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Objective: Root perforation is an adverse event that may accidentally occur during root canal treatment and can adversely affect the treatment plan and tooth prognosis. This study aimed to assess the accuracy of cone beam computed tomography (CBCT) for detecting the strip and furcal perforations with different sizes. Methods: The mesiolingual canals of 155 extracted human mandibular first molars were instrumented and randomly divided into four experimental groups and one control group (n = 31). Furcal (in the pulp chamber floor) and strip perforations with 0.5, 1, 1.5, and 2 mm in diameter were manually created. The teeth were randomly mounted in bovine ribs and scanned using CBCT. Two radiologists unaware of the study groups observed the images and reported the greatest perforation diameter. The inter-observer agreements were calculated. The diagnostic accuracy was compared for furcal and strip perforations with different sizes. Results: The inter-observer agreement for detecting furcal and strip perforations with different sizes were good. The diagnostic accuracy was 100% for the absence of perforation in each group. Conclusions: CBCT can detect the absence of perforation with high accuracy. The diagnostic accuracy of CBCT in the presence of strip and furcal perforation with different sizes was not significant. [ABSTRACT FROM AUTHOR]

Abstract Background The biocompatibility of NeoMTA Plus® (Avlon BioMed Inc., Bradenton, Fl) as a furcal perforation repair material is not fully understood. This study compares the biocompatibility of Mineral Trioxide Aggregate (MTA Angelus) and NeoMTA Plus® as delayed furcation perforation repair materials. Methods Pulpotomy and root canal obturation were performed in 72 premolars in six mongrel dogs and then a standardized furcal perforation was performed. The coronal access was left open for three weeks. After curetting, cleaning and drying of the perforations, these teeth were divided into three equal groups (N = 24 teeth/ 2 dogs each) according to the material used for perforation repair; group I: NeoMTA Plus®, group II: MTA Angelus and group III: no material (positive control). The coronal access cavities were sealed with a filling material. The inflammatory cell count and qualitative pathology (presence of calcific bridge, configuration of fibrous tissue formed, examination of tissue surrounding the furcation area, histology of intraradicular bone and the inflammatory nature of tissues) were carried out after one week (subgroup A, N = 8 teeth), one month (subgroup B, N = 8 teeth) and three months (subgroup C, N = 8 teeth). The inflammatory cell count was expressed as mean ± SD and statistically analyzed. P-value 0.05). In contrast to group II, there was no significant differences in inflammatory cell count between the subgroups in groups I and III (P > 0.05). NeoMTA Plus® exhibited better qualitative pathological features than MTA Angelus after one week and nearly similar features after one month and three months of repair. Conclusion NeoMTA Plus® has a better early biocompatibility than MTA Angelus after one week of delayed furcation perforation repair and a similar late biocompatibility after one month and three months.

This study aimed at evaluating volumetrically gaps and voids of calcium-silicate based materials of different generations and handling properties (BC—Endosequence BC RRM-Fast Set Condensable Putty, MTA—ProRoot MTA, and BIO—Biodentine) in simulated furcal perforations in an ex vivo setup by microcomputed tomography (Micro-CT) analysis. Thirty-six extracted human mandibular molars with sound furcation areas were selected. Standardized perforations were created in the furcation area of the pulp chamber using #4 diamond burs. The specimens were randomly assigned to three groups (BC, MTA and BIO; n = 12). Samples were then scanned (SkyScan 1172; Bruker-microCT, Kontich, Belgium), and three-dimensional (3D) images reconstructed. The relative volume of gaps (VG%) and voids (VV%) present on each material was calculated. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey's HSD test (p < 0.05). Mean VG% for BC, MTA, and BIO groups were, respectively, 0.513%, 1.128%, 1.460%, with BC presenting statistically (p < 0.05) fewer gaps formation than the other groups. Mean VV% were, respectively, 0.018%, 0.037%, and 0.065%. The was no statistical difference regarding VV%. There were no gap-free and void-free samples. BC group had the lowest VG% among the groups with a significant statistical difference (p < 0.05). [ABSTRACT FROM AUTHOR]

