Nonsurgical repair of perforation defects. Internal matrix concept

By Lemon RR

Date: 01/1992
Journal: Dental Clinics of North America

Summary:  

•Purpose:

to discuss the factors & techniques which affect the long-term prognosis for many types of perforations & internal matrix placement concept. •Factors influencing long-term prognosis for the repair of the furcation & root canal perforations:

(1)Defect size

(2) Time between perforation & repair

(3) Ability to hermetically seal the defect.

•Classic perforation repair technique :

(1) Nonsurgical repair – materials such as amalgam, ZOE , GP or cavit.

(2 )Surgical repair

(A) Surgical curettage

-to remove extruded repair material. The difficulty of controlling the internal repair material may result in overfill & under-fill or lack of seal.

 (B) Surgical alteration of the tooth – when perforation is too large or inaccessible without bone removal (Root amputation, hemisection, bicuspidization, internal replantation).

•Requirements for an ideal perforation repair:

(1)Hermetically seal the defect with non-resorbable biocompatible restorative material.

(2)Avoid contamination of the restorative material with hemorrhage. (3)Control the restorative material to prevent the overfill or underfill.

•To repair the defect internal matrix retainer is required to control the material (can not be removed after placement).

•Requirements of Internal matrix – must satisfy the criteria for an implant; biocompatible & not producing an inflammatory response.

•Case selection: 

Indications:

 1) accessible perforation below the crestal bone approximately 1mm or larger.

(2) Large perforation in the middle or apical third of the root in straight canals. vContraindications:

(1)Perforations inaccessible to matrix placement : strip perforation.

(2) perforations on the external root surface at or above the level of the crestal bone. ü •Success & failure determination :

(1) Symptoms:

-Mild & limited gingival soreness & bite sensitivity.

-Relieving the occlusion is advisable. –

The patient should be seen monthly until determining if the treatment was successful or failed..

(2)Periodontal evaluation : –

The most important factor. üGentle probing should not be done during early weeks of the recall period. (No/Reduced pocket=successful repair)

-More favorable prognosis – sinus tract communication through attached gingiva VS communication through the furcation.

(3)Radiographic evaluation :

-Evidence of bone formation can be seen within 3-6 months.

•Case selection:  vIndications:

 1) accessible perforation below the crestal bone approximately 1mm or larger.

(2) Large perforation in the middle or apical third of the root in straight canals. vContraindications:

(1)Perforations inaccessible to matrix placement : strip perforation.

(2) perforations on the external root surface at or above the level of the crestal bone.

•Success & failure determination :

(1) Symptoms:

-Mild & limited gingival soreness & bite sensitivity.

-Relieving the occlusion is advisable.

-The patient should be seen monthly until determining if the treatment was successful or failed..

(2)Periodontal evaluation :

-The most important factor.

-Gentle probing should not be done during early weeks of the recall period. (No/Reduced pocket=successful repair)

-More favorable prognosis -sinus tract communication through attached gingiva VS communication through the furcation.

(3)Radiographic evaluation :

-Evidence of bone formation can be seen within 3-6 months.

Clinical significance:

-Internal matrix concept of perforation repair offers distinct advantages over classic techniques.