Perforation of the tooth root with an inlay. The concept of tooth root perforation: causes and symptoms, treatment features and possible consequences. Tooth perforation as a complication of caries

Today, providing effective and high-quality medical care has not lost its relevance. This is fully applicable to dentistry. One of the most complex species Dental therapy is endodontic treatment (treatment of the dental canal and cavity). It is necessary to be aware of the possible complications of such treatment. One of these complications is perforation of tooth elements.

The concept of tooth perforation and the causes of its occurrence

What is perforation? This is a term of Latin origin, which implies the occurrence of a through defect (hole) in the wall of an organ. If we talk about this term in relation to dentistry, then perforation is an opening connecting the cavity and canals of the tooth with the external environment or surrounding tissues.

The causes of defects are varied. They can be classified according to etiological factors. Main reasons:

• individual anatomical structural features - curved and narrow root canals, which complicate treatment;
• injuries - fractures of teeth, jaws, mechanical disruption of tissue integrity, including as a result of dental procedures;
• pronounced carious process - with advanced disease, massive destruction of the middle of the crown occurs with the formation of defects.

Particular attention should be paid to iatrogenic causes of perforations. Prerequisites for medical errors:

Types and symptoms of pathology

There are several options for through defects. According to how long ago perforation occurred, it can be divided into:

• old perforation, which is a consequence of carious changes or old trauma and is characterized by infection of the surrounding tooth tissues;
• fresh - recognized immediately after exposure and treated upon occurrence.

Defects are also classified according to their location in parts of the tooth. The clinical picture of the disease depends on this. Perforation of a tooth can be located anywhere. Perforations are often localized:

• in the crown - the so-called coronal option, is easily accessible and easy to treat;
• in the roots of the tooth - apical, bifurcation and middle perforation of the dental canals, has average complexity;
• A defect in the bottom of a tooth cavity is the most complex type of pathology.

When localized in the crown in case of fresh perforation, the patient experiences severe toothache and bleeding appears. If this occurs during treatment, it may be possible to provide emergency assistance without significant consequences. If this is the result of external trauma, the clinical picture may be aggravated by the occurrence of inflammatory process. Old voids may not manifest themselves for a long time. Symptoms of inflammation appear, which is sluggish in nature (for example, aching pain, swelling of the gums, low-grade fever), granulation tissue is formed, which bleeds easily.

The clinical picture of root canal perforations also depends on the time of occurrence and location. With recent changes, root perforation can be suspected by the incorrect movement of the dental instrument, the appearance of acute pain in the tooth, and constant slight bleeding. If it was not recognized in time, the clinic manifests itself with signs of periodontitis: swelling and hyperemia of the gums, the affected tooth begins to ache, and symptoms of a general inflammatory reaction appear (malaise, headaches, low-grade fever).

Perforation of the bottom of the tooth cavity manifests itself with similar symptoms. Additionally, abrasion of the chewing surface of the tooth may occur.

Diagnostic methods

Diagnosis of perforations of the crown and bottom of the tooth is carried out during visual examinations. As a rule, such defects are well visualized. In rare cases, it is necessary to use an X-ray examination - intraoral contact radiography.

Difficulties arise when diagnosing root perforations. Inspection of the root canal is often difficult. This is due to poor visibility and insufficient space for manipulation. In such cases, the damaged canal is widened, it is tamponed with paper pins, and the possible localization of the defect is judged from traces of blood. Also in such a situation, it is advisable to use radiation research methods, including the use of contrast agents. When the contrast leaves the channel, the location of the perforation is clearly determined.

Features of treatment

The choice of treatment method depends on the age of occurrence, localization of the defect, and concomitant pathology. There are three main types of therapy for perforations:

• conservative;
• conservative-surgical;
• surgical.

For fresh perforations that occur in dental offices, diagnosis and treatment are carried out immediately.

In case of defects in the crown and cavity of the tooth, it is necessary to stop the bleeding and close the cavity as quickly as possible. For this purpose, the filling method is used.

For large defects or inconvenient location of perforation, a conservative surgical method in the form of microsurgical operations is applicable. The doctor creates convenient access to the defect, sanitizes it, removes remaining material, stops bleeding and performs irrigation. The cavity is then closed by filling.

In case of root perforations, the dentist decides on immediate or delayed treatment. Conservative therapy involves widening the canals, stopping bleeding, and sanitation. Next, the canals are sealed. If there is an apical defect, it is necessary to use surgical treatment - resection of the root apex.

If significant mobility of the affected tooth develops, purulent inflammation or extensive damage to the tooth root may require tooth extraction. Such cases are rare.

