Thanks to the services of unprofessional or illiterate dentists, teeth have to be re-treated. A very serious problem is perforation, which is a complication or incorrect actions of the doctor during endodontic treatment. Such problems can arise when the wrong instrumentation is used or a preliminary x-ray is not taken. Less commonly, the problem can occur with advanced caries, which most often leads to tooth loss.

Causes and types of tooth perforation

Depending on the location, the holes are divided into several types of perforation:

• at the bottom of the tooth cavity;
• in the side wall;
• at the root of the tooth.

The most common type of perforation occurs in the coronal part of the tooth. This occurs as a result of prolonged neglect of the dentist or incomplete treatment. Caries affects the tooth tissues deeper and deeper, softening and destroying them until the wall is depleted and a perforation is formed.

Another reason may be mechanical stress. As a result, a crack appears in the tooth. And the reason for this may be not only a strong blow, but also unskilled actions of the dentist when trying to install the pin with significant force.

The occurrence of perforation can be facilitated by the anatomical features of the patient’s tooth roots. The doctor may not be able to see the bends on a poor-quality x-ray and, when cleaning or expanding the canals, violate its integrity. If tooth perforation occurs during a dental appointment, you will feel it immediately. A sharp acute pain will not allow you to miss this moment. And the doctor should see characteristic signs - the appearance of bleeding from the formed hole.

A qualified specialist can and should correct this situation on the spot by filling the defect. But here one small condition arises, 1-1.5 mm in size. If the resulting hole is larger, then through it the filling material can go beyond the boundaries of the tooth and cause many problems, including periodontitis.

Perforation of one of the roots during endodontics is no less dangerous. This happens in most cases due to violation of the rules and techniques of working as a dentist. It makes no sense to figure out later why this happened, since there is a long work ahead to save the tooth. In this case, sitting in a chair, you will feel a stabbing pain, and the dentist will see blood appearing in the canal. These symptoms make it clear that there is a problem and it needs to be solved.

Perforations in the area of ​​the dental crown

It occurs most often, and it can be localized both in the area of ​​the wall of the tooth cavity and in the area of ​​its bottom. The anatomical features of the structure of the patient’s teeth predispose to this type of complications (deviation from the normal central axis, too thin tooth wall, small thickness of the bottom of baby teeth and errors in therapeutic manipulations (incorrect selection of instruments and speed mode of the bur, re-treatment of the tooth, insufficiently wide opening of the cavity , which impairs the view of the tissue being prepared).

The clinical picture of any fresh perforation is typical. At the moment of its occurrence, a person experiences severe toothache, and the damaged tooth begins to bleed. If this happens in the dentist's office during treatment, the doctor feels the "failure" of the instrument and can visually see blood coming out of the perforation.

Old perforations that were not detected at the time of occurrence and not treated sometimes do not manifest themselves at all, since they are often accompanied not by an acute, but by a sluggish inflammatory process. The patient may experience periodic aching pain. And only upon examination, the doctor discovers granulation tissue in the area of ​​the external opening, which bleeds when touched.

Typically, such perforations are immediately detected by a doctor and repaired with a filling. Moreover, the prognosis for wall damage is almost always favorable. But the result of treatment depends on the size of the perforation hole. If the size of the defect does not exceed 1-2 mm, then filling it can be quite effective. If the size of the canal and hole is more than 2 mm, then closing the tooth perforation will most likely lead to the pushing out of the active material into the periodontium and its infection with the development of severe forms of destructive periodontitis.

When a tooth is perforated in the area of ​​the visible part of the crown, diagnosis is not difficult, since the defect is visible even to the naked eye. If there are doubts about the presence of a complication, or it occurred in the area of ​​the bottom of the dental cavity, then it is necessary to take X-ray images with contrast (for example, a pin or file can act as contrast).

Closing a tooth perforation is a therapeutic measure that must be carried out as quickly as possible, since without treatment such a complication will lead not only to tooth loss, but also to the development of serious inflammatory reactions.

