Asgary Saeed, Eghbal Mohammad Jafar, Mehrdad Leili, Kheirieh Sanam, Nosrat Ali
Iranian Center for Endodontic Research, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Restor Dent Endod. 2014 May;39(2):137-42. doi: 10.5395/rde.2014.39.2.137. Epub 2014 Mar 21.
This article presents the successful surgical management of a failed mineral trioxide aggregate (MTA) orthograde obturation of a tooth with a history of impact trauma and perforated internal root resorption. A symptomatic maxillary lateral incisor with a history of perforation due to internal root resorption and nonsurgical repair using MTA was referred. Unintentional overfill of the defect with MTA had occurred 4 yr before the initial visit. The excess MTA had since disappeared, and a radiolucent lesion adjacent to the perforation site was evident radiographically. Surgical endodontic retreatment was performed using calcium enriched mixture (CEM) cement as a repair material. Histological examination of the lesion revealed granulation tissue with chronic inflammation, and small fragments of MTA encapsulated within fibroconnective tissue. At the one and two year follow up exams, all signs and symptoms of disease had resolved and the tooth was functional. Complete radiographic healing of the lesion was observed two years after the initial visit. This case report illustrates how the selection of an appropriate approach to treatment of a perforation can affect the long term prognosis of a tooth. In addition, extrusion of MTA into a periradicular lesion should be avoided.
本文介绍了一例对曾受撞击创伤且存在牙根内吸收穿孔的牙齿进行三氧化矿物凝聚体（MTA）常规根管充填失败后的成功手术治疗。一名有因牙根内吸收导致穿孔病史且曾使用MTA进行非手术修复的上颌侧切牙出现症状后前来就诊。初诊前4年曾意外用MTA超填了缺损处。此后多余的MTA已消失，且在穿孔部位相邻处可见一X线透射区。手术根管再治疗采用富钙混合剂（CEM）水门汀作为修复材料。对病变组织的组织学检查显示为伴有慢性炎症的肉芽组织，以及包裹在纤维结缔组织内的小块MTA。在1年和2年的随访检查中，所有疾病体征和症状均已消失，牙齿功能正常。初诊两年后观察到病变在影像学上完全愈合。本病例报告说明了选择合适的穿孔治疗方法如何影响牙齿的长期预后。此外，应避免将MTA挤出至根尖周病变中。