Possible consequences

With timely diagnosis and treatment of perforation of the crown, cavity or root of the tooth, as a rule, no negative changes occur. With prolonged asymptomatic course of the process and advanced clinical picture a number of changes are developing. The following should be highlighted dangerous consequences perforations:

• the appearance of a granuloma with purulent contents – requires surgical treatment;
• the appearance of a cyst, which is a consequence of granuloma and affects the surrounding tooth bone tissue(see also: consequences of removing a tooth with a cyst on the root);
• Violation of the integrity of tooth roots - treated by tooth extraction.

Modern methods of treating tooth perforations make it possible to save the tooth as functional unit. Treatment should be carried out by a competent, experienced specialist, which will minimize the occurrence of complications.

Tooth root perforation is one of the most common perforations and requires prompt treatment. Damage of this kind involves a through hole that arose as a result of a destructive process, for example, caries, or mechanical trauma, including from a dental instrument (drill).

Causes

The main causes of tooth root perforation are:

• errors in the processing of tooth canals, as a result of which a false passage was created (usually occur in those clinical cases when the canals are too narrow and difficult to pass, or are due to the insufficient level of qualifications of the specialist performing the procedure);
• untimely or poor quality treatment carious cavity;
• installation of the anchor pin.

The anatomy of root canals is complex; they often have several branches at once. Therefore, perforations are not uncommon. The possibility of saving a tooth and the success of the entire therapy are largely determined by the duration of the defect, its shape and size. Thus, fresh lesions, eliminated under aseptic conditions immediately after application, have a more favorable prognosis compared to 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 tooth root perforation is carried out using radiography. The x-ray image clearly shows the location of the defect and its size. Damage is repaired by filling using glass ionomer and composite materials. If false passages are detected, 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 equipment is selected depending on the size and location of the hole. In difficult cases, get by therapeutic methods extremely difficult, you have to resort to surgical intervention.

Endodontic surgery requires isolation of the perforated area followed by 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 vasoconstrictor effect.

A type of intervention to eliminate tooth root perforation is replantation. The operation consists of removing a tooth, eliminating factors that contribute to the development of infection or leading to bone destruction, and then re-implanting the same tooth into the socket. Such measures are resorted to relatively infrequently, especially when it is not possible to isolate the damaged area. In these cases, isolation of the perforation is carried out immediately after tooth extraction. Its re-placement in the alveolus for more reliable and durable fixation is followed by

Tooth perforation, despite the constant improvement of dental techniques, still remains a particularly pressing problem. According to statistics, this problem accounts for at least 9% of all dental diseases. If treated in a timely manner, it is not difficult to overcome it, but if chronic course or in neglected acute form Pathology can lead not only to tooth loss, but also to much more serious health problems.

When answering the question what is tooth perforation, first of all they note that this is a hole, characteristic feature which is the formation of connections between dental canals, internal cavities and tissues. Pathology is usually classified, depending on how long ago it occurred, into the following types:

1. fresh - when the patient or his doctor promptly identifies the pathology and deals with it;
2. outdated - diagnosed late, when the injury is of ancient origin and, accordingly, is characterized by infection of dental tissues.

The pathological process can be localized almost anywhere, including in the following:

• root tissues of the tooth (middle, apical or bifurcation perforation) - characterized by medium complexity, most often treated with filling;
• in the wall of the tooth itself (including the area above the gum) - the so-called coronal version; has good access to the site of the lesion, and therefore is easy to treat;
• in the bottom of the tooth cavity - the most complex variant of the pathology, often also called ridge.

Depending on the size of the pathological hole, tooth perforation is divided into 2 types:

1. Small. Such that it is smaller than an endodontic instrument with number 20. As a rule, it is treated simply and has no cause for complications. Such a small space can be quickly processed and reliably insulated.
2. Big. Accordingly, it is greater than the 20th number of the endodontic instrument. In most cases, it becomes a consequence of complex preparation of dental tissues or their severe damage. Their complete isolation is impossible; bacterial inflammatory processes are often associated. The prognosis is unfavorable. Such teeth are removed.

The most a big problem associated with tooth perforation - its long-term asymptomatic condition. By the time it is diagnosed, neoplasms may appear, which not only deprive doctors of the chance to save the tooth, but also call for more complex actions.

Among the possible dangers that can be caused by perforation of the dental canal, the following are worth highlighting:

• Granuloma. At its core, it is a small nodule (sac) filled with purulent contents. Its treatment requires surgery and gives good results if the patient applies in a timely manner. If the patient notices such a formation late, additional inflammatory processes begin, fistulas (holes in the soft tissues), the infection begins to spread to the bone tissue of the jaw.
• Cyst. It is one of the consequences of granuloma. It is characterized by particularly rapid growth and the ability to affect various organs and systems of the human body.
• Violation of the integrity of the tooth root.

