![]() The immediate sealing of a perforation is paramount to help prevent infection from communicating with the surrounding periradicular tissue. The larger the perforation, the more difficult sealing can be. 3 The more apical the perforation, the better the prognosis, but the more difficult the direct repair is. Much depends on the location, size, and time from occurrence. This can lead to a guarded long-term prognosis for the tooth. The biologic response of a perforated tooth is inflammatory and can cause a breakdown of the osseous and periradicular tissues. 2 To clinically determine if an endodontically perforated tooth should be extracted or saved, the clinician must first understand the prognosis and treatment. The prognosis is favorable if the perforation is small and no sulcular communication or osseous destruction is observed.Ī tooth perforation is a pathologic or iatrogenic communication between the root canal space and the periodontal apparatus. Other perforations can be from a post or a strip perforation created during aggressive instrumentation of the canal system. Immediate sealing of the perforation by biologically proven materials such as mineral trioxide aggregate (MTA) or a bioceramic material offers the best surface for osseous repair. Bacterial infiltration and the resulting inflammation create the defect that destroys a good prognosis. Quick seal: If there is healthy surrounding bone, a small perforation that is immediately sealed to prevent bacteria contamination provides the best prognosis. Size: For osseous repair, the smaller the perforation, the better the prognosis. Sufficient bone is available to endure the inflammation and create an environment for healing. If the perforation occurs in an area of the coronal structure that is surrounded by healthy bone, it is small and can be sealed immediately, leading to a better prognosis. Location: If the perforation is close to the crestal bone, inflammation can result, creating epithelial downgrowth and communication with the oral environment. Each can determine the prognosis, which depends on three factors: Further division includes iatrogenic and pathogenic. Endodontically perforated teeth can be categorized as coronal and root structure. Preserving natural tooth remains the best treatment decision. ![]() For an unfavorable treatment condition, there would be apical, crestal, or furcal perforation with sulcular communication and a probing defect with osseous destruction, delay with no repair or gross extrusion of the repair materials, and a large perforation. ![]() The treatment condition is questionable if the problem is mid-root or furcal with no sulcular communication or osseous defect, the repair was delayed, and the perforation is larger. The clinician should definitely attempt to save the endodontically perforated tooth, according to the American Association of Endodontists’ Treatment Options for the Compromised Tooth: A Decision Guide.1 The treatment condition is favorable if the issue is at the apex with no sulcular communication or osseous defect, the repair is performed immediately, and the perforation is small (relative to the tooth and location). Should endodontically perforated teeth be extracted or saved? Rossman, DMD James Bahcall, DMD, MS, FICD, FACD and Frederic Barnett, DMD The Endodontically Perforated Tooth: Hopeless or Savable?
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