26 March 2023

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What is the follow up for treatment of endodontic perforations with MTA?

Simona Chirico

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Root canal perforations are currently the most common endodontic complications (approximately 12% of failures). These lead to an inflammatory state and loss of attachment in the supporting tissues. If left untreated, perforations cause the tooth to lose its integrity, compromising its prognosis.

Mineral trioxide aggregate (MTA) was the first material to provide predictable healing of root perforations. Previously used materials had a poor prognosis, especially for relatively large perforations, mainly due to poor biocompatibility or insufficient sealing capacity of the material.

MTA, on the other hand, showed excellent biocompatibility and sealing ability, with bioactive properties. Its use for perforation repair has been evaluated in animal laboratory studies and several clinical studies; however, only a few studies have provided data on the long-term prognosis of MTA used to repair perforations.

Materials and methods

The study published in June 2022 in the Journal of Endodontics, conducted by Gorni et al, investigated the prognostic factors and outcome, after 14 years, of elements perforated and treated with MTA.

The study, conducted between 1999 and 2009, enrolled patients with a single dental perforation treated with MTA. Pre-operative, intra-operative and post-operative information were evaluated, and the results were dichotomized as healed or not healed.

Patients were followed up annually through 2018 for up to 17 years after treatment, with follow-ups for up to 14 years. Clinical and radiographic outcomes were evaluated using standardized follow-up protocols.

Results

Researchers enrolled 124 patients (mean age 36.5 years, 53.2% male) in the study. They noted that 115 recovered at their first (n = 110, 89%) or second (n = 5, 4%) annual post-treatment check-up, while nine injuries have not healed.

Characteristics significantly associated with non-healing were gender, positive probing, size, and perforation site.

Perforations presented complications in 48 teeth during follow-up with estimated odds of reversal at five, 10, and 14 years of 6% (95% CI, 2-10%), 30% (95% CI, 20-38%) and 62% (95% CI, 46-73%), respectively.

Positive probing had the highest risk of reversal (HR = 3.3, p ≤0.001) and perforations >3 mm were more likely to fail (HR = 4.1, p <0.001 ).

Conclusions

Root canal perforation treated with MTA shows problems with the increasing of time. In fact, after five years the probability of failure is extremely small (5%) but increases drastically after 14 years (62%). The advantage is that in any case patients can use their teeth for many years, thus postponing the implant surgery.

For more information: "Prognostic Factors and Primary Healing on Root Perforation Repaired with MTA: A 14-year Longitudinal Study."