Surgical Management of Root Canal Perforation Aided by CBCT Scan

Abstract

This study describes the surgical management of two Root Canal Perforations (RCP) in maxillary incisors aided by CBCT scans. In the first case, a patient was referred for retreatment due to a history of overfilling. The chief complaint was frequent discomfort and slight oedema in upper front tooth (#9). Periapical radiography showed gutta-percha extruded out of the root canal. CBCT revealed a RCP and more than 1 cm of a gutta-percha cone extruded out of the apex. At follow-up one year after surgical procedure for the removal of the extruded filling material and apicoectomy, bone tissue formation was observed, without clinical symptoms. In the second case, a series of RCP was verified in multiple maxillary incisors of the same patient, who was referred due to a history of unresolved pain. On clinical examination, no abnormalities of the soft tissue were observed. Imaging exams revealed RCP in all maxillary incisors. The patient underwent conventional treatment and follow-up surgical procedures to seal the RCP. One year after surgery, imaging exams demonstrated tissue formation without clinical symptoms. RCP is considered a serious error in operative procedure. Once properly diagnosed, localised and sealed with biomaterial, a favourable prognosis is often achieved. MTA offered a good seal of perforations, with promising results. The use of CBCT in diagnosis allowed better security, correct positioning and improved surgical planning of RCP.

Keywords

• cone-beam computed tomography
• endodontics
• mineral trioxide aggregate
• parendodontic surgery