D. Sealing Ability of One-Up Bond and MTA With and Without a Secondary Seal as Furcation Perforation Repair Materials. J Endod 2004;30(9):658-61. doi: 10.1097/01.DON.0000121619.33952.9A.

Torabinejad M, Parirokh M, Dummer PMH. Mineral Trioxide Aggregate and Other Bioactive Endodontic Cements: An Updated Overview – Part II: Other Clinical Applications and Complications. Int Endod J 2018;51(3):284-317. doi: 10.1111/iej.12843.

Dong X, Xu X. Bioceramics in Endodontics: Updates and Future Perspectives. Bioengineering 2023;10(3):354. doi: 10.3390/bioengineering10030354.

Tsai YL, Liao WC, Wang CY, Chang MC, Chang SH, Chang SF, et al. Horizontal Root Fractures in Posterior Teeth without Dental Trauma: Tooth/Root Distribution and Clinical Characteristics. Int Endod J 2017;50(9):830-5. doi: 10.1111/iej.12704.

Wang P, Wang S, Ni L. 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. Oper Dent 2009;34(4):497-502. doi: 10.2341/08-080-S.

Tsesis I, Rosenberg E, Faivishevsky V, Kfir A, Katz M, Rosen E. Prevalence and Associated Periodontal Status of Teeth with Root Perforation: A Retrospective Study of 2,002 Patients’ Medical Records. J Endod 2010;36(5):797-800. doi: 10.1016/j.joen.2010.02.012.

Ree M, Schwartz R. Management of Perforations: Four Cases from Two Private Practices with Medium- to Long-Term Recalls. J Endod 2012;38(10):1422-7. doi: 10.1016/j.joen.2012.06.029.

Marques NCT, Lourenço Neto N, Oliveira TM. Immediate and Mediate Furcal Perforation Treatment in Primary Molars: 24-Month Follow-Up. Eur Arch Paediatr Dent 2016;17(6):489-94. doi: 10.1007/s40368-016-0249-5.

Mente J, Hage N, Pfefferle T, Koch MJ, Geletneky B, Dreyhaupt J, et al. Treatment Outcome of Mineral Trioxide Aggregate: Repair of Root Perforations. J Endod 2010;36(2):208-13. doi: 10.1016/j.joen.2009.10.012.

Mente J, Leo M, Panagidis D, Saure D, Pfefferle T. Treatment Outcome of Mineral Trioxide Aggregate: Repair of Root Perforations – Long-Term Results. J Endod 2014;40(6):790-6. doi: 10.1016/j.joen.2014.02.003.

Main C, Mirzayan N, Shabahang S, Torabinejad M. Repair of Root Perforations Using Mineral Trioxide Aggregate: A Long-Term Study. J Endod 2004;30(2):80-3. doi: 10.1097/00004770-200402000-00004.

Pontius V, Pontius O, Braun A, Frankenberger R, Roggendorf MJ. Retrospective Evaluation of Perforation Repairs in 6 Private Practices. J Endod 2013;39(11):1346-58. doi: 10.1016/j.joen.2013.08.006.

Gorni FG, Andreano A, Ambrogi F, Brambilla E, Gagliani M. Patient and Clinical Characteristics Associated with Primary Healing of Iatrogenic Perforations after Root Canal Treatment: Results of a Long-Term Italian Study. J Endod 2016;42(2):211-5. doi: 10.1016/j.joen.2015.11.006.

Gorni FG, Ionescu AC, Ambrogi F, Brambilla E, Gagliani MM. Prognostic Factors and Primary Healing on Root Perforation Repaired with MTA: A 14-Year Longitudinal Study. J Endod 2022;48(9):1092-9. doi: 10.1016/j.joen.2022.06.005.

Vehkalahti MM, Swanljung O. Accidental Perforations during Root Canal Treatment: An 8-Year Nationwide Perspective on Healthcare Malpractice Claims. Clin Oral Investig 2020;24(10):3683-90. doi: 10.1007/s00784-

-020-03246-z.

