Root endo11/13/2023 ![]() 1 Indeed, it can significantly reduce the odds of success of root canal treatment by 56%, largely attributable to bacterial contamination during or after treatment. Though irreversible inflammation may not always result, if an irritating restoration is present or a microbial infection ensues, it is unlikely that healing will take place. 8 If the perforation is not detected early and repaired, then the breakdown of the periodontium may ultimately lead to a loss of tooth. ![]() ![]() If this is in close proximity to the supra crestal attachment there may be proliferation of epithelium and, ultimately, the formation of a periodontal pocket ( Fig. In the mid and apical portions of the root this may manifest as a radiolucency adjacent to the perforation. ![]() 8).įollowing the initial acute inflammatory response there may follow destruction of periodontal fibres, bone resorption and the formation of granulomatous tissue. 10 In addition to the methods described above, radiographs may reveal radiolucent lesions that have developed since the perforation occurred, as there may be local osteolysis ( Fig. Untreated perforations may be revealed by the presence of serous exudate or sinus from the site of perforation, sensitivity to percussion, localised periodontal pocketing and chronic inflammation of the gingiva when the inflammation has penetrated the alveolar bone. Late diagnosis of pathological perforations is largely a combination of clinical assessment, radiographs and the nature of the presenting complaint. Taking a second film and shifting the radiographic beam angulation to the mesial or distal aspect can partly overcome this. Radiographs can be used at the time of perforation, but do have their limitations: they are only a two-dimensional representation and so it may be difficult to accurately assess the site and extent of the perforation. The bright operating light and magnification make it excellent for visualising the position and extent of the perforation. Operating microscopes are becoming increasing popular in identifying perforations. By placing the file onto the perforation this will give a zero reading, indicating a communication with the periodontal ligament. 4, 5, 6Īpex locators are very useful in detecting perforations. Readers are referred to more comprehensive papers on the management of resorption. The ability to control the resorption is dependent upon the type, site and extent. There are different types of external resorption, but all have the potential to continue until the resorptive defect communicates with the root canal ( Fig. 4, 5Įxternal inflammatory root resorption can occur following damage to the cementum and periodontal ligament cells on the root surface. Thus, early detection and intervention is essential to control the disease before such an event occurs. Though the process is uncommon and often self-limiting, it can progress into a perforation. The exact cause is not known, but this process can follow trauma, pulpal inflammation and pulpotomy procedures. It is seen radiographically as an oval shape enlargement of the root canal system. 3 When occurring within the root canal system it is known as internal inflammatory root resorption. Root resorption is the progressive loss of dentine and cementum by the continued action of osteoclastic cells. These can result from root resorption or caries. Full size image Pathological perforations
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