Tooth perforation: causes, treatment, possible complications. Causes and treatment of perforation of teeth Articles modern methods of treatment of perforation of the roots of teeth
Thanks to the services of unprofessional or illiterate dentists, teeth have to be retreated. A very serious problem is perforation, which is a complication or incorrect actions of the doctor during endodontic treatment. Such problems can arise when using the wrong instrumentation or not having a prior x-ray. Less often, the problem can occur with advanced caries, which most often leads to tooth loss.
Causes and types of tooth perforation
Depending on the localization, the holes share several types of perforation:
- at the bottom of the tooth cavity;
- in the side wall
- at the root of the tooth.
The most common type of perforation is its occurrence in the crown part of the tooth. This happens as a result of prolonged neglect of the dentist or incomplete treatment. Caries affects the tissues of the tooth deeper, softening and destroying them until the wall is depleted and perforation is formed.
Another reason could be mechanical stress. As a result, a crack occurs in the tooth. And the reason for this can be not only a strong blow, but also unskilled actions of the dentist when trying to install the pin with significant use of force.
The anatomical features of the patient's teeth roots can contribute to the occurrence of perforation. The doctor may not consider the bends on a poor-quality x-ray and, when cleaning or expanding the channels, violate its integrity. If a tooth perforation occurs at a dentist's appointment, you will feel it right away. sharp sharp pain won't let you miss this moment. Yes, and the doctor should see the characteristic signs - the appearance of bleeding from the resulting hole.
A qualified specialist can and should correct this situation on the spot by filling the defect. But here one small condition arises, 1-1.5 mm in size. If the resulting hole is larger, then through it the filling material can go beyond the tooth and cause many problems, up to periodontitis.
No less dangerous is the perforation of one of the roots during endodontics. This happens in most cases due to a violation of the rules and techniques of the dentist. It makes no sense to figure out why this happened later, since there is a long work to be done to save the tooth. In this case, sitting in a chair, you will feel a stabbing pain, and the dentist will see how blood appeared in the canal. These symptoms make it clear that there is a problem and needs to be addressed.
Perforations in the area of the dental crown
It occurs most often, and it can be localized both in the region of the wall of the cavity of the tooth, and in the region of its bottom. The anatomical features of the structure of the patient's teeth predispose to this type of complications (deviation from the normal central axis, too thin tooth wall, small thickness of the bottom of milk teeth and errors in therapeutic manipulations (incorrect selection of instruments and speed mode of the drill, re-treatment of the tooth, insufficiently wide opening of the cavity). , which worsens the view of the dissected tissues).
The clinic of any fresh perforation is typical. At the time of its occurrence, a person experiences severe toothache, and the damaged tooth begins to bleed. If this happens in the dentist's office at the time of treatment, the doctor feels the “failure” of the instrument and can visually see the blood escaping from the perforation.
Chronic perforations that were not detected at the time of occurrence and were not treated sometimes do not manifest themselves in any way, since they are often accompanied not by an acute, but by a sluggish inflammatory process. The patient may be disturbed by periodic aching pains. And only upon examination, the doctor discovers granulation tissue in the area of the external opening, which bleeds when touched.
Typically, such perforations are immediately detected by the doctor and removed by filling. At the same time, the prognosis for damage to the wall is almost always favorable. But the result of treatment depends on the size of the perforation. If the size of the defect does not exceed 1-2 mm, then its filling is quite effective. If the size of the canal and hole is more than 2 mm, then the closure of the perforation of the tooth will most likely lead to the expulsion of the active material into the periodontium and its infection with the development of severe forms of destructive periodontitis.
When a tooth is perforated in the area of the visible part of the crown, the diagnosis is not difficult, since the defect is visible even to the naked eye. If there are doubts about the presence of a complication, or it occurred in the area of the bottom of the dental cavity, then it is necessary to conduct x-ray images with contrast (for example, a pin or file can act as a contrast).
Closing a perforated tooth is a therapeutic measure that must be carried out as soon as possible, because without treatment, such a complication will lead not only to tooth loss, but also to the development of serious inflammatory reactions.
Root perforation
Perforations in the root of a tooth (or root canal) are also one of the common complications of endodontic treatment, which often leads to tooth loss if the treatment is not correct.
At its core, perforation is a crack (hole) in the root of a tooth that creates an abnormal communication between the root canal and periodontal tissues.