Krupp C, Bargholz C, Brüsehaber M, Hülsmann M. Treatment Outcome after Repair of Root Perforations with Mineral Trioxide Aggregate: A Retrospective Evaluation of 90 Teeth. J Endod 2013;39(11):1364-8. doi: 10.1016/j.joen.2013.06.030.

Alves de Melo PH, Machado AG, Barbosa Machado AL, Carvalho FN, de Melo JB, Jochims Schneider LF. Evaluation of Root Perforation Treatments with Mineral Trioxide Aggregate: A Retrospective Case Series Study. Iran Endod J 2019;14(2):144-51. doi: 10.22037/iej.v14i2.22769.

Pace R, Giuliani V, Pagavino G. Mineral Trioxide Aggregate as Repair Material for Furcal Perforation: Case Series. J Endod 2008;34(9):1130-3. doi: 10.1016/j.joen.2008.05.019.

Al-Nazhan S, El Mansy I, Al-Nazhan N, Al-Rowais N, Al-Awad G. Outcomes of Furcal Perforation Management Using Mineral Trioxide Aggregate and Biodentine: A Systematic Review. J Appl Oral Sci 2022;30:e20220330. doi: 10.1590/1678-7757-2022-0330.

Siew K, Lee AHC, Cheung GSP. Treatment Outcome of Repaired Root Perforation: A Systematic Review and Meta-Analysis. J Endod 2015;41(11):1795-804. doi: 10.1016/j.joen.2015.07.007.

Barczak K, Palczewska-Komsa M, Sikora M, Buczkowska-Radlińska J. BiodentineTM – Use in Dentistry. Literature Review. Pomeranian J Life Sci 2020;66(2):39-45. doi: 10.21164/pomjlifesci.666.

Mungekar-Markandey S, Mistry L, Jawdekar A. Clinical Success of Iatrogenic Perforation Repair Using Mineral Trioxide Aggregate and Other Materials in Primary Molars: A Systematic Review and Meta-Analysis. Int J Clin Pediatr Dent 2022;15(5):610-6. doi: 10.5005/jp-journals-10005-2038.

Estrela C, Cintra LTA, Duarte MAH, Rossi-Fedele G, Gavini G, Damião Sousa-Neto M. Mechanism of Action of Bioactive Endodontic Materials. Braz Dent J 2023;34(1):1-11. doi: 10.1590/0103-6440202305278.

Abdelmotelb MA, Gomaa YF, Khattab NMA, Elheeny AAH. Premixed Bioceramics versus Mineral Trioxide Aggregate in Furcal Perforation Repair of Primary Molars: In Vitro and in Vivo Study. Clin Oral Investig 2021;25(8):4915-25. doi: 10.1007/s00784-021-03800-3.

Pruthi P, Goel S, Yadav P, Nawal R, Talwar S. Novel Application of a Calcium Silicate-based Cement and Platelet-Rich Fibrin in Complex Endodontic Cases: A Case Series. Gen Dent 2022;68(3):46-9.

Park HE, Song HY, Han K, Cho KH, Kim YH. Number of Remaining Teeth and Health-Related Quality of Life: The Korean National Health and Nutrition Examination Survey 2010–2012. Health Qual Life Outcomes 2019;17(1):5. doi: 10.1186/s12955-019-1078-0.

Park S, Byun S, Kim J, Yang B, Oh S. Treatment of Molar Incisor Malformation and the Short Term Follow-up: Case Reports. Eur J Paediatr Dent 2020;21(3):238-42. doi: 10.23804/ejpd.2020.21.03.15.

Aladimi A. Histologic Evaluation of Artificial Floors under MTA and Nano-Filled Resin-Modified Glass Ionomer Used to Repair Furcation Perforation in Dogs. Eur Endod J 2020;5(2):138-44. doi: 10.14744/eej.2020.44127.

Aggarwal V, Singla M, Miglani S, Kohli S. Comparative Evaluation of Push-out Bond Strength of ProRoot MTA, Biodentine, and MTA Plus in Furcation Perforation Repair. J Conserv Dent 2013;16(5):462. doi: 10.4103/0972--0707.117504.