Perforation of the tooth root

Perforations in the root of a tooth (or dental canal) are also one of the common complications of endodontic treatment, which, if treated incorrectly, often leads to tooth loss.

At its core, perforation is a crack (hole) in the root of a tooth, which creates a pathological communication between the root canal and periodontal tissues.

Depending on the place of origin there are:

• in the middle part of the tooth root;
• apex of tooth root;
• in the area of ​​root bifurcation (between the roots of the tooth).

Perforation of the root in the middle part occurs when the dental canal is treated incorrectly, during the process of re-treatment of incorrect canal filling, in preparation for the insertion of an anchor pin, or at the time of insertion of a dental pin (for example, a brass one). In the area of ​​the apex, perforations are often the result of incorrect selection of instruments and such a complication is quite difficult to diagnose.

Since clear visualization of perforation of the dental canal in the root area is practically impossible, its presence can be suspected by certain symptoms:

• the occurrence of weak but constant bleeding from the root canal;
• the appearance of sudden pain in the tooth area;
• a sharp change in the stroke of the instrument and a change in its normal position in the channel.

Root perforations that were not diagnosed in a timely manner manifest themselves as signs of periodontitis:

• pain in the area of ​​the affected tooth;
• swelling and redness of the gums over the area of ​​inflammation;
• general symptoms: weakness, malaise, headaches.

Diagnosis of such a complication consists of stopping the bleeding, expanding the root canal with the introduction of a paper pin, after removing which, traces of blood can suggest the location of the perforation. The perforation of dense tissue can be definitively confirmed using contrast-enhanced X-rays (a file inserted into the perforated canal is used as contrast).

The doctor decides how to treat tooth root perforation based on the size of the perforation, the location of the defect, the clinical picture and the presence of other complications. Conservative, surgical and conservative-surgical treatment options are possible.

Prevention and treatment of dental perforation

Prevention of tooth perforation consists in carrying out correct and competent treatment of dental canals, completely eliminating the likelihood of the formation of this defect. In order to protect the patient from tooth perforations, the doctor must follow a number of rules. During dental treatment, an excellent overview of the dental cavity must be provided.

The instruments used in treatment must be safe and modern. Sometimes it happens that an instrument, especially if the doctor makes a mistake, breaks in the patient’s mouth, which leads to the formation of tooth perforation. When performing interventions in the patient's oral cavity, precision in working with instruments is necessary. The burr must be used in a spherical surgical length.

Full control over the patient’s dental condition is very important. The doctor should always keep in mind the anatomical features of the patient’s jaw structure, the location of the tooth in the alveolus (tooth socket), and the degree of tooth displacement (if any). Basic actions must be accompanied by x-rays.

Before endodontic treatment, it is imperative to remove the artificial tooth crown, if the patient has one.

Treatment of tooth perforations, as already mentioned, must be carried out as quickly as possible after their discovery. The time elapsed since the formation of perforation and its location are key factors influencing the success of treatment.

Perforation caused by strong mechanical stress during dental treatment must be closed during the same visit. If you delay closing the perforation until your next visit to the doctor, treatment may not be effective.

The most favorable prognosis for the treatment of perforations is for those that are located as far as possible from the apex - the apex of the tooth root.

After passing and treating the root canals of the teeth, the doctor goes somewhat deeper with a cone bur from the side of the oral cavity to create retention - delay, preservation - of the material. The dentist inserts a large file into each root canal. Then the doctor places glass ionomer cement on the resulting perforation, and after a while the entire bottom is covered with cement. After the glass ionomer cement has hardened, the inserted files are removed from the oral cavity.

Treatment of tooth perforation does not end there. It is very important to regularly monitor the sealed canal using x-rays. Carrying out control images every six months will allow timely diagnosis of complications and inflammation.