Depending on the place of occurrence, there are:
- in the middle part of the tooth root;
- apex of the root of the tooth;
- in the area of bifurcation of the roots (between the roots of the tooth).
Perforation of the root in the middle part occurs when the root canal is not processed correctly, during the retreatment of the wrong canal filling, in preparation for the insertion of the anchor pin, or at the time of the insertion of the dental pin (for example, brass). In the region of the apex, perforations are more often the result of improper selection of instruments, and such a complication is rather difficult to diagnose.
Since a clear visualization of the perforation of the dental canal in the root area is almost impossible, then its presence can be suspected by some symptoms:
- the occurrence of weak but constant bleeding from the root canal;
- the appearance of sudden pain in the area of the tooth;
- a sharp change in the course of the tool and a change in its normal position in the channel.
Root perforations that were not diagnosed in a timely manner are manifested by signs of periodontitis:
- pain in the area of the affected tooth;
- swelling and redness of the gums over the area of inflammation;
- common symptoms: weakness, malaise, headaches.
The diagnosis of such a complication consists in stopping the bleeding, expanding the root canal with the introduction of a paper pin, after which the place of perforation can be assumed from the traces of blood. The perforation of dense tissues can be finally confirmed by x-rays with contrast (the file inserted into the perforated canal is used as a contrast).
The doctor decides how to treat perforation of the tooth root based on the size of the perforation, the location of the defect, clinical picture and presence of other complications. Conservative, surgical and conservative-surgical treatment options are available.
Prevention and treatment of tooth perforation
Prevention of tooth perforation consists in carrying out the correct and competent treatment of dental canals, which completely excludes the possibility of the formation of this defect. In order to protect the patient from tooth perforations, the doctor must follow a number of rules. During the treatment of the tooth, an excellent view of the dental cavity must be provided.
The instruments used in the treatment must be safe and modern. Sometimes it happens that the instrument, especially with the wrong actions of the doctor, breaks down in oral cavity patient, which leads to the formation of perforation of the tooth. When carrying out interventions in the patient's oral cavity, accuracy in working with instruments is necessary. Bur must be used spherical surgical length.
Full control over the condition of the patient's tooth is very important. The doctor should always keep in mind the anatomical features of the patient's jaw structure, the location of the tooth in the alveolus (tooth socket), the degree of tooth displacement (if any). The main actions should be accompanied by x-rays.
Before endodontic, it is necessary to remove the artificial crown of the tooth, if the patient has one.
Treatment of tooth perforations, as already mentioned, should be carried out as soon as possible after their discovery. The time elapsed since the formation of the perforation and its localization are key factors influencing the success of the treatment.
A perforation that has arisen due to a strong mechanical impact during dental treatment must be closed at the same visit. If you delay closing the perforation until the next visit to the doctor, then the treatment may not be effective.
The most favorable prognosis in the treatment of perforations is in those that are located as far as possible from the apex - the top of the tooth root.
After passing through and processing the root canals of the teeth, the doctor deepens somewhat with a cone bur from the side of the oral cavity in order to create retention - delay, preservation - of the material. The dentist inserts a large file into each root canal. Then the doctor places glass ionomer cement on the resulting perforation, after a while the entire bottom is covered with cement. After the glass ionomer cement has hardened, the inserted files are removed from the oral cavity.
The treatment of perforation of the tooth does not end there. It is very important to regularly monitor the sealed canal by taking x-rays. Carrying out control pictures every six months will allow diagnosing complications and inflammations in time.
In some cases, the treatment of perforation of the canals of the tooth with a microsurgical method may be indicated. This decision is made for perforations that are too large, as well as for an extremely inconvenient location of the defect. After creating a convenient access to the perforation, the doctor performs hemostasis (prevents bleeding), cleans the perforation and irrigates. Then the perforation of the tooth is restored with any modern filling composition.
Microsurgical intervention can also be performed after conservative sealing of the perforation of the tooth, if it is necessary to remove the rest of the material from the periodontium.
One of the most difficult options for treating a perforated tooth is replantation.
The replantation procedure involves the removal of a tooth to prevent the spread of infection or tissue destruction and the subsequent re-introduction of the tooth into the alveolus - the tooth socket. Tooth extraction during replantation is carried out in a gentle way. Replantation is resorted to in cases where it is difficult to determine the isolation of the perforation. Isolation is determined after tooth extraction, after which it is possible to carry out replantation with fixation of the tooth with a special splint.
