Management of concomitant strip and apical perforation in mandibular first molar.

Iatrogenic perforation is a complication that can occur during endodontic treatment. If left untreated, it adversely affects the prognosis of the tooth. The use of optimal magnification and appropriate repair material help in achieving favourable outcome. The current case report illustrates the management of concomitant strip and apical perforation in the mesial canals of lower first molar of 13 years old paediatric patient. The management of perforations was done with MTA under 25x magnification of a dental operating microscope. The periapical radiograph and clinical investigations revealed complete bone formation at the furcal area adjacent to the repaired strip perforation and ossification of the apical lesion indicating a favourable healing outcome at 18 months of follow up.

Fracture Resistance of Molars With Simulated Strip Perforation Repaired With Different Calcium Silicate-Based Cements.

Background and aims A root perforation is a connection between the root canal system and the external supportive tissues. Strip perforation (SP), occurring within root canals in a strip, can worsen the prognosis of a treated tooth, reduce its mechanical resistance, and impair the tooth structure. One of the suggested methods to treat SP is to seal it with a bio-material such as calcium silicate cement. Therefore, this in vitro study aimed to assess the molar structure impairment due to SP, which requires studying the fracture resistance, and the ability of mineral trioxide aggregate (MTA), bioceramic, and calcium-enriched mixture (CEM) to repair this perforation. Materials and methods Seventy-five molars were instrumented to size #25 and taper 4%, irrigated with sodium hypochlorite and ethylenediaminetetraacetic acid (EDTA), dried, and then divided randomly into five groups (G1-G5): in G1, root canals were filled with gutta-percha and sealer (negative control sample), whereas the rest of the groups (G2-G5) had a manual simulated SP made with Gates Glidden drill at the mesial root of the extracted molar, and filled with gutta-percha and sealer up to their perforation area; in G2, SP was filled with gutta-percha and sealer (positive control sample); G3 used MTA to repair the SP; G4 used bioceramic putty; and G5 used CEM. Fracture resistance tests of the molars were conducted in the crown-apical direction using a universal testing machine. One-way ANOVA test and Bonferroni test were used to study the significance of the differences in the mean values of the tooth fracture resistance, where statistical significance was set at 0.05. Results The ANOVA test showed that there were statistically significant differences between the fracture resistance (in newtons) values among groups (p = 0.000). The Bonferroni test showed that G2 had a smaller fracture resistance mean than the other four study groups (656.53 N; p = 0.000), and that of G5 was smaller than G1, G3, and G4 (794.40 N, 1083.73 N, 1025.20 N, and 1034.20 N, respectively; p = 0.000 in each pairwise comparison). Conclusion SP reduced the fracture resistance of endodontically treated molars. SP restored using MTA and bioceramic putty was better than that treated with CEM and similar to molars without SP. Moreover, MTA and bioceramic putty enhanced the fracture resistance of endodontically treated teeth to levels similar to molars without SP.

Assessment of the diagnostic accuracy of strip and furcal perforations in different sizes by cone beam computed tomography.

OBJECTIVE: Root perforation is an adverse event that may accidentally occur during root canal treatment and can adversely affect the treatment plan and tooth prognosis. This study aimed to assess the accuracy of cone beam computed tomography (CBCT) for detecting the strip and furcal perforations with different sizes. METHODS: The mesiolingual canals of 155 extracted human mandibular first molars were instrumented and randomly divided into four experimental groups and one control group (n = 31). Furcal (in the pulp chamber floor) and strip perforations with 0.5, 1, 1.5, and 2 mm in diameter were manually created. The teeth were randomly mounted in bovine ribs and scanned using CBCT. Two radiologists unaware of the study groups observed the images and reported the greatest perforation diameter. The inter-observer agreements were calculated. The diagnostic accuracy was compared for furcal and strip perforations with different sizes. RESULTS: The inter-observer agreement for detecting furcal and strip perforations with different sizes were good. The diagnostic accuracy was 100% for the absence of perforation in each group. CONCLUSIONS: CBCT can detect the absence of perforation with high accuracy. The diagnostic accuracy of CBCT in the presence of strip and furcal perforation with different sizes was not significant.

Nonsurgical Management of Strip Perforation Using Platelet-Rich Fibrin and MTA by Matrix Concept - A Case Report with One Year Follow-up.

Iatrogenic errors happen especially during endodontic treatment even with the experienced clinicians. It is impossible to predict the occurrence of an event. Although many of them can be corrected and managed successfully, few conditions might have the worst prognosis leading to uneventful extraction. The present case report highlights a 1-year follow-up of managed strip perforation in mesial canals of mandibular first molar, nonsurgically using MTA obturation. The present challenging case gives an insight on the importance of regenerative capacity and osteogenic potentiality of bioactive materials, when appropriate tissue engineering concepts are applied.

How Does Voxel Size of Cone-beam Computed Tomography Effect Accurate Detection of Root Strip Perforations.