Causes of pathology

The appearance of holes in one or another part of the tooth can occur as a result of the following factors:

Additional factors that make dental procedures difficult and cause holes to appear include:

• deviation of the dental axis in any direction (towards the tongue, cheek or lip);
• abrasion of tooth tissue, as a result of which thinning of the walls is observed (may be a consequence of an incorrect bite, very frequent consumption of some hard foods or bad habits);
• performing medical procedures through the crown.

Thus, it can be argued that the appearance of perforated areas is often the result of not too careful actions of doctors. It is not always associated with the unprofessionalism of the specialist; quite often it is explained by the condition of the dental tissues, the patient’s lack of treatment for dental diseases and injury.

Depending on the location of the pathology, it can have different manifestations. So, if there is damage in the area of ​​the dental crown, the patient complains of the following manifestations:

1. severe pain;
2. bleeding.

If a perforation occurs in the dentist's office, the doctor feels the instrument fall through. In this case, efficiency is important. Cleaning and filling are performed on the same day.

Old voids that were not healed in a timely manner may not manifest themselves in any way. The inflammatory process in this case is not acute, but chronic, sluggish.

The patient may indicate periodic, but mild painful sensations with fuzzy localization. During the examination, the doctor may notice a granuloma or minor bleeding.

Similar symptoms also appear when perforation occurs in the roots of the tooth. Sharp pain, change in the position of the dental instrument, bleeding when a tooth is damaged - symptoms of this type appear most often. Those root perforations that appeared a long time ago manifest themselves similarly to periodontitis. The main symptoms are:

• pain in the tooth area;
• general symptoms: headache, malaise, weakness;
• redness and swelling of the gums in the area of ​​the inflammatory process.

To identify pathology, the doctor must first stop the bleeding. Next, the channels are expanded and a paper pin is inserted into them. Having taken it out, the dentist notices interrupted traces of blood, thanks to them it is possible to find out exactly where the void has formed.

A thin file is the dental instrument that is used most often and makes it possible to find out where the void is. When inserting the file into the canal, the doctor may feel something sticky. An apex locator is another device that is particularly appropriate for use in this case.

The final research method, which makes it possible to establish an accurate diagnosis, is x-ray. To ensure clarity in the image, special substances are injected into the perforated canal the day before.

Specifics of treatment

Treatment of tooth perforation, as well as diagnosis of pathology, largely depends on the location of the lesion. So, with cavities in the coronal area, the doctor must close the void as quickly as possible. During this manipulation, microscopic equipment is necessarily used for better visibility.

Dental materials used for filling must be biocompatible with body tissues, have a good degree of hardening, and moisture resistance. In modern dentistry, imported MTA cement is increasingly used for this purpose. The tooth root can be treated using the following techniques:

Not only can tooth root perforation be cured in a dental office; the patient must continue treatment at home. Regardless of how severe the inflammatory process remains, the treatment regimen involves the use of antibiotics wide range impact. In addition to them, anti-inflammatory drugs and, if necessary, painkillers should also be used.

To prevent infection and speed up healing, the patient should rinse for several days after the operation. Suitable for this purpose as medication antiseptic solutions, such as Stomatidin, Chlorophyllipt, and herbal teas, for example, decoctions of chamomile, St. John's wort, bird cherry.

Treat perforation only with traditional methods is strictly prohibited, because the pathology in this case turns into more advanced stage, complicating the patient’s condition and the subsequent treatment process.

If a person consults a dentist in a timely manner or if a perforation occurs during the elimination of a dental problem and the doctor immediately notices it, treatment gives a particularly encouraging prognosis. Great importance has the location where the hole is diagnosed. In situations where the walls of the tooth root are damaged, the tooth can rarely be saved.

Even if the doctor retains it, he will no longer be able to fully perform his functions. Frequent inflammatory processes may periodically appear in this place. In addition, a tooth with a damaged root can no longer be used as a support for prosthetics. It is necessary to remove a tooth in cases where:

• tooth mobility is noticed, in grades II-III;
• the tooth root is especially badly damaged;
• it is impossible to use a conservative method of treatment due to certain anatomical features and technical difficulties;
• an inflammatory process develops, accompanied by suppuration.

It is possible to prevent the occurrence of perforation. To do this, the doctor must adhere to certain recommendations, in particular:

1. Before performing dental procedures, it is imperative to take an x-ray to detect the curvature of the tooth root;
2. provide good lighting and visualization of the work process;
3. if pathological curvature of the canals is detected, use appropriately shaped instruments;
4. constantly monitor the pressure of the tools even when encountering the least resistance.