In addition to diseases of an infectious nature, in the course of treatment, perforation of the tooth, roots and maxillary sinus may appear. What symptoms occur in this case, methods of treatment and photos will be provided below.
The reasons for this may be different diseases, but most often this problem occurs due to incorrect actions of the doctor, errors, as well as structural features of the tooth in individual cases. It is possible to avoid perforation, but the dentist should also know how to diagnose and treat the resulting cavity or crack immediately in order to prevent complications and unpleasant consequences.
What it is?
Tooth perforation is also called perforation. In fact, this is the formation of an unnatural cavity where it should not be, the appearance of a message between the channels or between the inside of the tooth and.
Such a cavity may appear:
- in the wall of the unit and become visible upon inspection;
- in different parts of the root or between them;
- at the bottom of the crown.
Perforation is also distinguished by the time of occurrence:
- fresh, newly formed in the process of dental intervention, it is very important to immediately notice and eliminate it;
- chronic, often arising from tissue infection and characterized by a sluggish course, unexpressed symptoms, can sometimes appear from trauma.
Causes
Etiology this disease has different origins:
- Individual features of the structure of the tooth, its canals, roots, etc. At the same time, it is difficult to foresee the direction of movement of the dental instrument, which is why a cavity is formed. Most often this occurs during the expansion of the dental canals, as well as during the introduction.
- Mechanical damage, traumatization of dense tissues from hard hit, incorrect operation of a medical instrument, from the application of significant force, which turns out to be unnecessary. Such a perforation may appear as a crack or hole. The volume of the resulting cavity will depend on the force of impact or the size of the traumatic instrument.
- Carious and other infectious effects, when an untreated disease gradually thins the walls of the tooth, and over time forms whole cavities inside it and even reaches the roots. This can happen in an acute form or in a latent form, when there are no obvious signs of the disease for a long time.
Not always the full fault lies with the dentist, because for the formation of perforation even during therapeutic treatment there may be a special predisposition:
- abnormal position of the dental axis not in the center, but with an offset to the tongue, lips or cheeks;
- , at which the volume of the tooth wall is significantly reduced;
- carrying out manipulations through a hole in an artificial crown.
Let us consider in more detail the causes and treatment of precisely those variants of the appearance of perforation that occurred in the process of dental intervention.
Perforation in the area of the crown of the tooth
It can appear both in the wall of the unit, and so does the perforation of the tooth. d on the. It is the structural features of the internal channels that most often contribute to this.
Also, the influence on the appearance of such cavities has an incorrectly chosen instrumentation of the doctor or his illiterate actions.
Symptoms
If such a perforation is fresh and appeared immediately in the course of therapeutic treatment, then its clinic is quite typical - the patient experiences acute pain, and blood is actively released in the area of influence. The doctor himself can feel at the same time how his instrument seemed to have failed.
A more complicated case is when the resulting cavity is old and almost does not manifest itself. A person may periodically feel insignificant, which rarely worries. Only with a careful examination by an experienced doctor can one notice granulation formations, internal bleeding and acute reactions to touch in a specific area.
As soon as the dentist discovers this, his task is to fill the cavity, if it is not more than 2 mm. Otherwise, the filling material will simply get into the periodontium and cause tissue infection, which will quickly develop into complex shape.
Diagnostics
In cases where perforation is formed in the wall of the tooth, it is easy to notice even with a cursory examination.
To detect such a problem in the bottom area, you will need to take an x-ray with contrast. To do this, use a pin or a special file.
Treatment
How to close the resulting cavity in the crown of the tooth? For this, fillings made of biocompatible material are used. If earlier GIC (glass ionomer cement) or amalgam were popular, today doctors prefer to use better substances - MTA (aggregate trioxide minerals).
Due to its good moisture curing properties and minimal risk of rejection, it is chosen as the most suitable for such applications.
It is desirable to carry out such elimination of perforation immediately, without leaving it for later, and also to use a special microscope for this in order to have good visibility of the cavity and carefully control the quality of treatment.
Perforation in the area of the tooth root
A crack can also form in the following places:
- the middle part of the root or along its length;
- only touching the top;
- in the so-called bifurcation zone.
Perforation of the dental canal may also appear in the process of inaccurate treatment, when the doctor has incorrectly processed the unit. This happens when filling the canal, preparing for the implantation of the anchor pin, or directly during its installation.