In some cases, treatment of perforation of tooth canals using a microsurgical method may be indicated. This decision is made when perforations are too large, as well as when the location of the defect is extremely inconvenient. After creating convenient access to the perforation, the doctor performs hemostasis (prevents bleeding), cleans the perforation and performs irrigation. Then the tooth perforation is restored with any modern filling composition.

Microsurgical intervention can also be performed after conservative sealing of the tooth perforation, if it is necessary to remove the remaining material from the periodontium.

One of the most difficult treatment options for tooth perforation is replantation.

The replantation procedure involves the removal of a tooth to prevent the spread of infection or tissue destruction and the subsequent reintroduction of the tooth into the alveolus - the tooth socket. Tooth extraction during replantation is carried out in a gentle manner. Replantation is resorted to in cases where it is difficult to determine the isolation of the perforation. Isolation is determined after tooth extraction, after which replantation can be carried out with the tooth fixed with a special splint.

If a dentist diagnoses a person with tooth perforation, treatment must be started immediately. If the doctor prescribes it in the early manifestations of perforation, it is most effective and short-lasting.

In an advanced form, complications can arise that will be very difficult to get rid of.

When a person hears from a doctor that he has been diagnosed with perforation, he needs to understand: tooth perforation what it is.

Perforation is defined as a small hole in a tooth cavity, which can be formed due to several processes, namely:

Complications caused by advanced perforation are changes in the structure of the tooth and destruction of bone tissue.

Symptoms of perforation

The symptoms of perforation at an early stage are obvious, it causes severe pain in the oral cavity. Bleeding from the tooth socket is observed, which can begin in the dentist’s office during procedures and at home. If the process began at a doctor’s appointment, he made a mistake when working with tools.

Unidentified perforation at an early stage of manifestation develops into an advanced form. It is dangerous because it causes virtually no pain. A person is only occasionally bothered by mild aching pain, and the internal process of inflammation proceeds rapidly.

This pathology can be noticed by a doctor during a preventive appointment.

If detected, the doctor will immediately suggest filling the tooth. In most cases, this is enough, the pathological process is suppressed. However, if the thickness of the hole exceeds 2 mm, then the filling is ineffective; moreover, it can cause the filling materials to be pushed into the periodontium and its subsequent infection. Destructive periodontitis occurs.

Types of perforation

Perforation of the tooth root

Perforation can be localized in the following areas of the oral cavity:

• at the bottom of the dental cavity;
• in the root part of the tooth;
• at the wall of the tooth.

From this, varieties of the pathological process are distinguished, which, depending on their location, are divided into several types:

• Perforation of the bottom of the tooth cavity may occur due to severe abrasion of the dental crown. Cases are identified when the given type of pathology manifests itself due to a strong expansion of the dental cavity at the time of its treatment. When the process occurs, a displacement of the dental axis towards the tongue or towards the cheek is observed.
• Root perforation occurs when the teeth are bent; the lesion can be identified by taking an x-ray of the jaw. This type of pathology must be cured as quickly as possible, because it is very important to protect the periodontium from possible destruction. Periodontal destruction threatens tooth destruction. The effectiveness of treatment is determined precisely by the degree of perforation that has occurred; the places in which the violation has occurred differ: the middle part of the tooth root, its apex and the position between the roots.
  

  Perforation in the upper part of the tooth root can be caused by incorrect selection of instruments by the doctor when filling the tooth; such a violation is quite difficult to immediately identify.

  Pathology in the middle part occurs when the dental canals are insufficiently treated or when they are filled incorrectly. The most dangerous is considered to be perforation that occurs between the roots of the teeth, because it can lead to disruption of the functioning of the teeth.

• Perforation occurring on the walls of the tooth, may be caused by a dentist’s mistake made during treatment of the disease with dental instruments. This may be due to the doctor’s unprofessionalism or due to malfunction of the instruments. Provided that the doctor immediately notices the mistake, he will eliminate the bleeding.

Diagnosis of perforation in visible parts is carried out quickly, and if the complication is localized at the bottom of the tooth cavity, it is first recommended to take an X-ray of the jaw using contrast devices.