Background: There is no consensus on which furcal perforation repair material induces a more favourable histological response. This systematic review of laboratory studies provides an overview of the studies comparing repair materials in animal models. Objectives: To evaluate whether mineral trioxide aggregate (MTA) yields a more favourable histological response than other materials when used to repair furcal perforations in animal experimental models. Methods: This review followed the PRISMA checklist. The studies included various materials used to repair furcal perforations and compared the histological responses with MTA. An electronic search was conducted in EMBASE, PubMed, Scopus and Web of Science up to 2 September 2020, with no language or publication date restrictions. Studies whose full text was unavailable were excluded. The ARRIVE and SYRCLE tools were used to assess the methodological quality and risk of bias (RoB) of the studies. Results: The studies included in the qualitative synthesis were conducted in rat (n = 3) and dog (n = 17) models. They were classified as having a low quality, high methodological heterogeneity and high RoB. MTA and Biodentine, the materials most often compared, reduced the inflammatory reaction to mild over time. In addition, a mineralized tissue was formed in all studies. The response yielded by MTA was better than or equivalent to that of the other tested materials. Discussion: This review confirmed that MTA is the reference standard material for furcal perforation repair. However, research using animal models has inherent limitations, and the substantial methodological heterogeneity across the studies included should be considered. Therefore, the knowledge generated by this systematic review should be translated into clinical practice cautiously. Conclusions: Features described in the report and quality assessment guidelines, such as PRIASE, ARRIVE and SYRCLE, should guide researchers. Despite the high RoB and the low methodological quality of the studies included, findings indicated that MTA yields a more favourable histological response than other materials in the repair of furcal perforations. Registration: PROSPERO (CRD42020181297). [ABSTRACT FROM AUTHOR]

Abstract Background This study evaluated the marginal adaptation, solubility and biocompatibility of TheraCal LC compared with mineral trioxide aggregate (MTA-Angelus) and Biodentine when used as a furcation perforation repair material. Methods The marginal adaptation was assessed by scanning electronic microscope and presence of any gap between the dentin surface and filling material in each quadrant of the sample was analyzed at 1000 X magnification. The solubility was measured after one week by the ISO standard method. Biocompatibility was evaluated by the inflammatory response and radiography after one month and three months of repair of experimental furcation perforations in dog's teeth. Results There were significant differences in the marginal adaptation, solubility and biocompatibility of the tested materials (P

Perforations, which are artificial contact connections among teeth and supporting tissues, have a substantial impact on the success of root canal therapy, whether caused by iatrogenic or pathological causes. This case report describes a 51-year-old female who had intermittent jaw pain that was diagnosed as perforation and was successfully controlled with endodontic intervention following a referral due to procedural problems. The perforation in the furcation zone of a molar was treated with biodentine, demonstrating its sealing, biocompatibility, and tissue restoration properties. The discussion emphasizes the necessity of choosing the right repair materials and techniques based on perforation size and location. Biodentine emerges as a viable option due to its capacity to form a dependable seal in demanding settings.  The study concluded by emphasizing the need for physician competence, tooth morphology understanding, and operative proficiency in preventing and properly treating perforations for the best treatment outcomes., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Suryawanshi et al.)

Objective: The aim of this study was to compare the sealing ability of pozzolan-based mineral trioxide aggregate (MTA) (Endocem) cement and pozzolan-based MTA (Endoseal) when used to repair the furcal perforations in permanent molars using the stereomicroscope. Materials and Methods: The study sample comprised forty-three recently extracted permanent molars. These teeth were placed in a 5.25% sodium hypochlorite solution for 24 h and washed with tap water. Access cavities were made using a #5 round bur in high-speed handpiece. Perforations were made in the center of the floor of the pulpal chamber using a round bur. The teeth were randomly assigned into three experimental groups based on the material used to seal the perforation: Group 1 – control group, Group 2 – Endocem MTA group, and Group 3 – Endoseal MTA group. The packed materials were allowed to set for 24 h. The samples were sectioned longitudinally, and the extent of marginal adaptation was measured by stereomicroscope. Kruskal–Wallis test was used for statistical analysis using SPSS software. Results: The difference in the mean length of dye penetration between groups was statistically significant. The pair-wise comparison was done between the three groups using Mann–Whitney U-tests as post hoc analysis, which reveals the difference between Group 1 and Group 2 was statistically significant P < 0.04 and also between Group 2 and Group 3 P < 0.001. However, the mean difference between Group 1 and Group 3 was non significant P < 0.31. Conclusion: Endoseal MTA showed more microleakage than Endocem MTA. Therefore, within the limitations of this study, we suggest that Endocem has the potential to be used as a perforation repair material rather than Endoseal MTA.