The tip of the root itself is easy to hook with a tool, especially if it is incorrectly selected in size. The most difficult is the case of damage to the bifurcation area, as this threatens with serious inflammatory processes, up to the loss of a healthy functioning unit.
Symptoms
Due to the deep and almost inaccessible location, perforation of the tooth root is practically not visualized. It can be found in the following ways:
- markedly weak bleeding from the root area;
- the appearance of sharp pain;
- sensations of the doctor when the instrument seems to go in a different direction than expected.
- constant painful sensations of an injured tooth;
- signs of inflammation of the gums, its redness and swelling around the unit;
- general symptoms of malaise, such as headaches, fever, weakness, etc.
Diagnostics
It is very important to stop the bleeding in order to better see the affected area. For high-quality treatment, the canal is expanded, a paper pin is inserted and, following the traces of blood, the exact place of perforation is established on it. For additional diagnostics, X-rays with contrast are also used.
Treatment
To decide how to fix such a problem, the doctor must take into account many factors - the exact location of the perforation, its size, the structural features of the patient's tooth, the overall clinical picture, and much more. There are two main methods for treating root perforation:
- Conservative, which most often involves filling the canal or closing the cavity using a file tab.
- The surgical method is used when the perforation has formed at the top of the root. In this case, resection of the damaged part is performed.
In some difficult situations, especially when the perforation affects the bifurcation area, the so-called conservative surgical treatment is performed. At the same time, with the help of a small incision, the gums reach the desired area and fill with suitable materials. Sometimes at the same time they also remove necrotic periodontal tissues, bone defects, etc.
In addition to office treatment, which can be carried out by a doctor, it will be necessary to pay attention to this at home for a long time. In this case, broad-spectrum antibiotics for oral administration are prescribed, but always those in which high performance penetration into bone tissue. You should also take anti-inflammatory drugs, and if pain is felt, then painkillers.
To improve the condition and relieve inflammation from the surrounding soft tissues, you can rinse with antiseptic solutions. For this, other drugs based on iodine are used. But to perform some manipulations from traditional medicine and you should not ignore the intervention of a doctor, as this will lead to inflammation of the surrounding tissues.
Perforation of the maxillary sinus
Therapeutic treatment and any other intervention on upper jaw often leads to injury to an area such as the maxillary sinus. Since the bottom thickness is too small around it, the bone trabeculae are thinned, and the roots of the teeth are in close proximity, even a minimal error may be enough to perforate the maxillary sinus during tooth extraction (especially molars and premolars).
In addition, some problems may contribute to this. So, with purulent processes of a different nature, periodontitis, formed cysts and periodontitis, it is possible to more rapidly destroy these bones, their resorption and increase the risk of trauma during the treatment or extraction of teeth in the upper jaw.
Signs and symptoms of such an injury include:
- bleeding from the hole along with air bubbles, the number of which increases with breathing;
- the beginning of the discharge of blood from the nose;
- changes in the patient's voice to "nasal".
Also, a person may complain that it is difficult for him to breathe through his nose and he feels the passage of air through the hole of the extracted tooth, and there are also sensations of fullness or heaviness in this place.
The most important treatments are:
- removal of a foreign object, if any;
- the formation of a blood clot at the site of perforation;
- closing the hole with a gauze swab with a drop of iodine.
The application of the last manipulation occurs every day for a week. If necessary, plastic plates are applied between the oral cavity and the opened sinus and fixed on the nearest teeth with clasps. Sometimes medical sutures are applied to the hole.
Also in this method of treatment, antibiotic therapy, the use of anti-inflammatory drugs and vasoconstrictors are used.
Indications for removal
In the most extreme case, when it is impossible to successfully treat the perforation, it is required to remove the entire damaged tooth. This is done in order to avoid deterioration due to the opened cavity. This happens when:
- the destruction is so great that neither filling nor any other method of closing the cavity becomes available;
- too strong tooth mobility resulting from such an injury;
- appeared purulent inflammation, which can lead to infection of surrounding tissues;
- special anatomical difficulties in the structure of the tooth, when it is impossible to reach the open area and treat it.
Consequences
Any prognosis in this case is based on specific features - the structure of the internal channels, the size of the lesion, the location, etc. For example, if only the outer part of the crown is affected, then it can be easily sealed almost immediately, as it is discovered.