Treatment of teeth affected by perforation with filling

Perforation can be caused by injuries, diseases, or medical errors.

Pathology treatment is carried out individually for each case., depending on the location where the perforation is localized and the extent of its spread.

Perforation of the tooth root, which can be treated immediately after its occurrence, is considered the most dangerous, as it can cause a large number of complications. How exactly the treatment should be carried out is decided by the doctor who evaluates the lesion.

An effective therapeutic method for treatment is tooth filling.. When filling, first of all, the doctor cleans the affected cavity of visible impurities, then a conical drill is introduced into the root part.

The doctor inserts a large file into the root canals one by one. Afterwards, the dentist places a special cement on the area affected by the perforation, which completely covers the root bottom of the tooth.

After the material hardens, the doctor removes the remaining files from the oral cavity. However, the treatment does not end there. After filling, it is recommended to take X-rays of the jaw every six months, so that if the inflammatory process possibly recurs, it can be eliminated immediately.

There are cases where treatment is indicated when using microsurgical methods. This manipulation can only be performed by an experienced dentist. The doctor makes this decision provided that the perforation is too large in size, or the affected area is in a hard-to-reach place.

The doctor makes it convenient to get to the affected area and prevents bleeding. Next, the affected area is cleaned and irrigation follows. After the procedure, all you need to do is fill the tooth.

Removal of teeth due to perforation

A dangerous consequence of tooth perforation is a cyst.

Replantation is considered one of the most difficult methods of treating perforation. It is carried out by removing a tooth and then inserting a dental implant into its alveoli.

It is noted that removal is performed in a gentle manner and is prescribed if it is not possible to determine the area in which the perforation site is localized.

If surgery has been performed, treatment does not end in the dentist's office. Even in the absence of a visible inflammatory process, patients are prescribed antibiotics. Drugs with the widest possible spectrum of action that are able to penetrate bone tissue are suitable.

For the first two or three days, medications with an anti-inflammatory effect are prescribed, which contribute to the rapid restoration of oral tissues. If the patient complains of severe pain, the doctor also prescribes painkillers.

For preventive purposes, it is recommended to rinse antiseptics, which can be purchased at a pharmacy or prepared at home. Chlorophyllipt is a good choice from pharmaceutical solutions, as it has not only an antiseptic, but also a mild anti-inflammatory effect.

To prepare the solution at home, it is recommended to use iodine; it has a strong antiseptic effect.

Preventive measures

Timely treatment of perforation makes it possible to save the tooth

Preventive measures consist in the fact that perforation should be treated by a competent specialist who will completely eliminate the formation of possible complications.

To keep the patient safe, the doctor pays attention to the following rules:

• During direct treatment, it is important to ensure a good view of the oral cavity.
• the required instruments for the procedure must be in full working order.
• It is necessary to fully control the condition of the patient’s tooth during treatment.

It is possible to protect yourself from the occurrence of possible violations of the structure of the teeth; you only need to pay special attention to the condition of your oral cavity.

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. With timely treatment, it is not difficult to overcome it, but in a chronic course or in an advanced acute form, the pathology can lead not only to tooth loss, but also to much more serious health problems.

When answering the question of what tooth perforation is, they first note that it is a hole, the characteristic feature of which is the formation of a connection between dental canals, internal cavities and tissues. Pathology is usually classified, depending on the duration of its occurrence, 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 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 biggest problem associated with tooth perforation is its long-term asymptomatic nature. 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) are formed, and 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 pain with unclear 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 appear similar 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 broad-spectrum antibiotics. 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. For this purpose, both medicinal antiseptic solutions, such as Stomatidin, Chlorophyllipt, and herbal preparations, for example, decoctions of chamomile, St. John's wort, and bird cherry, are suitable.

It is strictly prohibited to treat perforation only using traditional methods, because the pathology in this case goes into a 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. It is of great importance 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 force 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 to systemic damage to 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.