As for the preventive measures that every person should adhere to, these can be called:

• timely treatment of any dental problems;
• using only safe products;
• prevention of mechanical tooth injuries;
• systematic oral hygiene procedures.

Tooth perforation can lead to infection of the oral cavity, and sometimes systemic damage other organs or the entire body. With this in mind, every person should have a dental examination every year. You should not postpone a visit to the doctor if the first symptoms of diseased teeth occur. It is worth asking your dentist about perforation - what it is and how to prevent its occurrence.

Perforation of the crown or root of a tooth – this is a violation of integrity, the formation of a small hole through which the focus of inflammation and healthy surrounding tissues are combined. A crack can appear as a result of the development of caries and various traumatic factors. To save a tooth with perforation, it is necessary to take urgent measures as soon as possible to eliminate the defect. Otherwise, the infectious process will spread to periodontal tissue and lead to dangerous consequences (root granuloma, periodontitis, periostitis, sepsis).

Causes of pathology

Violation of the integrity of dental tissues can be caused by various factors. Most common cause the formation of a through hole is a medical error. Trouble occurs during expansion, cleaning or filling of root canals, installation of a pin or inlay. In most cases, the formation of a hole is accompanied by sudden pain and bleeding from the defect. Some unscrupulous doctors try to hide the fact of a medical error, restore the coronal part and send the patient home. Such an action constitutes medical negligence and does not go unnoticed. Later a short time, after treatment, severe pain appears, which forces you to seek repeated help from a dentist. An x-ray helps detect tooth perforation and accurately determine its location.

The root wall defect is visible in the photo:

Medical error can occur as a result of various reasons:

• the presence of narrowed, tortuous root canals in the patient;
• application of force during endodontic treatment;
• little work experience and low level doctor's knowledge;
• treatment of periodontitis. When trying to unfill previously treated root canals, the doctor warns the patient in advance about possible complications;
• use of low-quality dental instruments. There are cases when there is no violation of integrity, but a dental instrument breaks off in the root canal. Removal foreign body from a cavity without a special microscope is almost impossible. A broken instrument prevents high-quality endodontic treatment. As a result, after some time a person’s tooth begins to ache, and signs of periodontal inflammation appear;
• anatomical feature of the structure of a canine, incisor or molar.

To reduce the likelihood of perforation, dentists use special magnifying devices - binocular glasses and a microscope.

Violation of the integrity of the membranes can occur as a result of injury or the development of caries. If a defect is detected, it is recommended to carry out therapeutic actions to eliminate it.

Symptoms and signs

Photo

If perforation of the root or crown occurs during endodontic treatment, the patient may not feel the changes, as he is under the influence of local anesthetic. If the defect is not corrected in a timely manner, after the anesthesia wears off, the person will develop a nagging toothache.

Gradually, as inflammation develops, signs or periostitis form:

• increased sensitivity when biting;
• the appearance of a pathological formation on the gum;
• tissue swelling;
• the formation of a fistula (an outlet for pus) improves the patient’s well-being, but does not cure him of the pathology. Some people try to carry out self-treatment and do not go to the dentist for a long time. This is a big mistake. With absence adequate treatment, the chance of saving the tooth decreases, the likelihood of developing sepsis and phlegmon increases;
• fever, deterioration general well-being.

Sometimes, perforation of the tooth wall is accompanied by a sluggish inflammatory process and is not expressed by significant symptoms. Externally, an incisor, molar or canine may look completely healthy, but if left untreated for a long time, it becomes dark in color.

If during cleaning or filling the root canals, a violation of the integrity of the cavity occurs, the dentist will immediately notice this. Symptoms of fresh perforation: bleeding, sensation of changing the movement of the instrument in the root canal. If a defect is detected, the responsible doctor immediately begins to eliminate it.

Types of defects

The pathological hole can be localized in various parts:

• on the wall of the crown;
• at the bottom of the tooth;
• in the root area.

Perforation of the tooth crown most often occurs during a carious process. Caries gradually destroys the walls of enamel and dentin. If treatment is not started in a timely manner, pathological process completely affects all healthy tissues, leading to the development of pulpitis. Symptoms of nerve fiber damage are: paroxysmal pain that intensifies at night, the presence of a deep carious cavity, and deterioration in general well-being. Treatment of pulpitis involves removing the pulp and filling the root canals of the tooth.

Crown perforation can also occur due to a fall or strong impact. Most rarely, the cause of a violation of the integrity of the coronal part is the inaccurate actions of the doctor.