Tawfik HE, Abu-Seida AM, Hashem AA, El-Khawlani MM. Treatment of Experimental Furcation Perforations with Mineral Trioxide Aggregate, Platelet Rich Plasma or Platelet Rich Fibrin in Dogs’ Teeth. Exp Toxicol Pathol 2016;68(6):321-7. doi: 10.1016/j.etp.2016.03.004.

Bakhtiar H, Mirzaei H, Bagheri MR, Fani N, Mashhadiabbas F, Baghaban Eslaminejad M, et al. Histologic Tissue Response to Furcation Perforation Repair Using Mineral Trioxide Aggregate or Dental Pulp Stem Cells Loaded onto Treated Dentin Matrix or Tricalcium Phosphate. Clin Oral Investig 2017;21(5):1579-88. doi: 10.1007/s00784-016-1967-0.

Al-Daafas A, Al-Nazhan S. Histological Evaluation of Contaminated Furcal Perforation in Dogs’ Teeth Repaired by MTA with or without Internal Matrix. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(3):e92-9. doi: 10.1016/j.tripleo.2006.09.007.

Al-Nahlawi T, Ala Rachi M, Abu Hasna A. Endodontic Perforation Closure by Five Mineral Oxides Silicate-Based Cement with/without Collagen Sponge Matrix. Int J Dent 2021;2021:4683689. doi: 10.1155/2021/4683689.

Youssef Youssef Abdelati N, Hassan Elkalla I, Mohamed Awad S, Mahmoud Shalan H. Histopathological Evaluation of Periodontium after Repairing Furcation Perforation with MTA and Biodentine. Pediatr Dent J 2018;28(1):33-9. doi: 10.1016/j.pdj.2017.09.002.

Pinheiro LS, Kopper PMP, Quintana RM, Scarparo RK, Grecca FS. Does MTA Provide a More Favourable Histological Response than Other Materials in the Repair of Furcal Perforations? A Systematic Review. Int Endod J 2021;54(12):2195-218. doi: 10.1111/iej.13617.

Ibarrola JL, Biggs SG, Beeson TJ. Repair of a Large Furcation Perforation: A Four-Year Follow-Up. J Endod 2008;34(5):617-9. doi: 10.1016/j.joen.2008.01.017.

Buła K, Palatyńska-Ulatowska A, Klimek L. Biodentine Management and Setting Time with Vicat and Vickers Evaluation; a Survey-Based Study on Clinicians’ Experience. Arch Mater Sci Eng 2020;103(2):75-85. doi: 10.5604/01.3001.0014.3358.

Ezawa N, Akashi Y, Nakajima K, Kokubun K, Furusawa M, Matsuzaka K. The Effects of Tricalcium-Silicate-Nanoparticle-Containing Cement: In Vitro and In Vivo Studies. Materials (Basel) 2023;16(12):4451. doi: 10.3390/ma16124451.

Oliveira TM, Sakai VT, Silva TC, Santos CF, Machado MAAM, Abdo RCC. Repair of Furcal Perforation Treated with Mineral Trioxide Aggregate in a Primary Molar Tooth: 20-Month Follow-Up. J Dent Child (Chic) 2008;75(2):188-91.

Drukteinis S, Peciuliene V, Shemesh H, Tusas P, Bendinskaite R. Porosity Distribution in Apically Perforated Curved Root Canals Filled with Two Different Calcium Silicate Based Materials and Techniques: A Micro--Computed Tomography Study. Materials (Basel) 2019;12(11):1729. doi: 10.3390/ma12111729.

da Fonseca TS, Silva GF, Guerreiro-Tanomaru JM, Delfino MM, Sasso-Cerri E, Tanomaru-Filho M, et al. Biodentine and MTA Modulate Immunoinflammatory Response Favoring Bone Formation in Sealing of Furcation Perforations in Rat Molars. Clin Oral Investig 2019;23(3):1237-52. doi: 10.1007/s00784-018-2550-7.

de Sousa Reis M, Scarparo RK, Steier L, de Figueiredo JAP. Periradicular Inflammatory Response, Bone Resorption, and Cementum Repair after Sealing of Furcation Perforation with Mineral Trioxide Aggregate (MTA AngelusTM) or BiodentineTM. Clin Oral Investig 2019;23(11):4019-27. doi: 10.1007/s00784-019-02833-z.

