Explorations into the Possibility of Preserving Perforated Tooth

Abstract

In the symposium entitled “Reconsideration of tooth extraction criteria during implant treatment” held at the 47th Annual Meeting of the Japanese Society of Oral Implantology, I gave a lecture. Since I was asked to speak from the standpoint of an endodontist, I discussed the kinds of endodontic diseases where tooth extraction is indicated.

Clinically, there are five major scenarios when tooth extraction is considered from an endodontic point of view :

1. Complete vertical root fracture

2. Shortage of residual sound dentin

3. Lesion at the root apex with zipping that cannot be modified or broken files in a root canal that cannot be removed and for which root apex resection is difficult for anatomical reasons

4. Large perforation

5. Endo-perio lesion with communication (Periodontal regeneration therapy cannot be expected in such cases.) In this symposium, cases with perforation were discussed. The approach to perforation depends on its location. When the perforation is visible, physical sealing is performed using a biomaterial such as mineral trioxide aggregate (MTA). When it cannot be confirmed visually, induction of hard tissue (cementum) is attempted using a calcium hydroxide agent. However, when physical sealing is difficult or when biological cure cannot be expected, tooth extraction might be conducted.

Here, through several clinical cases, I discuss the causes and treatments of perforations in the sidewalls and furcation area of the root.