Surgical Management of Root Canal Perforation Aided by CBCT Scan

• Main Authors: Alvaro Henrique Borges, Durvalino Oliveira, Iussif Mamede-Neto, Cyntia Araujo Rodrigues Estrela, Carlos Estrela
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2018-12-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: cone-beam computed tomography; endodontics; mineral trioxide aggregate; parendodontic surgery
• Online Access: https://jcdr.net/articles/PDF/12408/37435_CE[Ra1]_F(SL)_PF1(AB_SL)_PN(SL).pdf

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.