Background: The biocompatibility of NeoMTA Plus® (Avlon BioMed Inc., Bradenton, Fl) as a furcal perforation repair material is not fully understood. This study compares the biocompatibility of Mineral Trioxide Aggregate (MTA Angelus) and NeoMTA Plus® as delayed furcation perforation repair materials. Methods: Pulpotomy and root canal obturation were performed in 72 premolars in six mongrel dogs and then a standardized furcal perforation was performed. The coronal access was left open for three weeks. After curetting, cleaning and drying of the perforations, these teeth were divided into three equal groups (N = 24 teeth/ 2 dogs each) according to the material used for perforation repair; group I: NeoMTA Plus®, group II: MTA Angelus and group III: no material (positive control). The coronal access cavities were sealed with a filling material. The inflammatory cell count and qualitative pathology (presence of calcific bridge, configuration of fibrous tissue formed, examination of tissue surrounding the furcation area, histology of intraradicular bone and the inflammatory nature of tissues) were carried out after one week (subgroup A, N = 8 teeth), one month (subgroup B, N = 8 teeth) and three months (subgroup C, N = 8 teeth). The inflammatory cell count was expressed as mean ± SD and statistically analyzed. P-value < 0.05 was considered significant. Results: In all subgroups, the control group exhibited the highest number of inflammatory cell count, followed by MTA Angelus group and the least inflammatory cell count was shown by NeoMTA Plus® group. There was a significant difference in the inflammatory cell count between the NeoMTA Plus® and MTA Angelus after one week (P < 0.05) while no significant differences were recorded between them after one month and three months (P > 0.05). In contrast to group II, there was no significant differences in inflammatory cell count between the subgroups in groups I and III (P > 0.05). NeoMTA Plus® exhibited better qualitative pathological features than MTA Angelus after one week and nearly similar features after one month and three months of repair. Conclusion: NeoMTA Plus® has a better early biocompatibility than MTA Angelus after one week of delayed furcation perforation repair and a similar late biocompatibility after one month and three months. [ABSTRACT FROM AUTHOR]

This study aimed at evaluating volumetrically gaps and voids of calcium-silicate based materials of different generations and handling properties (BC—Endosequence BC RRM-Fast Set Condensable Putty, MTA—ProRoot MTA, and BIO—Biodentine) in simulated furcal perforations in an ex vivo setup by microcomputed tomography (Micro-CT) analysis. Thirty-six extracted human mandibular molars with sound furcation areas were selected. Standardized perforations were created in the furcation area of the pulp chamber using #4 diamond burs. The specimens were randomly assigned to three groups (BC, MTA and BIO; n = 12). Samples were then scanned (SkyScan 1172; Bruker-microCT, Kontich, Belgium), and three-dimensional (3D) images reconstructed. The relative volume of gaps (VG%) and voids (VV%) present on each material was calculated. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey’s HSD test (p < 0.05). Mean VG% for BC, MTA, and BIO groups were, respectively, 0.513%, 1.128%, 1.460%, with BC presenting statistically (p < 0.05) fewer gaps formation than the other groups. Mean VV% were, respectively, 0.018%, 0.037%, and 0.065%. The was no statistical difference regarding VV%. There were no gap-free and void-free samples. BC group had the lowest VG% among the groups with a significant statistical difference (p < 0.05).

The purpose of treating a furcal perforation is to seal the artificial communication between the endodontic space and the periradicular tissue to prevent alveolar bone resorption and damage to the periodontal ligament. These complications are not infrequent in cases of large furcal and/or old perforations, which have a worse prognosis than recent, small, coronal and apical perforations. Mineral trioxide aggregate (MTA) is widely used to seal perforations, because of its biocompatibility and sealability. This case report describes the management of a large furcal perforation in a mandibular first molar. Although most of the pulpal floor was destroyed and the roots were damaged, an attempt was made to repair the defect and restore the tooth. The perforation was cleaned with saline solution and ultrasonic tips. Finally, the perforation was sealed with MTA and the tooth restored coronally. A 21-month recall showed no evidence of periodontal breakdown, no symptoms, and complete healing of the surrounding periodontal tissue. [ABSTRACT FROM AUTHOR]

