Root Perforation Repair with Calcium Silicate Cements: Part 1 Basic Knowledge and Treatment Outcomes
Keywords:
calcium silicate cement, prognostic factors, root perforation repair, treatment outcomeAbstract
Root perforation can occur due to pathological conditions, iatrogenic factors during root canal treatment, or post-space preparation in the restorative procedure. The perforation creates a pathway of infection connecting the root canal system and the external root surface making endodontic treatment more complicated. Diagnosis of root perforation can be achieved through comprehensive clinical and radiographic evaluations. The classification of root perforations has been based on 1) the location of the root perforation, 2) the size of the root perforation, and 3) the time to repair the root perforation. The principles of managing root perforation involve eliminating any infection at the perforation site and sealing the perforation with a material that is biocompatible and provides a good seal. Currently, calcium silicate cements are used as root repair materials, with mineral trioxide aggregate (MTA) being the first widely adopted material due to its excellent sealing ability, antibacterial properties, and biocompatibility. However, MTA has drawbacks such as long setting time, difficult handling, and potential tooth discoloration. Therefore, new types of calcium silicate cement materials have been developed, maintaining the primary components of dicalcium silicate and tricalcium silicate, and used for root perforation repair. Evaluating the success of root perforation repairs is generally based on a combination of clinical and radiographic examinations. In the average follow-up period ranging from 6 to 168 months, the success rates of root perforation repair with calcium silicate cement materials (mostly repaired with original MTA) ranged from 73.3-100% according to the strict criteria (healed). The success rates were 100% according to the lenient criteria (healed or healing). Most studies observed a reduction in the size of periapical lesions within 6 months after treatment, and complete healing of the lesions within 12-24 months. However, late failures after treating root perforations can be observed in the 2-3 years range postoperatively or longer. Long-term follow-up of the treatment is necessary to ensure the stability of the repair without peri-radicular lesions or root fractures. The main prognostic factors to outcomes of root perforation repair will be further described in the next article (part 2).
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