Perforation of the bottom of the tooth cavity is dangerous because the integrity of the bifurcation zone (bifurcation of the roots) is disrupted. The situation arises when the rules for installing pins in the root canal are violated. The occurrence of a non-physiological hole leads to the development of bleeding and further periodontal inflammation. The prognosis for violation of the integrity of the bottom of the unit is most often unfavorable.

Depending on the time of appearance, perforations can be fresh or old.

When assessing the possibility of saving a tooth, the dentist takes into account three main factors: how long ago the defect formed, its location and size.

Treatment

If a pathological defect is detected, immediate treatment is carried out. If perforation occurs during endodontic intervention, it is necessary:

1. Stop the bleeding.
2. Disinfect the cavity.
3. Dry the cavity with paper points.
4. Close the defect using special cements - mineral trioxide aggregate (MTA), AUREOSEAL, PROROOT. Many budget clinics do not have expensive equipment and materials. In this case, they send the patient for tooth extraction without even making an attempt to save it.
5. Prescribing painkillers and antibacterial drugs to the patient.

At subsequent visits, the root canals are filled and the crown is restored. After completion of dental treatment, the patient is under the supervision of a dentist and is examined every 6 months.

The quality of perforation elimination and assessment of root canal filling is carried out using x-rays.

When eliminating large defects, they resort to surgical procedures (resection of the root apex, tooth replantation). If there is no inflammation in the periodontal tissues and a significant crack is detected, the dentist may recommend removing the affected tooth and installing an implant.

After detecting perforation of the root, crown or bottom of the unit, the doctor assesses the situation and makes a decision. In most cases, if there is a pathological hole with a diameter of more than 1.5 mm, treatment is carried out without a guarantee.

The dentist’s procedure for perforating a tooth is described in detail in the video:

Question answer

After treatment of pulpitis, the child complains of pain when biting. Does perforation of baby teeth happen and can it cause pain?

Yes, perforation of baby teeth is not uncommon. To determine the cause of the pain, take an x-ray and consult several doctors. If you find a defect in the cavity of an incisor, canine or molar, contact your dentist as soon as possible to close the pathological cavity.

What complications can tooth perforation lead to?

If the pathological hole remains unclosed, then dangerous consequences develop. These include: periodontitis, periostitis, cyst formation, granulomas.

What prognosis do doctors give in the presence of tooth perforation?

With timely detection and closure of a defect with a diameter of up to 1 mm, the prognosis is favorable. If the hole is old, large in size, and an area of ​​inflammation has formed around it, it will be difficult to save the tooth.

How to protect yourself from tooth perforation?

Prevention is aimed at maintaining dental health. To avoid the development of caries, perform oral hygiene 2 times a day using a brush and paste. Use irrigator, floss and rinses.

Since the main cause of perforation is the human factor, carefully choose a doctor and clinic.

When turning to a dentist for help, pay attention to the following characteristics: the doctor’s experience, the presence of special magnifying devices (microscope, binocular glasses), diagnostic devices (radiovisiograph, computed tomograph, x-ray machine).

Why does the dentist not guarantee successful treatment for large perforations?

If there is a through hole in the tooth cavity larger than 1.5 mm, when it is closed, there is a high probability of pushing dental cement into the periodontal zone. As a result of the infected area getting into the dental tissue, an inflammatory process occurs that is difficult to eliminate.

Unlike a carious cavity, tooth perforation is a lesion in which a single hole or multiple cracks appear. Through them, tooth tissue begins to contact the root canals, forming inflammation, risks of infection and pain, comparable in symptoms to most serious illnesses.

According to the location of perforation, there are:

• At the bottom of the dental cavity - a common, but difficult to treat type. Detectable using complex diagnostics.
• On the wall of the tooth - easily visible to the naked eye, often leading to gingivitis, periodontitis, pulpitis and other diseases.
• On the root part - localized in the apical, middle or bifurcation region between the roots. Tooth root perforation is the most difficult to diagnose and treat, and only after an X-ray and panoramic tomography of the jaw.

Panoramic tomography of the jaw

Interesting fact

According to dental statistics, even in countries with high level In medicine, dental perforations are detected in 9-10% of absolutely all patients, regardless of diagnosis. Moreover, in 90% of clinical cases, the chewing surface of the crown suffers, which is whyexperienced dentist(link to our doctors)should exclude caries and similar diseases.

Perforation is also divided according to the degree of neglect:

• Fresh injury – no more than 24 hours have passed since the injury; ideally, the problem was discovered during the same session in the doctor’s office.
• An old lesion - the hole was not noticed by the dentist, and extensive inflammation of the pulp or the growth of mechanical damage began.

