(TC37) Perforation Management Over the Years

According to the AAE Glossary, perforations are mechanical or pathologic communication between the root canal system and the external tooth surface. In endodontics they are caused by complex anatomy, calcifications, caries, resorptive defects, or iatrogenic events. An invasion into the supporting structures initially incites inflammation and loss of attachment and may ultimately compromise the prognosis of the tooth. An ideal repair material should induce osteogenesis and cementogenesis, be compatible, nontoxic, noncarcinogenic, easily obtainable, convenient to use, and relatively expensive (Hartwell & England, 1993). Initially amalgam, Cavit, zinc oxide-eugenol cement, chlor percha, and gutta-percha were proposed for the nonsurgical repair of perforation defects. However, the potential of these materials' lack of proper placement and overfilling was a common difficulty that led to inflammation. The idea of an internal matrix has been used with calcium hydroxide initially; collagen material more recently has been used as a matrix. Over the years, more biocompatible, nontoxic, and easy-to-handle materials have come to market, including mineral trioxide aggregate, Biodentine, Geristore, and Bioceramic putty. This review presents information on preventing, identifying, and treating such problems through discussion of the causes, diagnosis, prognosis, and therapy of root perforations. Along with comparing the evidence-based characteristics of all these materials, information will be provided on which material is most appropriate depending on time, location, and size.