A perforation in the furcation area is a potential risk factor for extension of pulpal inflammation into the periodontium and formation of advanced furcation defect with severe loss of clinical attachment and interradicular bone. Furthermore, the management of such furcal perforation is difficult due to poor accessibility, visibility, and regenerative potential. The development of such advanced furcation defects further compromises the prognosis of the treatment as they preclude effective plaque control and maintenance by the patient. Therefore, the management of advanced furcation defects remains an enigmatic and challenging task for the clinician. This case report describes a minimally invasive approach for the treatment of a furcal perforation by a conservative tunnel preparation. The present case report aims to highlight the importance of surgical tunnel preparation as an alternative to conventional flap procedure to repair furcal perforation with advanced furcation defects.

Aim: An endodontic perforation is a pathologic or iatrogenic communication between the root canal space and the attachment apparatus. The repair of perforation defects has been achieved using different materials. Hence this is an in vitro study aimed at analysing the sealing ability of MTA angelus and biodentine in repairing furcal perforations of primary molars. Material and methods: Sixty extracted primary molars were used in this study. All the teeth were extracted due to either caries, periodontal problems, or preventive orthodontic treatments and had no treatment done on it. Only primary molars were included that had intact furcation with two third the root length. Teeth with internal or external pathologic root resorption and physiologic root resorption more than two-third of root length, cracked teeth and teeth with the extensive decay of crown were excluded from the study. They were divided into 4 groups namely group 1: perforation sealed with MTA Angelus, group 2: perforation sealed with biodentine, group 3: positive control, group 4: negative control. Dye extraction method was done to analyse the sealing ability of MTA Angelus and biodentine. Statistical analysis was done using ANOVA to compare the means between different groups. Results: The highest dye absorbance with a mean value of 0.130 was seen in the positive control group. The mean value of MTA Angelus was 0.057 and Biodentine was 0.032. The lowest dye absorbance was seen in negative control with a mean value of 0.003. Statistical analysis was done using ANOVA and the values were statistically significant. Conclusion: Within the limitations of this study, we can conclude that dye leakage of MTA angelus was more when compared to biodentine and this result was statistically significant. [ABSTRACT FROM AUTHOR]

Furcal perforation is one of the most common undesired complications during dental treatment. It requires immediate seal to ensure the prognosis of the involved tooth. The aim of this study is to compare the sealing ability of injectable dental composites, namely G-aenial Universal Flo (GAUF) and Paracore with Biodentine and Mineral Trioxide Aggregate (MTA) as furcal perforation materials. This study was conducted on 68 extracted teeth. Upon decoronation of the tooth 4mm above cementoenamel junction, endodontic access cavity was done followed by the creation of furcal perforation in the pulp chamber floor. The teeth were assigned randomly into four experimental and two control groups. These perforations were then repaired with the intended materials. The teeth were submerged in 2% basic fuchsin for 24 hours then sectioned and evaluated for dye leakage. The data were analysed using Median's Test and Mann Whitney U Test. One specimen for each test group were inspected under scanning electron microscope (SEM). The results showed that the percentage of dye penetrations were significantly lower in Paracore and GAUF compared to Biodentine and MTA groups (p<0.001). Paracore demonstrated less gap at material tooth interface under SEM. Both Paracore and GAUF sealed furcal perforation better than Biodentine and MTA. [ABSTRACT FROM AUTHOR]

Aim: To compare the effect of furcal perforations of various sizes on the biomechanical response of mandibular first molars with or without periodontal bone loss at the furcal region via three‐dimensional (3D) finite element analysis (FEA). Methodology: The 3D geometric basic model was reconstructed from the micro‐computed tomographic images of an extracted mandibular first molar. Five different models were constructed from this molar in group 1 as follows: intact molar model, root filled (RCF) model and three models with furcal perforations (1, 2 and 3 mm in diameter) repaired with a calcium silicate‐based cement (CSC). In group 2, a lesion simulating bone resorption at the furcal region was modelled on the models in group 1. A force of 200 N was applied to simulate normal occlusal loads. Static linear FEA was performed using the Abaqus software (Abaqus 6.14; ABAQUS Inc., Providence, RI, USA). The maximum principal stresses (Pmax) and maximum displacement magnitude were evaluated. Results: The range of Pmax values of the models in group 1, from high to low, was as follows: RCF + 3 mm perforation > RCF + 2 mm perforation > RCF + 1 mm perforation > RCF > intact model, and the range of Pmax values of the models in group 2 was as follows: RCF + 3 mm perforation + furcal lesion > RCF + 2 mm perforation + furcal lesion > RCF + 1 mm perforation + furcal lesion > RCF + furcal lesion > intact model + furcal lesion. All of the models in group 2 exhibited lower Pmax values and higher maximum displacement magnitude than their counterparts without lesions in group 1. Conclusions: The size of the furcal perforation affected the accumulation and distribution of stress within the models. Mandibular molar teeth with large furcal perforations treated with a calcium silicate‐based cement may be associated with an increased risk of fracture whether or not accompanied by bone resorption. [ABSTRACT FROM AUTHOR]

