A Contemporary Treatment of an Iatrogenic Root Perforation: A Case Report

CBCT in contemporary endodontics

Cone-beam computed tomography (CBCT) is a three-dimensional imaging modality which can aid endodontic diagnosis and treatment planning. While there are guidelines available describing the indications, there are divergent philosophies on when this technology should be applied in clinical practice. This paper reviews the applications of CBCT including the clinical relevance of parameters which can be assessed, highlights the limitations of this technology, and provides guidance on how to maximise its clinical utility.

EDTA Combined with C-Pilot Files and Microultrasound for Root Canal Calcification: Dredging Effect and Safety Analysis

Objective

This paper discussed the dredging effect and safety of ethylenediaminetetraacetic acid (EDTA) combined with C-pilot files and microultrasound (mUS) on root canal calcification.

Methods

From October 2021 to January 2022, 132 patients with calcified root canals treated in our hospital were selected as the research subjects. Among them, 64 cases who received EDTA combined with C-pilot Files and mUS plus ultrasonic instruments to dredge calcified root canals were regarded as the research group (RG), and another 68 cases given ultrasonic instruments plus C-pilot files were regarded as the control group (CG). The root canal dredging time was recorded, and the dredging success rate and total success rate of different tooth positions and calcification sites were compared between groups. The clinical efficacy was assessed 6 months after treatment. Pain severity was evaluated by the Pain Intensity Numerical Rating Scale (PI-NRS) before (T0), during (T1), and after treatment (T2). Finally, the incidence of adverse reactions within one week after treatment was counted.

Results

RG was observed with statistically higher success rates of root canal dredging in different tooth positions and calcified sites than CG (P < 0.05). Besides, the total effective rate of treatment was 92.19% in RG, which was also higher compared with CG, while the root canal dredging time in RG was shorter than that in CG (P < 0.05). Increased NRS scores were found in both groups at T1, and the score in RG was significantly lower compared with that in CG. At T2, both groups showed a lower PI-NRS score than T1 but higher than T0, and the score at T2 was also lower in RG as compared to CG (P < 0.05). Moreover, the reduced incidence of adverse reactions were observed in RG compared with CG (P < 0.05).

Conclusions

EDTA combined with C-pilot files and mUS can effectively improve the dredging success rate of root canals obstructed by calcification, shorten the dredging time, and improve patient comfort, which is an effective method for clinical dredging of calcification obstructed root canals.

Limitations and Management of Static-guided Endodontics Failure

Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided endodontics has become an alternative approach for pulp canal calcification, facilitating the location of root canals more predictably through the combined use of cone-beam computed tomographic imaging, oral scanning, and endodontic access guides. Although several reports have shown that guided endodontics is safer, faster and can be performed without an operating microscope and by less experienced operators, the technique has limitations, and iatrogenesis may occur. This article describes the limitations of static-guided endodontics and possible causes of failures. In the present case, not fixing the guide to the bone and inaccuracies generated by manually performing mesh merger software led to root perforation. Endodontic microsurgery was effective in resolving this case and should be considered the treatment of choice when guided endodontics cannot be used safely or when it fails.