There are three options for perforation, depending on its location:

1. Perforation of the bottom of the tooth cavity. Damage occurs due to the physiological structure and medical errors.
2. Perforation of walls. It occurs for the same reasons as perforation of the bottom of the cavity. This complication is the easiest to treat. The hole is visible visually, which makes it easier to close.
3. Root perforation. The most complex type of complication, often leading to the removal of an incisor, canine or molar. The location of the perforation can only be detected using contrast X-ray diagnostics. To do this, files are entered into the channel and a picture is taken from different angles. Perforation of tooth roots can be localized:

What is tooth perforation?

Perforation of a tooth is a hole that forms in it for some reason, through which contact occurs between its internal and periodontal tissues. Depending on the location, there are the following types pathologies:

1. perforation of the tooth bottom: occurs as a result of excessive abrasion of the tooth crown or due to excessive expansion of the tooth cavity during treatment. In such a situation, virtually the entire tooth breaks,
2. tooth root perforation: a common pathology that, if left untreated, leads to periodontitis. It may appear due to poor treatment of the tooth canals or due to a violation of the filling process, as well as due to improperly growing (crooked) roots. Early diagnosis and timely treatment is a guarantee of a successful outcome. To clarify the extent of the problem, you need to take an x-ray,
3. perforation of the tooth wall: this option is often caused by medical errors. Signs may include sharp pain and directly chipping part of the tooth.

Based on the time of formation, two types of pathology are distinguished: fresh and old. In the first case, we are talking about a problem that the doctor or patient noticed immediately at the moment of its formation. In the second, from the moment of discovery it has passed long time, tissue infection began. A situation like this requires emergency measures that will help save the tooth.

Tooth perforation (or perforation) is the formation of a pathological communication between the internal cavities and canals of the tooth with the surrounding tissues. The formation of such holes may be associated with mechanical trauma, or it may be a consequence of an advanced carious process.

Perforation can be localized:

• in the area of ​​the bottom of the dental cavity;
• in the wall of the tooth;
• in the area of ​​the tooth root (apical, middle or bifurcation).

Depending on how long ago it occurred, perforation of the tooth canal can be:

• fresh, when a complication is detected and treated almost immediately;
• old, in which infection of the dental tissues already occurs, and a sufficiently long period of time has passed since the injury.

Possible complications

Perforation of the tooth root or other forms of perforation are dangerous because they do not have characteristic symptoms. The malaise experienced by the patient is characteristic of many diseases. During the development of the disease, neoplasms of an extremely dangerous nature may appear in the oral cavity. Typical dental pathologies resulting from perforation are:

1. granuloma, which is the localization of pathogens and the products of their activity in dental tissue;
2. dental cyst infecting the gum and internal organs;
3. root breakage leads to inflammation and tooth loss;
4. jaw asymmetry;
5. If a root fragment gets into the gum, it threatens to become overgrown with soft tissues and, as a result, gum inflammation, which can be eliminated surgically under general anesthesia.

The main danger of such a dental disease is that it does not have pronounced symptoms. And during the time of damage, formations may appear in the dental tissue that can lead to tooth loss.

Complications of perforation are:

1. Granuloma, which is a focus of infection in the dental bone tissue.
2. A dental cyst is dangerous because if not treated in a timely manner, not only the gum cavity, but also other body systems can become infected.

In a damaged area, the root breaks, which can lead to:

1. Tissue infection.
2. Loss of a diseased tooth.
3. The patient's jaw may become asymmetrical.
4. The client experiences discomfort while eating food, as well as at the moment when he opens or closes his mouth.

A whole root or a piece of it may remain in the gum. This can happen if the doctor provided illiterate treatment.

Due to such an oversight, the following unpleasant situation will occur:

1. The remaining root will eventually become overgrown with soft tissue.
2. Inflammation of the gums will occur.
3. Urgent need surgical intervention, before which the patient will be given general anesthesia.

Unfortunately, even a qualified dentist cannot give a 100% guarantee of successful treatment, and in some cases several negative scenarios are possible:

• The infection has spread deep into the soft tissue to the periosteum.
• The channels were not completely sealed or cleaned.
• Due to inflammation, periodontitis began.
• Due to the doctor's oversight, a fragment of the removed root got stuck in the soft tissues.

Only timely seeking help from a dentist can prevent Negative consequences and give a good prognosis for treatment.

After treatment, pain (tooth aching) may occur for up to 2 weeks with a gradually decreasing intensity. But complications are the result of incorrect actions by the dentist.