A 28 year old male patient came to the outpatient Department complain-ing of discomfort on his lower right first molar tooth during mastication for one month. The patient also stated that he had received dental treatment on the lower right side three months back. Clinically, the tooth appeared sound but there was poor coronal filling of the affected tooth and the pocket depth was within normal range (Figure 1A,B). When the pulp vitality test was performed, it responded negatively. However, percussion pain was present. It seems that due to iatrogenic mishaps, chronic periodontitis could be developed in this case.

BACKGROUND AND AIM: One of the most common reasons for the failure of endodontic treatment is root perforation. Perforations might occur due to carious lesions, tooth resorption or they might be iatrogenic during endodontic treatment or in most cases they might occur during post space preparation. CASE REPORT: A 31-year-old female patient presented with a complaint of chronic pain on tooth #30 during last 6 months and sensitive to bite since a few days ago. There was a mild swelling on the gingival tissue in the furcation area in the intraoral examination, with a narrow strip-shaped pocket measuring 3 mm in depth. Radiographic examination revealed an incomplete root canal treatment of the tooth. A prefabricated post had been placed in the distal root, with an incorrect path toward the furcation area. There was a small radiolucency in the furcation area and a pronounced radiolucency around the mesial root of the tooth. After removal of the post, hemorrhage was observed in the furcation area. The diameter of the perforation was approximately 1 mm. The perforated area was sealed with Pro Root mineral trioxide aggregate (MTA). In the next session when setting of MTA was evaluated and confirmed, retreatment of the tooth was done. After 6 months, no swelling or sensitivity was observed and after 6 year follow-ups radiographic examination revealed that the lesion had almost resolved. CONCLUSION: In the present case, the lesion of furcation perforation was small in size, but the time interval between the occurrence of perforation and the repair procedure was long, success was achieved due to the control of the aseptic conditions, control of hemorrhage and proper placement of the repair material, which was confirmed in the 6 year follow-ups.

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A perforation in the furcation area is a potential risk factor for extension of pulpal inflammation into the periodontium and formation of advanced furcation defect with severe loss of clinical attachment and interradicular bone. Furthermore, the management of such furcal perforation is difficult due to poor accessibility, visibility, and regenerative potential. The development of such advanced furcation defects further compromises the prognosis of the treatment as they preclude effective plaque control and maintenance by the patient. Therefore, the management of advanced furcation defects remains an enigmatic and challenging task for the clinician. This case report describes a minimally invasive approach for the treatment of a furcal perforation by a conservative tunnel preparation. The present case report aims to highlight the importance of surgical tunnel preparation as an alternative to conventional flap procedure to repair furcal perforation with advanced furcation defects. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to assess the clinical and radiological outcome following repair of furcal perforation by mineral trioxide aggregate (MTA) and intermediate restorative material (IRM) in mandibular molar teeth. Forty teeth having furcal perforation were enrolled in this study, out of which 20 teeth were treated with MTA and the remaining 20 teeth were subjected to IRM treatment. Following perforation repair, all teeth were subjected to root canal treatment followed by final restoration. Clinical and radiological outcome was evaluated at 3, 6 and 12 months interval. The results showed that in both MTA and IRM groups, pain, tenderness on percussion as well as swelling and sinus was gradually decreased with the increase of the observation period. Furthermore, the widening of the periodontal ligament space and communi-cation with the oral cavity were gradually decreased. Although there was no significant differences between MTA and IRM at 3 and 6 months observation period but at 12 months, the clinical outcome between MTA and IRM was statistically significant (p