Technologies in dental practice are improving all the time, but sometimes complications arise in dental treatment. Despite the fact that dental perforation occurs in only 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.

Concept and causes of tooth perforation

Tooth perforation is the appearance of a hole between the area in which the disease is localized and other tooth tissues, including root canals. This is a rare complication that occurs as a result of an error by the dentist during treatment, mechanical injury, or as a consequence of the development of caries. Possible localization sector:

• in the area of ​​the bottom of the dental cavity;
• in the walls of the tooth crown;
• in the root area.

According to the timing of formation, perforation of tissues and tooth roots is divided into the following types:

1. Fresh - the dentist discovered it at the moment it arose. Then it is eliminated immediately after detection.
2. Old – sufficient time has passed since its onset for infection. Requires emergency intervention. Further delay threatens complications.

The causes of perforation can be impact, caries, as well as poor quality therapy, namely:

There are reasons that increase the risk of tooth perforation during treatment, regardless of the doctor’s qualifications:

• the central dental axis is deviated from the middle of the jaw axis towards the cheek, tongue, lips;
• thinning of bone tissue as a result of wear and tear;
• Carrying out dental work through the crown.

Symptoms of perforation

The following symptoms indicate the formation of a pathological hole:

• During treatment, the patient felt severe pain and bleeding appeared.
• The dentist felt the instrument sink and saw blood from the wound. If such a situation occurs, the perforation is immediately eliminated. If there is a small perforation, a filling is installed. Negative consequences depend on the size of the hole formed. If it is less than 2 mm, then the defect will be eliminated without complications.
• The patient complains of aching pain in the area of ​​the recently filled tooth, which periodically arises and subsides. This is a symptom of an old perforation.

Diagnostic methods

When the outer part of the tooth crown is perforated, the defect is detected visually. The dentist immediately takes action to correct the problem. If there is a suspicion of a perforation, or injury has occurred at the bottom of the dental cavity, then X-rays with contrast are taken. The contrast can be a pin or a file. Fluoroscopy is the most important tool for diagnosing perforation.

When a dental canal is perforated, it is impossible to visually determine the damage (we recommend reading: how to clean dental canals?). Its presence can be assumed based on the following signs:

• small but stable bleeding from the root canal;
• unexpected change in the stroke and position of the tool;
• The patient has a toothache.

Diagnosis of damage to the dental canal consists of:

• eliminating bleeding;
• drilling and examining the dental canal using a paper point, the presence of interrupted traces of blood on which makes it possible to determine the location of the damage;
• radiography using a file placed in the canal as contrast.

Features of treatment

Tooth perforation must be eliminated immediately after detection. Its age, location and depth of the lesion are the most important factors for successful treatment.

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

• 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.
• Surgical treatment – ​​resection of the root apex.
• The conservative surgical method is used if periodontitis is diagnosed in the soft tissues (see also: symptoms and methods of treating periodontitis).
• 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 a 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.

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.

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 gums 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.

Prevention of tooth root perforation

As a rule, dental errors lead to perforation, so when performing manipulations the following conditions must be met:

• use of modern high-quality tools;
• providing a good overview of the entire oral cavity and the diseased tooth;
• Before starting treatment, crowns must be removed;
• the use of x-rays to analyze the physiological characteristics of the patient’s teeth, the shape, location and size of the dental roots.

Today we will look at a rather rare, but at the same time, pressing problem in dental practice. Tooth perforation is one of the complications of dental treatment, which occurs in approximately 9% of cases. This problem can arise despite high technology and its constant improvement.

What is this pathology?

When this type of problem occurs, a hole is formed between the cavity and the root canals with tissue. This problem can arise due to mechanical damage to the tooth during an injury, in the event of a medical error during treatment, as well as in advanced caries.

Perforation (perforation) occurs in the following places:

• in the area of ​​the bottom of the dental cavity;
• in the root system;
• in the walls of the tooth.

