ENDODONTIC RETREATMENT USING MTA-BASED SEALANTS IN A TOOTH WITH
PERFORATION AND PERIAPIAL LESION: A CLINICAL CASE REPORT
Figure 7. A. Try in of the gutta-percha points; B. Final radiographic
aspect after filling.
Within 4 weeks, patient asymptomatic, the working
length was confirmed via apical and radiographic
locator (Fig. 4) and the perforation was filled again
with MTA HP REPAIR (Angelus Indústria de Produtos
Odontológicos, Paraná, Brazil) (Figs. 5 and 6) in
order to increase the perforation protection (Fig. 2B).
Medication was changed inside the canals.
After a month with medication, the total
biomechanical preparation was performed, with
the Oregon technique and intra canal medication
was provided again. The patient returned after 15
days without pain, with the presence of periapical
repair, and the canals were filled with gutta-percha
and sealant (Fig. 7). MTA Fillapex (Angelus Indústria
de Produtos Odontológicos, Paraná, Brazil) was
applied using the Schilder Plus technique at the
CDC adhesion level, and the distal canal was left with
a 12mm relief for the placement of intra radicular
retainer
After 7 months of follow-up, the patient does
not present, clinically, pain symptoms and
radiographically there was repair of the bone
resorption in the mesial and distal roots (Fig. 8).
3. Discussion
The purpose of repairing a root perforation is to
maintain a healthy periodontal, in juxtaposition with
the perforation place, so that it is free of persistent
inflammation and preventing or reestablishing the
periodontal ligament insertion to nearby tissues.
The success of the perforation repair depends on
a good sealing of the perforated location with a
biocompatible material and that it maintains the
health conditions of the periodontal ligament. 7
Some authors report that MTA can be used to repair
root perforations with predictable results, since in
examined cases, teeth did not present pathological
changes after 12 to 45 months, and more than 82%
of treated patients exhibited radiographic success
with absence of pain. 8,9,10
According to Siew 2015, in a revision conducted with
a total of 188 perforations included in the analysis, a
success rate of 72.5% was concluded, regardless of
the materials used, and of 80.9% for the use of MTA.
These results suggested that non-surgical repair
using MTA material can result in a higher success rate
compared to other materials. 7,11
What differentiates MTA from other materials
is its ability to promote the regeneration of the
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Figure 8. Follow-up radiography after 7 months.
sealant, thereby facilitating the regeneration of the
periodontal ligament. Therefore, it establishes an
effective sealing of root perforations and can be
considered a potential repair material that improves
the prognosis of perforated teeth that otherwise
would be compromised. 2,11
Therefore, the choice of the material used in this
clinical case both for the perforation repair and the
filling sealant was based on the most recent literature.
The radiographic follow-up shows that the success of
the case represents what is found by other writers,
with absence of pain, or periapical changes.
The ability to promote a proper sealing is a primary
factor in the attempt to restore periodontal health, 2
and this must consider the technical skill and
professional features and characteristics of the
material used. The new formulations of the restorative
sealant based on MTA facilitated the insertion of the
material, mainly in small cavities or difficult access.
Burst perforations interfere in the dental element
prognosis. The mesio vestibular root of the upper
molars and the mesial root of the lower molars are
highly susceptible to this type of perforation due to
the thin root walls. 1 In addition to the limitation of
sealing, the difficulty in determining the perforation
location, its size and shape can be limiting for the
case. Using microscope surgery is an effective tool
in th