Zahid Talal M
Department of Periodontology, King Abdulaziz University, Jeddah, Saudi Arabia.
Case Rep Dent. 2023 Sep 27;2023:7335196. doi: 10.1155/2023/7335196. eCollection 2023.
Iatrogenic root perforation presents a significant management challenge for clinicians as it may seriously harm the periodontium. More specifically, perforations occurring relative to the crestal bone have a poor prognosis even after repair due to their proximity to the gingival tissues. The current literature reports the use of various materials for root perforation repair including calcium hydroxide, glass ionomer cement, amalgam, and mineral trioxide aggregate (MTA), to name a few. This case report describes the clinical management of a cervical perforation that occurred on the maxillary central incisor. The perforated area was initially repaired with MTA but failed after one year, which resulted in an active lesion at the midlabial aspect of the tooth. The case was subsequently treated using a resin-modified glass ionomer cement (Geristore®) and deepithelialized free gingival graft (DGG). There were favorable clinical and radiographic outcomes at 1-, 3-, and 5-year follow-up. The use of DGG, however, led to some late complications such as gingival cul-de-sac and color discrepancy, which were later resolved with gingivoplasty and frenectomy. We thus conclude that Geristore® has the potential to be a better repair material than the existing ones for crestal and subcrestal root perforations.
医源性牙根穿孔给临床医生带来了重大的治疗挑战，因为它可能会严重损害牙周组织。更具体地说，相对于牙槽嵴顶骨发生的穿孔，即使在修复后预后也很差，因为它们靠近牙龈组织。目前的文献报道了使用多种材料进行牙根穿孔修复，包括氢氧化钙、玻璃离子水门汀、汞合金和三氧化矿物凝聚体（MTA）等等。本病例报告描述了上颌中切牙发生的颈部穿孔的临床治疗情况。穿孔区域最初用MTA修复，但一年后失败，导致牙齿唇面中部出现活动性病变。该病例随后使用树脂改性玻璃离子水门汀（Geristore®）和去上皮游离龈瓣（DGG）进行治疗。在1年、3年和5年的随访中，临床和影像学结果良好。然而，DGG的使用导致了一些晚期并发症，如牙龈盲袋和颜色差异，后来通过牙龈成形术和系带切除术得到了解决。因此，我们得出结论，对于牙槽嵴顶和牙槽嵴下牙根穿孔，Geristore®有可能成为比现有材料更好的修复材料。
