Clinical Case of Conservative Retreatment of Compromised Tooth
Ivanka Dimitrova and Vladimira Dimitrova*
11Department of Conservative Dentistry, Faculty of dental medicine, Medical University, Sofia, Bulgaria
22Faculty of dental medicine, Medical University, Sofia, Bulgaria
Submission: September 27, 2021; Published: October 08, 2021
*Corresponding author: Vladimira Dimitrova, Faculty of dental medicine, Medical University, Sofia, Bulgaria
How to cite this article: Ivanka D, Vladimira D. Clinical Case of Conservative Retreatment of Compromised Tooth. Adv Dent & Oral Health. 2021; 14(5): 555900. DOI: 10.19080/ADOH.2021.14.555900
Abstract
This clinical case demonstrates the successful retreatment of chronic apical periodontitis complicated by iatrogenic Strip furcal perforation during root canal treatment (RCT), made by a dental student. Apical periodontitis (AP) is an inflammatory process of the periradicular tissues caused by a microbial infection. The risks of retreatment, especially in obliterated root canals and student treatment, are significant. In addition, perforations can increase the chance of treatment failure. Factors that have impact include location and size of the perforation, potential microbial colonization of the endodontic system, the time between the occurrence of the perforation and its repair as well as the filling material. The clinical case could be further complicated by perforation in the risk zone, which makes the expected outcome of treatment rather unfavorable. For a long-term success it is important to disinfect and sterilize both the perforated area and the root canals. The result of this retreatment has been tracked for one calendar year in the present study. It concluded that the examined clinical case is an example of a favorable outcome of treatment of a complicated situation and also demonstrates the correct clinical approach in terms of student learning.
Keywords: Periapical Periodontitis; Retreatment; Strip perforation
Abbreviations: RCT: Root canal treatment; AP: Apical periodontitis
Introduction
Modern dental science aims to improve patients’ oral health by preserving as much teeth as possible. Apical periodontitis (AP), a prevalent dental disease, resulting from a microbial infection of the root canal system, is one of the main reasons for tooth extraction. The treatment and nature of the healing process of chronic AP is complex and depends on many factors. The success of root canal retreatment is affected by the correct choice of clinical protocol, removal of bacteria from infected root canals, control of secondary infection, size of periapical lesion, the restorability of the tooth and its strategic position in the dentition, periodontal health, the patient’s health history and motivation, the skill level of the dentist Yamaguchi [1]. The basic factor influencing success is the preoperative status of the tooth. Teeth with an apical radiolucency show a 20% lower success rate than teeth without lesion Sjögren [2]. A size of periapical radiolucency greater than 2 mm diameter may have a negative outcome of RCT Ng YL [3]. The average success rates of nonsurgical endodontic re-treatments are around 70–80% Rosen [4]. The different complications during RCT may raise additional dilemmas during the decision-making process. We present a clinical case of retreatment of chronic apical
periodontitis, complicated by iatrogenic strip furcal perforation during RCT, made by 5th year student in a clinical student hall under the guidance of a supervisor. The strategic importance of the tooth and the patient’s strong desire to keep it were crucial factors for the proceeding of the retreatment. Further factors which highly affect the treatment prognosis are time, size and shape of the perforation as well as its location. Moreover, controlling the infection at the perforated location is also of importance Aidasani & Mulay [5].
Case Report
A 45-year-old female patient visited the Department of Conservative Dentistry, Faculty of Dental Medicine, Medical University – Sofia, Bulgaria, with complaints of pain and discomfort when eating and slight swelling in the area of lower left first molar 36. The patient reported previous endodontic treatment of that tooth with acute symptoms when she was 18 years old. After treatment, the final recovery took place with the placement of a ceramic crown. The patient did not provide data on systemic diseases and allergies. During the intraoral examination a tooth with a ceramic crown was present, the mucosa above the periapex was red, and a bulging vestibular sinus track, lightly red without a formed tip, was also observed. While palpating the mucosa in the area above the apex the patient felt slight pain and discomfort. A vertical percussion and mobility examination did not indicate any signs of pain. The radiographic examination done outlined a diffuse extensive flame-like radiolucency in the apex area of the distal root, destruction of lamina coritcalis apically and gradual transition between the area of bone destruction to healthy surrounding bone filling, loss of lamina dura apically at both roots (Figure 1). A root canal filling at MV and ML canals was present; short, without reaching the foramen apicale, very thin and delicate, inhomogeneous shade of the filling which was an indication of insufficiently shaped and widened canal; shadow between the filling and the root wall.
The patient was given informed consent stating that the treatment would be done by a student. The treatment started with a removal of the crown, followed by opening of the pulp camber, locating all canals and removing the old root canal filling manually. During retreatment iatrogenic strip furcal perforation occurred due to an incorrect instruments stroke. The patient reported a feeling of strong pain and slight bleeding. The bleeding was stopped, and a radiography was performed in order to precisely locate the perforation. (Figure 2). The perforation was located in the region of cervical mesio-vestibular canal (Figure 3)? After the bleeding was stopped, the perforated area was irrigated with 2% sodium hypochlorite and dried again, followed by sealing with gray MTA Angelus (Angelus, Londrina, PR, Brazil) and then an absorbent cotton roll was placed over the seal. X-ray sealing quality control was also performed (Figure 4).