diagnosis and treatment of strip perforation using MTA

1. MUNAWAR AZIZ
BDS 3RD PROF

2.  Root Perforation
 Causes
 Factors Affecting Prognosis
 Classification Of Root Perforation
 Diagnosis
 Strip Perforation
 Mineral Trioxide Aggrigate
 Case Report
 References

3. It Is An Artificial Communication Between The Root Canal
System To The Supporting Tissues Of The Teeth Or To The
Oral Cavity.
Causes:
1. Iatrogenic
2. Non-iatrogenic

4.  Depends Upon:
1. Time From The Perforation To Detection.
2. Size Of Perforation.
3. Location Of Perforation.

5. By Fuss and Trope:
1) FRESH PERFORATION
2) OLD PERFORATION
3) SMALL PERFORATION
4) LARGE PERFORATION
5) CORONAL PERFORATION
6) CRESTAL PERFORATION
7) APICAL PERFORATION

6.  sudden bleeding and pain during instrumentation of root
canals or post preparations in teeth are warning signs of
potential root perforation.
 the appearance of blood on paper points may also be
indicative.
 radiographs taken at different angles with radiopaque
instruments in the rc are a better option and may confirm the
presence of root perforation.

7. NORMAL VIEW ANGULATED VIEW

8.  To enhance radiographic detection, it has been proposed to place a
highly radiopaque CaOH paste, by inclusion of Barium sulphate in the
root canal

9.  Electronic apex locators can accurately determine the location
of root perforations, making them significantly more reliable
than radiographs.
 A dental operating microscope is another helpful tool,
effective in detecting root perforations during RC therapy
and surgical endodontic treatments.

10.  Cause by excessive flaring of the root canal
with files or drill by rotary instruments

11.  Mineral trioxide aggregate (MTA) is a
unique material with several exciting
clinical applications.
 MTA is one of the most versatile
materials of this century in the field
of dentistry.
 During endodontic treatment of
primary and permanent teeth MTA
can be used in many ways.

12. MTA has been used for both surgical and non surgical
application including ;
1-direct pulp capping
2.pulpatomy
3-perforation repairs
in root or furcation.
3-root end filling
4-appexification .etc…

13. Iran Endo J. 2013 Spring; 8(2): 80–83.
Published online May 1, 2013.

14. Root perforations are an undesired complication of
endodontic treatment which result in loss of integrity of the
root,
Recently MTA has been introduced as an ideal material for
perforation repair.
In this article a successful repair of strip root perforation of
mandibular molar using MTA .
This case suggests that MTA may be a substitute material for
the treatment of strip perforation.

15.  PRESENTING COMPLAIN
A 25-year-old woman with the complaint of persistent
drainage of pus in the right mandibular vestibule region.
 MEDICAL HISTORY
Not significant

16.  CLINICAL EXAMINATION
 The right mandibular first molar was sensitive to percussion
 Probing depth and mobility were within normal range.
 No response to thermal and electric pulp testing.
 Tracing with gutta-percha pointed to the right first mandibular
molar as the origin of the draining sinus tract.
 RADIOGRAPHIC EXAMINATION
 Furcal and periapical radiolucency
 DIAGNOSIS
 Pulp necrosis with chronic peri radicular periodontitis

17. MANAGEMENT
 After isolation , standard access cavity was prepared, and canal
instrumentation was started.
 The instrumentation was stopped because of sudden bleeding in
mesiolingual canal of mesial root.
 Stripping perforation of the mesial root was seen on the intraoral
periapical radiograph
 The instrumentation of the canals was continued except in the
mesiolingual canal to prevent increasing the size of perforation.
 1% sodium hypochlorite was used as irrigant during
instrumentation.

18.  A calcium hydroxide dressing was placed into the canals, and the
tooth was temporary restored.
 The patient was asymptomatic between appointments.
 7 days later, the tooth was isolated, temporary restoration was
removed, and the canals were thoroughly irrigated.
 The canals were then gently dried and obturated with gutta-percha
 The gutta-percha coronal to the perforation site in mesiolingual
canal was removed. Root MTA was mixed and compacted into the
coronal section of the canal and perforation site using plugger.
 After 48 hours, the temporary restoration were removed, and the
tooth was permanently restored with amalgam.
 On 15-month recall, the patient had no signs or symptoms, and
radiographic examination demonstrated complete resolution of
furcal and periapical radiolucency

19.  Mineral trioxide aggregate is well known biocompatible material
that induces cementogenesis around the perforation sites.
 This case presented successful treatment of strip perforation using
Root MTA.
 We can conclude that Root MTA is a suitable material for
perforation.

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22. THANK YOU