| ObjectivesRoot canal perforation, perforation of pulp floor is a common complication of endodontic treatment. Caries, pathologic uptake or root canal treatment may lead to accidents are all part of pulp cavity and root canal perforation. As the perforation involved teeth, periodontal two kinds of organizational structure, not promptly fix or repair properly, can easily lead to periodontal disease, and secondary alveolar bone resorption, ultimately leading to endodontic treatment failure and teeth were extracted. Ideal repair materials can be used to maximize the retention teeth. The material should be non-toxic, no stimulation, no absorption, insoluble in tissue fluid, has strong antibacterial, antimicrobial, and has a good seal and biocompatibility, can promote periodontal tissue regeneration.Clinically, a variety of repair materials have been tried, such as:silver amalgam, glass ionomer cement, cement powder, clove oil, but because of poor seal strength is not enough, easy to decompose, the shortcoming of clinical maneuver gradually be eliminated. Light curing calcium hydroxide(LCH), light-cured glass ionomer(LGIC) or hydroxyapatite (HA) such as the repair material, since it has good biological properties. can induce and promote the formation of reparative dentin, in recent years has been more common in clinical. However, these materials during the cure is difficult to avoid volume contraction, and in the perforation area is often blood or tissue fluid leakage, moisture can not be truly separated, resulting in poor marginal seal perforated area, prone to micro-leakage and inflammation. Therefore, the long term efficacy of view is not ideal. Mineral trioxide aggregates (MTA) is a new type of biological material. MTA was first reported in 1993 by Lee, which has ideal material for most of the characteristics, is widely used in pulp and periapical disease treatment:vital pulp, such as preservation, Apexification, root end filling, root canal perforation, repair of perforation of pulp floor and so on. Later, in vitro, animal studies and clinical case reports on the clinical efficacy of MTA very excellent, but few reports related to domestic. In this study, root canal with MTA to repair the wall, perforation of pulp floor and study the clinical effects observed.Materials and MethodsCollection of clinical root canal wall for various reasons, the permanent teeth pulp floor perforation 42, were randomly divided into two groups:experimental group and control group of 21 cases. Perforation areas were routine debridement, disinfection and dry. The experimental group filled with ProRoot MTA directly perforation. As the MTA can only be cured in the moist environment, and the curing time of about 4 hours, so take home a nest inside the cave, wet cotton ball to keep the MTA moist, and then temporarily closed. Control group, calcium hydroxide direct light curing (LCH) covered perforation, light curing 40s. Zinc phosphate cement base, temporarily closed. There were no clinical after a week and symptoms that do root canal treatment. Observed for half an month to complete, if the symptoms are permanent filling. Shooting preoperative and postoperative X-ray film.After one year based on clinical symptoms and X-ray effects were observed.Results According to proposed evaluation standard: Success:spontaneous pain-free teeth, no bite pain, clinical examination no loosening, percussion pain, periodontal pockets and sinus; X ray showed that root canal wall, pulp floor perforation sparse areas disappear.Effective:subjective symptoms and clinical examination with success, X ray film of root canal wall, sparse perforation of pulp floor areas reduced significantly.Failure:spontaneous pain after treatment of teeth, masticatory pain, clinical examination loosening teeth, periodontal pockets, sinus or abscess formation; X ray film of root canal wall, pulp floor perforation apparent sparse areas or sparse area increases. As long as there is that the failure of any one indicator.MTA group 21 cases,16 cases were successful,3 were effective and 2 cases failed. LCH group 21 cases were successful in 9 patients,5 were effective,7 cases of failure. Comparison of two groups was significant difference (P=0.035). The same patch with the MTA, the case of small diameter perforation efficacy were better than the large diameter (P=0.024).Clinical cases of iatrogenic perforation was better than those who carious perforation (P=0.043).ConclusionMTA has excellent biocompatibility, edge sealed, micro-leakage is small, compared with the LCH, it is an ideal root canal wall repair, pulp chamber perforation of the material, worthy to be popularized and applied. MTA to fix the results were, and other factors:such as the location of perforation, reason, diameter, perforation of time, perforation regional periodontal and periapical situation. The smaller, shorter hole, patch the better. Latrogenic perforation of the cases, the surrounding tissure basically no apparent disease, the prognosis is usually good.
|
PDF Full Text Request