In case of damage to the root of the tooth, especially in the area of its divergence, then you need to choose between treatment and removal of the unit. Even with successful closure of the cavity, such a root will no longer be able to act as a reliable support for prosthetics or withstand a large chewing load. And over time, inflammation of the surrounding tissues may develop in this area.
The earlier the perforation is detected and repaired, the greater the chance that the outcome of the treatment will be successful and the problem will not worry the patient or cause any trouble.
Video: perforation of the bottom of the maxillary sinus.
Prevention measures
In order to avoid such injury during the treatment or removal of the unit, the clinician should act according to the preventive precautions:
- Conduct an x-ray diagnosis of the tooth, clarify the curvature of the canals, their location features, etc.
- The choice of tools used according to the size, shape and bends of the roots.
- Create a good view of the work area by opening the cavity just enough to completely cover it.
- Careful control of the tool during operation, accurate movements, without excessive use of force.
- At the first sensation of any obstacle, reduce pressure.
Additional questions
Why doesn't the x-ray show a perforated tooth?
Diagnosis using x-rays is not always completely reliable, as it has some features. Due to the two-dimensionality of the image, the buccal or oral surface of the root may not be visible on the image, which makes this method limited.
If a dentist has diagnosed a person with a perforated tooth, treatment should be started immediately. If the doctor prescribes it in the early manifestations of perforation, it is most effective and short in time.
In a neglected form, complications can form, which will be very difficult to get rid of.
When a person hears from a doctor that he has been diagnosed with perforation, he needs to understand: what is tooth perforation.
A perforation is defined as a small opening in a tooth cavity that can be formed by several processes, namely:
Complications caused by neglected perforation - changes in the structure of the tooth and destruction bone tissue.
Perforation symptoms
Symptoms of perforation early stage explicit, it calls severe pain in the oral cavity. There is bleeding from the socket of the tooth, which can begin in the dentist's office during procedures and at home. In case the process started at the doctor's appointment, he made a mistake while working with the instruments.
An unrevealed perforation at an early stage of manifestation develops into a neglected form. It is dangerous because it practically does not cause pain. A person is only occasionally disturbed by mild aching pains, and the internal process of inflammation proceeds rapidly.
This pathology can be noticed by a doctor during a preventive appointment.
Upon detection, the doctor will immediately offer to fill the tooth. In most cases, this is enough, the pathological process is suppressed. True, if the hole thickness exceeds 2 mm, then the filling is ineffective, moreover, it can cause the filling materials to be pushed out into the periodontium and subsequently become infected. Destructive periodontitis occurs.
Varieties of perforation
Root perforation
Perforation can be localized in the following areas of the oral cavity:
- at the bottom of the tooth cavity;
- in the root of the tooth;
- at the wall of the tooth.
From this, varieties of the pathological process are distinguished, which, depending on their location, are divided into several types:
- Perforation of the bottom of the tooth cavity may occur due to severe abrasion of the dental crown. Cases are determined when the given type of pathology manifests itself due to a strong expansion of the tooth cavity at the time of its treatment. When the process occurs, there is a displacement of the dental axis towards the tongue or in the direction of the cheek.
- Root perforation occurs when the teeth are crooked, the lesion can be identified if an X-ray of the jaw is made. This type of pathology must be cured as soon as possible, because it is very important to protect the periodontium from possible destruction. The destruction of the periodontium threatens with the destruction of the teeth. The effectiveness of treatment is determined precisely by the degree of perforation that has occurred, the places where the violation has occurred are different: the middle part of the tooth root, its apex and the position between the roots.
Perforation in the upper part of the tooth root can be caused by the wrong choice of instruments by the doctor when filling the tooth, it is quite difficult to immediately identify such a violation.
Pathology in the middle part occurs with insufficient processing of the dental canals or with their incorrect filling. The most dangerous is the perforation that occurs between the roots of the teeth, because it can lead to disruption of the functioning of the teeth.
- Perforation occurring on the walls of the tooth, may be caused by a mistake made by the dentist during the treatment of the disease with dental instruments. This may be due to the unprofessionalism of the doctor or the malfunction of the instruments. Provided that the doctor immediately notices the mistake made, he eliminates the bleeding.
Diagnosis of perforation in the visible parts is made quickly, and if the complication is localized at the bottom of the cavity of the tooth, it is first recommended to take an x-ray of the jaw using contrast devices.
