Alzahrani Omar, Alghamdi Faisal
Department of General Dentistry, The University Dental Hospital, King Abdulaziz University, 80209 Jeddah 21589, Saudi Arabia.
Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, 80209 Jeddah 21589, Saudi Arabia.
Case Rep Dent. 2021 Mar 24;2021:5583909. doi: 10.1155/2021/5583909. eCollection 2021.
This study illustrates a conservative approach to nonsurgical management of apical root perforation in maxillary first molars. A patient was referred for retreatment of a maxillary left first molar. Her chief complaint was dull pain while biting in her maxillary left first molar. Periapical radiography showed radiolucency related to the mesiobuccal root and overextended gutta-percha through a perforation in the apical part of the distobuccal root. A CBCT scan was acquired and revealed the location and size of the apical perforation. The clinical examination showed that the tooth has been endodontically treated and the canals were filled, tender to percussion and palpation. Thus, the nonsurgical root canal retreatment was done and the perforation site was repaired by using mineral trioxide aggregate (MTA). At the one-year follow-up, after the management of apical root perforation, we observed periapical tissue healing and no pain due to percussion and palpation, without any clinical/radiological signs or symptoms. The prognosis of this case has a higher success rate with the development of new materials such as MTA. The MTA not only can seal the site of the perforation but also has the ability to induce calcification. Many factors can contribute to the success rate of perforated cases, including time, size, and location of the perforation. With the use of this material and good tools like a microscope, there are those with having higher chances of repair and eventually higher success rates.
本研究阐述了对上颌第一磨牙根尖穿孔进行非手术治疗的保守方法。一名患者因上颌左第一磨牙再治疗前来就诊。她的主要诉求是上颌左第一磨牙咬合时出现钝痛。根尖片显示与近中颊根相关的透射区，以及通过远中颊根根尖部穿孔处超充的牙胶。进行了CBCT扫描，显示了根尖穿孔的位置和大小。临床检查表明该牙已进行根管治疗且根管已充填，叩诊和触诊时有压痛。因此，进行了非手术根管再治疗，并使用三氧化矿物凝聚体（MTA）修复穿孔部位。在根尖穿孔治疗后的一年随访中，我们观察到根尖周组织愈合，叩诊和触诊时无疼痛，无任何临床/影像学体征或症状。随着MTA等新材料的发展，该病例的预后成功率较高。MTA不仅可以封闭穿孔部位，还具有诱导钙化的能力。许多因素会影响穿孔病例的成功率，包括穿孔的时间、大小和位置。使用这种材料以及显微镜等良好工具，修复的机会更大，最终成功率也更高。
