The purpose of the article, presenting summarized data from various and extensive literature sources, is to provide information on iatrogenically induced perforations of the root canal system, their diagnosis, timely treatment and prognosis. Root perforation is a pathological communication between the walls of the root canal and the periodontal space (the outer surface of the tooth). It usually occurs as a result of an accident during endodontic treatment or a pathological change (such as aggressive dental caries, external or internal inflammatory root resorption). Reaching the pulp chamber and the furcation area of the root, a caries can cause a perforation defect. Identification of root perforations is done through a combination of clinical and imaging exams. Cone-beam computed tomography represents an important resource for the diagnosis and prognosis of this clinical condition. The prognosis of a tooth with a root perforation depends on the time elapsed before obturation of the perforation, the location and size of the lesion, and the sealing ability of the material used. Perforation defects can be treated by non-surgical or surgical techniques and methods. A small perforation of the root immediately sealed and located apical from the alveolar bone and epithelial attachment has a better prognosis.
Seltzer S, Bender IB, Smith J, Freedman I, Nazimov H. Endodontic failures: an analysis based on clinical, roentgenographic, and his tologic findings. ORAL SURG ORAL MED ORAL PATHOL. 1967;23:500-30.
Grossman LI, Shepard LI, Pearson LA. Roentgenologic and clinical evaluation of endodontically treated teeth. Oral Surg Oral Med Oral Pathol. 1964 Mar;17(3):368-74.
Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J. 2007 Oct;40(10):818-30.
Shemesh H, Cristescu RC, Wesselink PR, Wu MK. The use of cone-beam computed tomography and digital periapical radiographs to diagnose root perforations. J Endod. 2011 Apr;37(4):513-6.
Katsumata A, Hirukawa A, Noujeim M, Okumura S, Naitoh M, Fujishita M, et al. Image artifact in dental cone-beam CT. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 May;101(5):652-7.
Adel M, Tofangchiha M, Yeganeh LA, Javadi A, Khojasteh AA, Majd NM. Diagnostic accuracy of cone-beam computed tomography and conventional periapical radiography in detecting strip root perforations. J Int Oral Health. 2016 Jan;8(1):75-9.
Fuss Z, Trope M. Root perforations: classification and treatment choices based on prognostic factors. Endod Dent Traumatol. 1996 Dec;12(6):255-64.
Estrela C, Holland R, Estrela CR, Alencar AH, Sousa-Neto MD, Pécora JD. Characterization of successful root canal treatment. Braz Dent J. 2014 Jan-Feb;25(1):3-11.
Walton RE, Torabinejad M. Principles and practice of endodontics. Philadelphia: WB Saunders, 1989:210.
Tronstad L, Andreasen JO, Hasselgren G, Kristerson L, Riis I. pH changes in dental tissues after root canal filling with calcium hydroxide. J Endod. 1981 Jan;7(1):17-21.
Lee SJ, Monsef M, Torabinejad M. Sealing ability of a mineral trioxide aggregate for repair of lateral root perforations. J Endod. 1993 Nov;19(11):541-4.
Torabinejad M, Watson TF, Pitt Ford TR. Sealing ability of a mineral trioxide aggregate when used as a root end filling material. J Endod. 1993 Dec;19(12):591-5.
Holland R, Otobani Filho JA, Souza V, Nery MJ, Bernabé PF, Dezan Junior E. Mineral trioxide aggregate repair of lateral root perforations. J Endod. 2001 Apr;27(4):281-4.
Camilleri J, Pitt Ford TR. Mineral trioxide aggregate: a review of the constituents and biological properties of the material. Int Endod J. 2006 Oct;39(10):747-54.
Bortoluzzi EA, Araújo GS, Guerreiro Tanomaru JM, Tanomaru-Filho M. Marginal gingiva discoloration by gray MTA: a case report. J Endod. 2007 Mar;33(3):325-7.
Marciano MA, Costa RM, Camilleri J, Mondelli RF, Guimarães BM, Duarte MA. Assessment of color stability of white mineral trioxide aggregate angelus and bismuth oxide in contact with tooth structure. J Endod. 2014 Aug;40(8):1235-40.
Camilleri J. Hydration mechanisms of mineral trioxide aggregate. Int Endod J. 2007 Jun;40(6):462-70.
Wang Z. Bioceramic materials in endodontics. Endod Topics. 2015 May;32(1):3-30.
Grech L, Mallia B, Camilleri J. Investigation of the physical properties of tricalcium silicate cement-based root-end filling materials. Dent Mater. 2013 Feb;29(2):e20-8.
Lovato KF, Sedgley CM. Antibacterial activity of endosequence root repair material and proroot MTA against clinical isolates of Enterococcus faecalis. J Endod. 2011 Nov;37(11):1542-6.