Treatment of perforated teeth with fillings
The causes of perforation can be injuries, diseases, and medical errors.
Treatment of pathology is carried out individually for each case., depending on the place where the perforation is localized and on the degree of its spread.
Perforation of the tooth root, which can be treated immediately after the manifestation, is considered the most dangerous, as it can cause a large number of complications. How exactly the treatment should be performed is decided by the doctor who evaluates the lesion.
For treatment, an effective therapeutic method is noted: tooth filling. When filling, first of all, the doctor cleans the affected cavity from visible contaminants, then the cone drill is introduced into the root part.
IN root canals, alternately, the doctor introduces a large file. After the dentist puts a special cement on the area affected by the perforation, which completely covers the root bottom of the tooth.
After the material hardens, the doctor removes the remaining files from the oral cavity. However, the treatment does not end there. After the filling is done, it is recommended to take X-rays of the jaw every six months, so that if the inflammatory process occurs again, it can be immediately eliminated.
There are cases when treatment is indicated using microsurgical methods. This manipulation can only be performed by an experienced dentist. The doctor makes this decision, provided that the perforation is too large in size, or the affected area is in a hard-to-reach place.
The doctor creates convenience in order to get to the affected area and prevents bleeding. Next, it cleanses the affected area and irrigation follows. After the procedure, it is enough to fill the tooth.
Removal of teeth in case of perforation
A dangerous consequence of a perforated tooth is a cyst.
Replantation is considered one of the most difficult methods of perforation treatment. It is carried out by removing a tooth and then inserting a dental implant into its alveoli.
It is noted that the removal is performed in a sparing manner and is prescribed if it is not possible to determine the area in which the perforation focus is localized.
If surgery has been performed, treatment does not end in the dentist's office. Even in the absence of a visible inflammatory process, antibiotics are indicated for patients.. Suitable drugs with the widest possible spectrum of action, which are able to penetrate into the bone tissue.
For the first two or three days, anti-inflammatory drugs are prescribed, which contribute to quick recovery oral tissues. If the patient complains of severe pain, the doctor also prescribes painkillers.
IN preventive purposes, it is recommended to rinse antiseptics, which can be bought at a pharmacy, or prepared at home. Of the pharmacy solutions, chlorophyllipt is well suited, since it has not only an antiseptic, but also a slight anti-inflammatory effect.
To prepare the solution at home, it is recommended to use iodine, it has a strong antiseptic effect.
Preventive measures
Timely treatment of perforation makes it possible to save the tooth
Preventive measures are that a competent specialist should treat perforation, which will completely exclude the formation of possible complications.
In order for the patient to be safe, the doctor pays attention to the following rules:
- in direct treatment, it is important to ensure good review oral cavity.
- the required tools for the procedure must be fully operational.
- it is necessary to fully control the state of the patient's tooth during treatment.
It is possible to protect yourself from the occurrence of possible violations of the structure of the teeth, it is only necessary to monitor the condition of your oral cavity with special care.
Root perforation is one of the most common perforations and requires prompt treatment. Damage of this kind suggests a through hole that has arisen as a result of a destructive process, for example, caries, or mechanical injury, including from a dental instrument (drill).
Causes
The main causes of root perforation are:
- errors in the processing of tooth canals, as a result of which a false move was created (usually occur in those clinical cases when the channels are too narrow and difficult to pass, or due to insufficient skill level of the specialist performing the procedure);
- untimely or poor-quality treatment of a carious cavity;
- anchor pin installation.
The anatomy of root canals is arranged in a complex way, often they have several branches at once. Therefore, perforations are not uncommon. The possibility of saving the tooth and the success of the entire therapy is largely determined by the duration of the defect, its shape and size. Thus, fresh lesions, repaired under aseptic conditions immediately after application, have a more favorable prognosis, compared with old ones, the treatment of which is carried out already in the conditions of the development of a bacterial infection.
Diagnosis and treatment
Diagnosis of perforation of the tooth root is carried out in the framework of radiography. The x-ray image clearly shows the location of the defect and its size. Elimination of damage is carried out by filling with the use of glass ionomer and composite materials. If false passages are found, special cement or a special paste is used to fill them, which hardens on its own. Apical perforations require resection of the upper part of the root. Dental technique is selected depending on the size and location of the hole. Avoid in difficult cases therapeutic methods extremely difficult, it is necessary to resort to surgical intervention.
