Treatment of Strip Perforation Using Root MTA: A Case Report
Treatment of Strip Perforation Using Root MTA: A Case Report
Treatment of Strip Perforation Using Root MTA: A Case Report
ARTICLE INFO
ABSTRACT
Article Type:
Case Report
Received: 26 May 2012
Revised: 07 Oct 2012
Accepted: 22 Oct 2012
*Corresponding author: Amin Salem Milani, Dental
and periodontal research center, Tabriz University of
medical sciences, Daneshgah Ave., Tabriz, Iran.
Tel: + 98-4113355965
Fax: +98-4113346977
Email: Amin.salemmilani@gmail.com
Introduction
Froughreyhani et al.81
Figure 1. A) preoperative tracing radiograph showing large furcal and periapical lesions at the mesial and distal roots of the mandibular first
molar; B) a strip perforation on the distal aspect of the mesiolingual canal; C) repair of the perforation with Root MTA; slight extrusion of the
material is evident; D) 15-month Follow-up radiograph showing complete resolution of periapical and furcal lesions.
Root MTA was developed by Lotfi in Tabriz
University of Medical Sciences, (Iran) as a less expensive
brand of MTA. Studies have shown favorable properties of
Root MTA [23, 24]. There are still not enough case reports
and clinical studies demonstrating the clinical applications
of Root MTA. This study presents a mandibular molar
with iatrogenic stripping perforation which was
successfully managed using Root MTA.
Case Report
A 25-year-old woman with the complaint of persistent
drainage of pus in the right mandibular vestibule region was
referred to the Endodontic Department of Tabriz Dental
School. Patients medical history revealed no significant
findings.
On clinical examination, the right mandibular first
molar was sensitive to percussion; however, probing depth
and mobility were within normal range. Right mandibular
first molar showed 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 also revealed furcal and apical
radiolucency (Figure 1A). Diagnosis of pulp necrosis with
chronic periradicular periodontitis was established. After
isolation with rubber dam, 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 (Figure 1B). The patient was immediately
referred to the post-graduate section of the Endodontic
Department. There, the instrumentation of the canals was
continued using ProTaper Universal (Dentsply Maillefer,
Ballaigues, Switzerland) in a crown down approach except in
the mesiolingual canal to prevent increasing the size of
perforation. One percent sodium hypochlorite (NaOCl) was
used as irrigant during instrumentation. Because of
persistent hemorrhage, a calcium hydroxide dressing was
placed into the canals, and the tooth was temporary restored
with Zonalin (Purton, Wiltshin, Sweden). The patient was
asymptomatic between appointments. At the subsequent visit
7 days later, the tooth was isolated, temporary restoration
was removed, and the canals were thoroughly irrigated with
Discussion
Strip perforation is an unwanted procedural accident that
negatively affects the prognosis. Mesiobuccal root of maxillary
molars and the mesial root of mandibular molars are highly
susceptible to strip perforation because of thin dentinal walls.
Inappropriate instrumentation as well as large instruments
during preparation in these thin root canals can cause strip
perforation. Mechanical trauma to periodontal tissue as a
result of perforation and possible contamination of the site
often lead to inflammation and osseous destruction. Strip
perforation differs from other perforations because of its large
affected area, irregular edge of the perforation site, and
difficulty in sealing the perforation [3]. One of the most
important factors affecting the prognosis is the time elapsed
since the occurrence of the perforation [1, 25]. In the present
case, the time between perforation and repair was short; this
contributed to the success of the treatment. In this case, the
canals were treated with calcium hydroxide between
appointments to reduce exudation, excessive bleeding, and
inflammation of the periradicular tissues before the obturation
of the canals and sealing of the perforation with MTA. Studies
have shown that calcium hydroxide eliminates bacteria and
reduces inflammation and bleeding from the perforation site
[26, 27]. Application of calcium hydroxide in this case reduced
inflammation and bleeding, making the treatment less
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