Among them:

• oversensitivity– when the treated dentin becomes too dry during operation;
• fracture of the filling or its loss– due to violation of installation technology;
• secondary caries– when the area between the filling and the tooth depressurizes;
• papillitis – swelling of the gingival papilla and its inflammation – when the gum tissue is damaged or infected;
• inflammation, and subsequently necrosis of the pulp– in case of overheating or infection.

Sometimes pigmentation of the filling can occur - a change in color due to the presence of various dyes in drinks and food.

Tooth perforation is dangerous if it is asymptomatic. If it is not detected immediately, a sluggish infectious process will begin. It can lead to:

• periodontitis – inflammation of the root apex;
• granuloma - a small sac filled with pus;
• cyst - a complication of granuloma.

Also, an unsealed pathological hole can lead to tooth root breakage during stress.

In some cases, tooth extraction is indicated. It is carried out when:

• significant destruction root canal;
• the appearance of mobility of the chewing unit;
• the addition of infection and the development of inflammation;
• technical impossibility of closing the defect.

What drugs are used?

Modern dentistry requires careful attitude to the teeth. The main principle is maximum tissue preservation.

That is why in the treatment of deep caries various modern materials, including gaskets, the bulk of which are made on the basis of calcium hydroxide.

This base has the formula – Ca(OH)2. Its use in dental practice is based on a highly alkaline reaction, due to which the drug penetrates into the pulp through the dentinal tubules and produces a therapeutic effect.

Such drugs have many advantages:

• have an odontotropic effect, that is promote the formation of replacement dentin.
• have a strong antimicrobial effect and prevent infection from penetrating deep into the tooth- into the pulp area.

It is worth talking about some of their specific varieties:

• Calmecin, Dycal. Manufactured by Dentsply. It is used not only for indirect pulp capping, but also in case of accidental pulp exposure.

  It is also used during pulp amputation to stimulate the closure of the root canal orifice by forming a dentin bridge.

• Calcipulpe. Manufacturer: Septodont. At deep caries used as a neutralizing agent and a protective layer for dentin. Hardens very quickly and does not require additional drugs.
• Life. Manufactured by Kerr. A durable gasket that, in addition to its pronounced antibacterial and odontotropic effect, also protects the pulp from overheating.

  This is due to the low thermal conductivity of the material, which is an additional advantage.

• Calcimol. Gasket from Voco. The material, in addition to protecting the pulp and other necessary effects, is also radiopaque, which is important for subsequent visits and studies. It consists of two components - a base and a catalyst.
• Reocap. Manufactured by Vivadent. Refers to calcium salicylate cements of chemical curing. It is characterized by simplicity and ease of use, as well as excellent performance.

Treatment

Damage caused by the dentist must be repaired during the same visit to the dental office. Delaying treatment reduces its effectiveness.

• The conservative surgical method is used if periodontitis is diagnosed in the soft tissues (see also: symptoms and treatments for periodontitis).

Perforation of the bottom of the tooth cavity occurs due to displacement of the tooth axis. The indirect cause is the abrasion and thinning of the crown. Perforation of the dental cavity can occur due to excessive drilling of the dental cavity. Conservative treatment is possible for defects no more than 2 mm. For larger tooth perforations, surgical treatment is performed.

Technologies in dental practice are improving all the time, but sometimes complications arise in dental treatment. Despite the fact that dental perforation occurs only in 9% of complications, it still remains a pressing problem for dental practice. Let's look at this phenomenon and find out why perforation is dangerous and what are the ways to prevent it.

• Conservative treatment is used if the perforation occurs near the crown. Therapy is carried out by filling the canal or closing the perforation with an inlay.
• Surgery– resection of the root apex.
• The conservative surgical method is used if periodontitis is diagnosed in the soft tissues.
• Microsurgery is performed if the size of the damage is significant or access to it is limited. In this case, the surgeon provides access to the perforation, performs hemostasis, and the therapist cleans the damage and rinses (irrigates) the perforation site, and then fills the tooth.
• Replantation is a modern, complex treatment method that requires the highest qualifications of the dentist. It is resorted to if the location of the tooth perforation cannot be determined. The essence of treating tooth root perforation with replantation is to remove the damaged tooth, restore it in the laboratory and then implant it in its place. The restored tooth is protected with a special splint.

What to do and how to treat perforation? Depending on the area of ​​the hole and its nature, treatment can be therapeutic or surgical. Let's consider both options in more detail.

Attention! Under no circumstances should you try to fix the problem at home. ethnoscience will not help eliminate the defect, but will only worsen the situation.

This method is used to eliminate a hole in the coronal area and involves a filling procedure. To begin with, the doctor will clean the affected area from visible contaminants, carry out an antiseptic treatment, and then restore its shape using a composite material.