Endodontic surgery prescribes isolation of the perforated area with subsequent bone replacement. Osteoplastic materials are used to close the hole. The operation is performed under local anesthesia. In order to ensure normal hemostasis, preference is usually given to anesthetic drugs from the group of vasoconstrictors that have a vasoconstrictive effect.
A type of intervention to eliminate perforation of the tooth root is replantation. The operation consists in the removal of a tooth, the elimination of factors that contribute to the development of infection or leading to the destruction of bone tissue, and the subsequent re-implantation of the same tooth in the hole. Such measures are resorted to relatively infrequently, especially when it is not possible to isolate the damaged area. In these cases, perforation isolation is carried out immediately after tooth extraction. Its re-placement in the alveolus for more reliable and durable fixation should be
Tooth perforation is one of the complications that occur after the treatment of dental pathologies. This phenomenon occurs in approximately 9% of patients. Perforation requires immediate treatment, as it leads to serious consequences.
About perforation
Perforation is a hole that occurs between the dental cavities and canals with their surrounding tissues. It is formed for a variety of reasons, including medical errors committed during treatment.
Perforation is localized:
- at bottom cavities;
- in dental walls;
- near root.
There are two types of perforations:
- fresh, occurring immediately after treatment;
- old, formed over time.
The last type of hole is often infected.
Causes
Tooth perforation occurs under the influence of several factors.
Curved root canals
The presence of bends in the structure of root canals complicates a number of dental procedures. In particular, difficulties arise when expanding these parts of the tooth during the installation of the pin.
abnormal The structure of root canals is considered the most common cause of cavity formation. This phenomenon complicates the treatment of diseases localized in the oral cavity.
Mechanical damage
Tooth perforation occurs due to impact (the hole in this case looks like a crack) or due to mistakes made by the doctor in the process of treating caries and other dental pathologies.
Caries
The long-term development of the carious process leads to a thinning of the tooth enamel, resulting in the formation of a through hole that goes into the cavity or canal.
Doctors identify a number of factors that can provoke perforation. These include:
- deviation the central axis of the tooth to the side;
- thinning dental tissue;
- dental treatment diseases through the crown.
The presence of a pathological hole contributes to a change in the structure of the tooth and the gradual destruction of the jaw bones located at the location of the perforation.
Symptoms
The symptoms and treatment of a perforation differ depending on which part of the tooth has the hole. When the bottom of the cavity or wall is damaged, the patient experiences acute pain. There is bleeding at the site of the hole.
If the presence of perforation is not detected at an early stage, then it acquires a neglected form, characterized by the absence of vivid symptoms. In this case, the inflammatory process develops rapidly. During an external examination in the affected area, the doctor detects the presence of granulations, which, when pressed, begin to bleed.
More often, perforations in the coronal part are detected almost immediately. The prognosis for such a tooth lesion is favorable.
Perforation at the root is a crack through which channels and periodontal tissues communicate. It is formed:
- in middle and upper parts of the root;
- between roots.
Perforation in the area of the tooth root often occurs as a result of errors during dental procedures. These complications are more difficult to diagnose. The most severe consequences occur when a crack forms between the roots. It often causes tooth loss.
It is possible to determine the presence of perforation in the root canals by the following symptoms:
- weak bleeding, arising at the root of the tooth;
- painful a syndrome that appears suddenly;
- in progress research tooth dental instrument abruptly changes direction.
As additional symptoms that may indicate perforation of the tooth root, are:
- edema and redness of the gum tissue;
- head pain;
- general weakness and feeling unwell.
These symptoms are also characteristic of periodontitis.
Diagnostics
If you suspect the presence of holes in the tooth, an external examination of the affected area is performed. If perforation is observed in the coronal part, it is not difficult to identify it. When it occurs in the region of the bottom of the cavity, it is additionally assigned X-ray examination with the introduction of a contrast agent.
If root canal involvement is suspected, extension the latter in order to introduce a paper pin. According to the bruises on it, the location of the cracks is established. In this case, an X-ray examination with the introduction of a contrast agent is also prescribed to confirm the diagnosis.
Treatment
Treatment of the pathological phenomenon is determined depending on the nature of the lesion and the location of the hole.