Introduction: Our study aimed to assess the diagnostic accuracy of different voxel sizes for cone-beam computed tomography (CBCT) when detecting strip perforations of variable sizes. We used 0.2 and 0.3 mm3 voxel for detecting root strip perforations. Methods and Materials: This was an in vitro study conducted on 155 extracted humans' mandibular first molars. The teeth were randomly divided into five groups (n=31). Perforation were not induced in the control group. In the remaining four groups, strip perforations of 0.5, 1, 1.5, and 2 mm diameters were created in the mesiolingual canal using #3 Gates Glidden drills. The CBCT scans were taken first with a 12×9 cm field of view (FOV), 90 kVp, 4 mA, and 0.2 mm3 voxel size for 24 sec and then with a 12×9 cm FOV, 90 kVp, 2 mA, and 0.3 mm3 voxel size for another 24 sec. Two observers evaluated the images and reported the largest diameter of perforations. The results were compared with the gold standard values (determined by an electronic digital caliper) using statistical methods, including the kappa coefficient and generalized estimating equation (P<0.05). Results: Based on the findings of our study, the inter-observer agreement ranged from 58-100%, while the intra-observer agreement was reported to be around 100%. The difference in accuracy between 0.2 and 0.3 mm3 voxel sizes was not statistically significant (P>0.05). In addition, the accuracy of detecting different perforation sizes in the CBCT did not follow a specific pattern. Conclusion: This in vitro study showed that CBCT is a reliable diagnostic tool, and even in lower dosages of 0.3 mm3 voxel size, image resolution and diagnostic accuracy was not affected. Moreover, smaller root perforations could be detected as accurately as larger ones with CBCT.

Detection of root perforations using conventional and digital intraoral radiography, multidetector computed tomography and cone beam computed tomography.

OBJECTIVES: This study aimed to compare the accuracy of conventional intraoral (CI) radiography, photostimulable phosphor (PSP) radiography, cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) for detection of strip and root perforations in endodontically treated teeth. MATERIALS AND METHODS: Mesial and distal roots of 72 recently extracted molar were endodontically prepared. Perforations were created in 0.2, 0.3, or 0.4 mm diameter around the furcation of 48 roots (strip perforation) and at the external surface of 48 roots (root perforation); 48 roots were not perforated (control group). After root obturation, intraoral radiography, CBCT and MDCT were taken. Discontinuity in the root structure was interpreted as perforation. Two observers examined the images. Data were analyzed using Stata software and Chi-square test. RESULTS: The sensitivity and specificity of CI, PSP, CBCT and MDCT in detection of strip perforations were 81.25% and 93.75%, 85.42% and 91.67%, 97.92% and 85.42%, and 72.92% and 87.50%, respectively. For diagnosis of root perforation, the sensitivity and specificity were 87.50% and 93.75%, 89.58% and 91.67%, 97.92% and 85.42%, and 81.25% and 87.50%, respectively. For detection of strip perforation, the difference between CBCT and all other methods including CI, PSP and MDCT was significant (p < 0.05). For detection of root perforation, only the difference between CBCT and MDCT was significant, and for all the other methods no statistically significant difference was observed. CONCLUSIONS: If it is not possible to diagnose the root perforations by periapical radiographs, CBCT is the best radiographic technique while MDCT is not recommended.

Nonsurgical approach for strip perforation repair using mineral trioxide aggregate.

"Stripping" is lateral perforation is caused by overinstrumentation through a thin wall in the root and is most likely to occur at the inside wall of a curved canal, such as the distal wall of the mesial roots in mandibular first molars. In the past, poor prognosis for strip and furcation perforations was probably due to bacterial leakage or lack of biocompatibility of repair materials. However, the recent development in the techniques and materials such as mineral trioxide aggregate (MTA) has enhanced the prognosis for such cases. There is limited literature on use of MTA as an obturating material in the treatment of strip perforation. This study presents two cases of strip perforation that are successfully repaired nonsurgically using MTA with 2-year follow up. Cases suggest that MTA can be used as an alternative root canal obturation material for the treatment of strip perforation. The property differences between gray and white MTA are reviewed.

Detection of root perforations using conventional and digital intraoral radiography, multidetector computed tomography and cone beam computed tomography

OBJECTIVES: This study aimed to compare the accuracy of conventional intraoral (CI) radiography, photostimulable phosphor (PSP) radiography, cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) for detection of strip and root perforations in endodontically treated teeth. MATERIALS AND METHODS: Mesial and distal roots of 72 recently extracted molar were endodontically prepared. Perforations were created in 0.2, 0.3, or 0.4 mm diameter around the furcation of 48 roots (strip perforation) and at the external surface of 48 roots (root perforation); 48 roots were not perforated (control group). After root obturation, intraoral radiography, CBCT and MDCT were taken. Discontinuity in the root structure was interpreted as perforation. Two observers examined the images. Data were analyzed using Stata software and Chi-square test. RESULTS: The sensitivity and specificity of CI, PSP, CBCT and MDCT in detection of strip perforations were 81.25% and 93.75%, 85.42% and 91.67%, 97.92% and 85.42%, and 72.92% and 87.50%, respectively. For diagnosis of root perforation, the sensitivity and specificity were 87.50% and 93.75%, 89.58% and 91.67%, 97.92% and 85.42%, and 81.25% and 87.50%, respectively. For detection of strip perforation, the difference between CBCT and all other methods including CI, PSP and MDCT was significant (p < 0.05). For detection of root perforation, only the difference between CBCT and MDCT was significant, and for all the other methods no statistically significant difference was observed. CONCLUSIONS: If it is not possible to diagnose the root perforations by periapical radiographs, CBCT is the best radiographic technique while MDCT is not recommended.