Retrograde Sealing of Accidental Root Perforations with Dentin-Bonded Composite Resin

By Rud J, Rud V, Munksgaard EC

Date: 06/1999
Journal: JOE

Summary:  

Purpose:

To examine the healing results of surgical Gluma Retroplast seals of iatrogene root perforations, which were not suited for immediate orthograde treatment.

Materials and Methods:

 – n: 100 patients with iatrogene root perforations that were treated from 1984-1995.

-All patients had pre and post operative radiograph and were followed up from 1 year up to 11 years the mean F/U period was 4 years.

-Non of the perforation cases were referred immediately.

-Access to the perforation site was done surgically and the site of the perforation was hallowed and treated with Gluma and the area was sealed with Retroplast.

-Healing was classified radiographically and clinically. Healing followed Rud criteria which has been adjusted to evaluate perforation healing.

-Radiographs were examined by two examiners.

Complete healing: Radiographic bone regeneration next to perforations Fig.1, ± PDL space up to 2x as large as normal.

Partial healing: Bone regeneration up to the level of the seal with a border of compact bone or LD Fig.2.

Uncertain healing: a decreased RL without a compact bone border or LD. Failure: Unchanged or enlarged rarefaction originating from the perforation; loose sealing material seen on radiograph; presence of clinical signs of inflammation originating from the perforation area such as a fistula or an abscess.

Most highlighted results:

-Maxillary teeth constituted most of the sample and most of the perforated roots had posts.

-Mid root perforation was more common than apical or coronal perforations.

-Healing of perforations at various site other than the furcation at later F/U was 82%, and failure was 18% as shown in Table.1.

-Healing of furcal perforations at later F/U was 71% which is sig less than other perforated sites and failure was 29% .

-A RL was noted in 94% proximal to the perforation site and more than half of the RL extended to the cervix (crestal bone) (43 out of 83).

-Cases without RL extending to the cervix had higher complete healing (62% vs. 47%) but was no sig diff Table.2.

-Most of the furcal perforations were in mandibular molars and 72% were in the D root.

Clinical Significance:

– The worst prognosis is found in furcal perforation with RL extending to the crestal bone. Thus, preparing the D root of mandibular molars for post placement should be done meticulously.