A clinical and roentgenological study of 55 cases of root perforation.

By Kvinnsland I, Oswald RJ, Halse A, Grønningsaeter A

Date: 03/1990
Journal: IEJ

Purpose: To present the etiology and location of root perforations, and to relate their outcome

to the pretreatment conditions and various procedures used to treat the perforations

N= 55 root perforations were recorded over a period of 11 years

Materials and Methods:

•Recall for all patients with perforation repair for radiographic evaluation •Mean recall period 3,5 years:

oSuccess: normal PDL width, lamina dura is continuous

oUncertain: PDL space twice-normal thickness. A radiolucency reduced in size but has not resolved during a postoperative period < 2 years.

oFailure: radiolucency unchanged or has increased in size. The radiolucency has reduced in size but has not resolved ≥2 years postoperatively, or lesion had developed.

Results:

•Perforations were more common in the maxilla (73%) than in the mandible (27%)

•In the maxillary arch, canine was the most frequently perforated tooth, followed by the lateral incisor.

•In the mandibular arch, the first molar was the most

•Buccal (35%) and mesial (35%) root surfaces were most frequently perforated

Etiology:

A) During endodontic treatment: 47%, mostly in the midroot level or apical third •Attempting to negotiate calcified canals 42%

•Root canal instrumentation 35%

•Attempting to locate canal orifices 23%

B) During post preparation: 53%, mostly in the midroot level.

•The overall success rate (for the 39 treated cases): 56%, and failure rate: 36%

Prognosis: •Treatment success when perforations are in the apical part of roots greater than those located coronally

Treatment outcome in relation to type of treatment performed:

•Highest success rate was found when combined orthograde and surgical treatment were performed.

•When s treated only with orthograde, 5 cases were diagnosed in the recall as failure. After surgical treatmen, the success rate of this method (orthograde + surgical) would be considered 92%.

Clinical significance:

•Repairing root perforations has favorable results, especially when combined orthograde and surgical approach is performed

•Perforation repair success could reach above 50%