Silva RAB, Borges ATN, Hernandéz‐Gatón P, de Queiroz AM, Arzate H, Romualdo PC, et al. Histopathological, Histoenzymological, Immunohistochemical and Immunofluorescence Analysis of Tissue Response to Sealing Materials after Furcation Perforation. Int Endod J 2019;52(10):1489-500. doi: 10.1111/iej.13145.

Silva LAB, Pieroni KAMG, Nelson-Filho P, Silva RAB, Hernandéz-Gatón P, Lucisano MP, et al. Furcation Perforation: Periradicular Tissue Response to Biodentine as a Repair Material by Histopathologic and Indirect Immunofluorescence Analyses. J Endod 2017;43(7):1137-42. doi: 10.1016/j.joen.2017.02.001.

Cardoso M, Dos Anjos Pires M, Correlo V, Reis R, Paulo M, Viegas C. Biodentine for Furcation Perforation Repair: An Animal Study with Histological, Radiographic and Micro-Computed Tomographic Assessment. Iran Endod J 2018;13(3):323-30. doi: 10.22037/iej.v13i3.19890.

Alipour M, Faraji Gavgani L, Ghasemi N. Push‐out Bond Strength of the Calcium Silicate‐based Endodontic Cements in the Presence of Blood: A Systematic Review and Meta‐analysis of in Vitro Studies. Clin Exp Dent Res 2022;8(2):571-82. doi: 10.1002/cre2.546.

Nagas E, Cehreli ZC, Uyanik MO, Vallittu PK, Lassila LVJ. Effect of Several Intracanal Medicaments on the Push‐out Bond Strength of ProRoot MTA and Biodentine. Int Endod J 2016;49(2):184-8. doi: 10.1111/iej.12433.

Alsubait S, Alsaad N, Alahmari S, Alfaraj F, Alfawaz H, Alqedairi A. The Effect of Intracanal Medicaments Used in Endodontics on the Dislocation Resistance of Two Calcium Silicate-Based Filling Materials. BMC Oral Health 2020;20(1):57. doi: 10.1186/s12903-020-1044-6.

Afkhami F, Razavi S, Ghabraei S. The Effect of Different Intracanal Medicaments on the Dislodgement Resistance of Mineral Trioxide Aggregate. BMC Oral Health 2022(1);22:207. doi: 10.1186/s12903-022-02213-2.

Das M, Al Malwi AA, Mohapatra A, Kader MMA, Ali ABM, Shetty SC, et al. In Vitro Assessment of Sealing Ability of Various Materials Used for Repair of Furcal Perforation: A SEM Study. J Contemp Dent Pract 2022;23(11):1136-9. doi: 10.5005/jp-journals-10024-3425.

Guneser MB, Akbulut MB, Eldeniz AU. Effect of Various Endodontic Irrigants on the Push-out Bond Strength of Biodentine and Conventional Root Perforation Repair Materials. J Endod 2013;39(3):380-4. doi: 10.1016/j.joen.2012.11.033.

Możyńska J, Metlerski M, Lipski M, Nowicka A. Tooth Discoloration Induced by Different Calcium Silicate-Based Cements: A Systematic Review of In Vitro Studies. J Endod 2017;43(10):1593-601. doi: 10.1016/j.joen.2017.04.002.

Shokouhinejad N, Nekoofar MH, Pirmoazen S, Shamshiri AR, Dummer PMH. Evaluation and Comparison of Occurrence of Tooth Discoloration after the Application of Various Calcium Silicate-Based Cements: An Ex Vivo Study. J Endod 2016;42(1):140-4. doi: 10.1016/j.joen.2015.08.034.




DOI: https://doi.org/10.21164/pomjlifesci.985

Copyright (c) 2024 Krystyna Pietrzycka

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/