Elimination of perforation in the crown part is carried out by filling. Dental measures for this form of lesion are carried out using a microscope. This decision is explained by the fact that such holes can have a very small size, invisible to the human eye.
Filling is carried out when the crack diameter does not exceed two millimeters. Aggregate trioxide mineral is more commonly used to close this hole. The material hardens quickly in a humid environment and practically does not cause rejection.
If the size of the hole in the crown part exceeds 2 mm, then filling is not carried out. Closing the perforation in this case leads to the expulsion of the cementing material into the periodontal tissue, which contributes to the development of the inflammatory process.
The elimination of cracks formed in the root canals is carried out through the following techniques:
- conservative therapy;
- surgical intervention;
- combination the two methods given.
Cracks are closed by:
- fillings channel;
- cementing channel with the installation of a sealing file.
At the beginning of the procedure, the doctor cleans the damaged area from various contaminants, after which he inserts a cone drill into it. Further, a large file is lowered into the root canals. At the end of the above manipulations, a special cement is applied to the affected area, which should completely cover the bottom of the tooth. After the material has hardened, the file is removed.
During the first 6 months after the completion of root perforation treatment, regular X-rays of the jaw are recommended. They will allow you to identify the presence of foci of inflammation in advance and take timely measures to eliminate them.
In the presence of perforations in the apical region, resection of the apical part of the root is prescribed.
In the case when a crack has formed between the channels, a combination of conservative therapy and surgical intervention is indicated. Similar treatment is carried out in the presence of chronic inflammation in periodontal tissues. The method involves making an incision in the gums, through which the doctor gains access to the affected area.
Next, the defect is sealed using glass ionomer or MTA cement. Depending on the indications, during the procedure, damaged periodontal tissues are removed, and the destroyed bone is restored using osteogenic materials.
Upon completion of all manipulations, the patient is prescribed antibiotics to prevent the development of the inflammatory process. Drugs used in the treatment of perforation should have a wide spectrum of action and good permeability into bone structures.
For the prevention of complications are also prescribed:
- anti-inflammatory drugs;
- painkillers medicines;
- antiseptic oral treatment.
Closing a perforation does not always bring results. In some cases, the damaged tooth is removed. The procedure is indicated for:
- significant destruction dental root;
- high mobility tooth
- availability suppuration in the affected area;
- lack of opportunities for conservative therapy due to the structural features of the jaw.
After removal, antibiotics and anti-inflammatory drugs are prescribed.
Possible Complications
The development of tooth perforation over a long period of time is not accompanied by the appearance of characteristic symptoms. If the closure of the pathological opening was not performed in a timely manner, it causes complications.
Granuloma
Granuloma develops against the background of infection of the bone tissue. It is a pathological nodule filled with purulent contents. As the granuloma develops, bone tissue becomes infected. In the future, a cyst forms in its place.
root fracture
Due to a broken tooth root, the patient experiences discomfort during chewing. This type of complication leads to infection of the tissues located in the oral cavity and displacement of the jaw.
Mistakes made in the course of dental actions can lead to an inflammatory process. It is formed if, after treatment, a root remains in the gum. He over time acquires new tissues. Surgical intervention is required to extract the remaining root. The operation in such circumstances is performed under general anesthesia.
Prevention and prognosis
Prevention of tooth perforations is that the treatment of diseases should be carried out by an experienced dentist. Before starting therapy for various pathologies, it is necessary:
- assess the degree curvature root canals on x-ray;
- use instruments, the shape of which corresponds to the curvature of the root canals;
- provide good visibility;
- reduce pressure when there are obstacles that interfere with the further movement of the tool.
In addition, in order to prevent perforations, it is recommended to examine the jaw after strong blows.
The prognosis for the treatment of the defect in question directly depends on the area of its localization and the nature of the lesion. If a crack formed in the crown part, and its closure was carried out on time, then negative consequences do not arise.
With perforation of root canals, the prognosis is unfavorable. Even with proper treatment, the tooth is not able to fully perform its functions. For example, it cannot act as a support for prosthetics. In addition, root canal perforation is often complicated by inflammation of periodontal tissues.
Pathological holes in the teeth occur due to mistakes made by the dentist in the process of treating diseases. This complication is accompanied by the appearance of bleeding and pain in the oral cavity.
Treatment of perforations depends on the location of the defect. Restoration of the integrity of the tooth is carried out by filling the damaged area. If there are appropriate indications, surgical intervention is prescribed.