It may also occur perforation of the maxillary sinus after tooth extraction.

There are two types of perforation depending on the duration of their formation:

• fresh – treatable immediately after its detection;
• neglected - the tissues have been injured for quite a long time, which led to the development of infection.

What are the reasons for tooth perforation?

Among the main reasons for the development of pathology, it is worth highlighting the following:

• Features of the structure of the root system. The likelihood of a perforation increases if the dental canals become bent, as the treatment process becomes more complex.
• Injury to a tooth due to impact. In this case, the perforation is a crack.
• Damage to dental tissue by caries. Such processes can lead to thinning of hard tissue and the emergence of a through passage into the tooth cavity or its canal.

In addition, there are a number of reasons that increase the risk of perforation, regardless of the qualifications of the specialist and compliance with the technological process:

• the central axis of the tooth has a deviation towards the cheek, lips or tongue;
• abrasion of tooth tissue, which leads to thinning of its walls;
• when performing therapeutic measures directly through the dental crown.

How does tooth root perforation occur?

One of the complications of endodontic therapy is perforation of the tooth root, which, if treated incorrectly, can lead to tooth loss. The pathology is a crack formed in the root of the tooth, connecting the canal with the periodontal tissues.

There are several types of perforation depending on its location:

• in the central part of the root;
• in its upper part;
• between the roots (at the place of their bifurcation).

Perforation in the central part of the root mainly occurs when the canal treatment technology is violated, during re-treatment of improper filling of the canals, during preparation for the installation of an anchor pin or during its insertion.

In the upper part of the root, pathology can occur due to the wrong choice of tools. It is typical that this problem is quite difficult to diagnose.

The most severe complication is perforation at the site of canal bifurcation, as it can lead to complex inflammatory processes and even tooth loss.

How to detect perforation?

You can suspect a perforation of a dental canal based on the following signs:

• constant slight bleeding from the canal;
• sudden onset of toothache;
• a sudden change in the location and advancement of the instrument in the canal during its examination by a specialist.

If this type of pathology is not detected in a timely manner, the following symptoms occur:

• pain at the location of the damaged tooth;
• swelling and redness of the gums at the site of inflammation;
• weakness, headaches, malaise.

Diagnostic measures involve stopping the bleeding, opening the canal and inserting a paper pin into it, from the blood imprints on which it will be possible to understand exactly where the hole occurred. The most accurate diagnosis of perforation is possible using x-rays. In this case, a special contrast agent is used.

What treatment method is used?

Treatment methods will depend on the size of the perforation, its location, the clinical picture as a whole, as well as the presence of complications. Conservative, surgical or mixed treatment is usually used.

Traditional therapy involves closing the perforation. This treatment can be applied only when the hole is close to the dental crown, as well as when the root canal is clearly visible.

In this situation, two types of therapy can be used:

• filling the main canal, in which the hole will be closed;
• closing the hole with preliminary sealing of the main channel with a special substance.

If an apical perforation is detected, an exclusively surgical treatment method is used, which involves resection of the apex of the tooth root.

Possible complications

Perforation is a dangerous pathology, as it can often be asymptomatic. In this case, it is difficult to detect it in time, and if it continues for a long time, various formations can arise in the dental tissue, which will subsequently lead to tooth loss or more severe complications.

How to avoid tooth perforation?

To avoid the occurrence of such unpleasant consequences of treatment as perforation, it is recommended to take preventive measures:

• mandatory X-ray examination of the bends of the dental canals in all patients without exception;
• the use of instruments that match the shape of the root canal;
• clear visualization of the work area;
• thorough control of the movement of the dental instrument;
• eliminating pressure on the tool when the slightest difficulty appears in its advancement.

In turn, each patient must carefully choose a dental clinic and a specialist to contact. To prevent unpleasant consequences of treatment, you should avoid going to unknown clinics. It is better to carry out treatment from trusted specialists. The health of your teeth depends entirely on this!