If the crown of the tooth is severely damaged, you will have to carry out prosthetics - for example, install a pin inside the tooth root (the nerve, of course, is first removed), a stump inlay or a regular inlay, or a crown. After installing the filling, it is recommended to do it once every six months. x-rays. Such control will reveal possible complications, that is, secondary caries under the filling.

Microsurgical methods are used in cases where the hole is too large or its location is difficult to reach. For example, when the hole is localized at the apex of the root, a decision is made to perform an operation, since attempts to fill it can cause even more harm. There is no need to be afraid of the procedure. Under local anesthesia, the specialist makes a small incision in the gum, through which the affected root is removed, while preserving its healthy part.

In cases where it is not possible to determine the location of the hole, the diseased tooth is removed. After the operation, the patient is prescribed a course of antibiotics that will help avoid the development of the inflammatory process. At severe pain painkillers are prescribed. It is also recommended to rinse your mouth with antiseptic solutions.

Toothache always gives a person a lot of unpleasant sensations. In addition to caries, dental perforation can also cause such discomfort. What it is and how it is treated will be discussed in this article.

Tooth perforation is a defect in its tissues and the appearance of a hole between the oral cavity and the dental canals.

Occurs due to:

1. If caries was not cured on time.
2. For mechanical injuries of hard tissues. The patient can receive these injuries in the following situations: due to an impact; if the dentist pressed too hard on the working instrument during treatment.
3. At anatomical features root canals, namely they have such bends, because of which the attending physician cannot completely cure the client’s diseased tooth.

There are several types of perforation:

1. Old. In this case, treatment of the damaged area was started at the wrong time. And so the process of infection began in the tissues.
2. Fresh. Immediately after a tooth injury, the patient sought help from specialists.

Such unpleasant sensations can occur in places such as:

1. Walls of the tooth.
2. Bottom of the dental cavity.
3. Root system area.

Treatment of perforation should be surgical. It is advisable to carry it out on the same day. The doctor’s actions are aimed at closing the hole with special filling materials. They are subject to strict requirements:

• the ability to quickly harden even upon contact with saliva;
• high biocompatibility with tissues.

Today, imported material is used - mineral trioxide aggregate (MTA). It is not rejected by the body and provides greater treatment success compared to previously used amalgam and glass ionomer cement.

Also, the probability of success depends on technical support clinics. Closing the pathological hole is best done under a special endodontic microscope. It allows visual control of each stage.

Perforation is treated using three methods:

1. Conservative. It is possible to close the perforation in two ways:

2. Surgical-conservative. It is used if the root has been damaged, with old perforation or after an unsuccessful conservative treatment. An incision is made in the gum to provide access to the defect. Through it, the hole is sealed and osteogenic materials are implanted.

3. Surgical. It is carried out using two types of surgical intervention:

• root apex resection– its excision;
• replantation - the tooth is carefully removed from the alveolar socket; after all defects have been eliminated, it is returned to its place and fixed with a splint. If the operation was successful, it will take root after a while.

The last treatment option is the most difficult. Not every clinic has the opportunity to use it. If the defect is too extensive, they prefer to remove the tooth.

Important! Even after successful restoration, the tooth cannot fully function. Intense chewing loads are excluded, and in the future it will not be possible to use prosthetics.

Even after successful restoration, the tooth cannot fully function.

After dental interventions continue therapy at home. Antibiotics, anti-inflammatory medications, analgesics, and rinsing the mouth with antiseptic solutions are prescribed.

Therapy always begins with preparatory stage, which includes:

• Visual inspection and identification of problem areas.
• X-ray or panoramic tomography.
• Removing plaque and tartar is a must.
• Treatment of all inflammations in the oral cavity, including stomatitis.

There are five requirements for the dentist himself:

• A complete medical history is collected from the patient - information about nutrition, hygiene, previous diseases and treatment results.
• If there are dentures, pins and crowns in your mouth, check their condition, remove and replace if necessary.
• Remove old or unsuccessfully installed fillings, including from canals.
• Demonstrate upon request that only new and sterile equipment is used - especially for fragile hand instruments.
• Tomography and targeted imaging should be prescribed as many times as necessary for an accurate diagnosis of the condition of the root canals.

As soon as the patient is ready and the condition of the tooth allows for conservative therapy, the doctor begins the standard stages of treatment:

1. Anesthetize the area with 2-3 injections of ultracaine.
2. Isolation of problem teeth with rubber dam or cotton swabs.
3. Drilling the cavity with a drill and cleaning the root canals.
4. If necessary, add medicinal paste for disinfection and install a temporary filling.
5. Final filling of both the damaged canal and the hole itself.