Furcal perforation is usually undesirable and unfortunate incident commonly encountered during an endodontic access cavity or exploration of orifices of canal/s. A randomized control trial was conducted on 90 patients with furcal perforation. The objective was to compare effectiveness of Mineral Trioxide Aggregate (MTA) with Calcium Hydroxide in furcal repair in lower molars. radiographic assessment was done at 3 and 6months interval.the collected data was analyzed using SPSS version 14. 90 patients with furcal perforation divided into group A and group B with 45 patients in each group. Group A was treated with MTA and Group B with Calcium Hydroxide respectively. After 3 &6 months, a radiographic effectiveness was considered with the resolution of peri-radicular lesion. In group A, 43 patients showed complete recovery (success rate 95.6%). In Group B, 21 patients showed complete recovery(success rate 46.6%). It was concluded, MTA was better material for repair of furcal perforation than Calcium hydroxide. [ABSTRACT FROM AUTHOR]

The case report sheds light upon a non-surgical repair of a furcation defect. A 57-year old female reported for examination of tooth no. 46. The presenting complains included mild to moderate pain with small localized swelling and discharge from lingual aspect of tooth. Clinical examination revealed a discharging sinus with moderate inflammation at gingival margin on lingual aspect, with negative percussion. A diagnosis of chronic peri-radicular abscess of the tooth was made and the defect was repaired by using Mineral Trioxide Aggregate (MTA). The clinical sign and symptoms resolved after treatment within a week period. [ABSTRACT FROM AUTHOR]

Furcal perforations are significant iatrogenic complications of endodontic treatment and could lead to endodontic failure. Mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair, retrograde filling, pulp capping, and apexification. This case report describes a furcal perforation in a maxillary first molar, which was repaired using MTA. The tooth was endodontically treated and coronally restored with resin composite. After 2 years, the absence of periradicular radiolucent lesions, pain, and swelling along with functional tooth stability indicated a successful outcome of sealing the perforation using MTA.

Mineral Trioxide Aggregate (MTA) was introduced into dentistry as a root-end filling material. Several researches and investigations were done on its properties and uses. In this review, the composition, properties and indications of MTA are mentioned, along with the techniques for its use in various clinical situations like pulp capping, internal and external root resorptions, lateral and strip perforations, furcal perforation, apexification, root-end filling and root-canal filling. A case report of repairing furcal perforation using MTA is also documented.

Introduction The purpose of this study was to assess cone-beam computed tomographic (CBCT) imaging with different voxel sizes and an intraoral sensor in the detection of furcation perforations. Methods In 40 teeth, furcation perforations were created, and 40 intact teeth served as the control. Five image sets were obtained: (1) CBCT, 0.1 mm 3 voxel size; (2) CBCT, 0.15 mm 3 voxel size; (3) CBCT, 0.2 mm 3 voxel size; (4) CBCT, 0.4 mm 3 voxel size; and (5) digital periapical images. Images were evaluated twice by 3 observers. Perforation widths were measured by CBCT software. Receiver operating characteristic analysis was used to assess the observers' ability to detect perforation, and area under the curve values were compared by using t tests, with a significance level of α = 0.05. Results No differences ( P > .05) were found between any of the median area under the curve and true positive rate values obtained with different CBCT voxel sizes. Actual perforation width correlated highly with CBCT width measurements. Conclusions Low-resolution CBCT imaging can be preferred for furcation perforation diagnosis because of its low dose and reliable diagnostic outcome. [ABSTRACT FROM AUTHOR]

The article investigates the furcal perforation of primary molar teeth which is repaired using the pro-root mineral trioxide aggregate (MTA) and new endodontic cement (NEC). Two layers of resin composite were used to seal the orifes and the root apices of the extracted primary molars. The teeth were covered with a nail polish. Both pro-root MTA and NEC were found to have the same capability in sealing the furcal perforations of the primary molars.

Aim: The aim of the current in vitro research was to evaluate the sealing capacity of three different agents employed for the repair of perforations at the furcation area., Materials and Methods: Recently 60 extracted human mandibular permanent molars having well apart plus fully formed roots, and intact furcation were chosen. The 60 samples were allocated at random to three groups of 20 samples: Group I: Furcation perforation repair by means of mineral trioxide aggregate (MTA)-Angelus, Group II: Furcal perforation repair using Biodentine, Group III: Furcal perforation repair by EndoSequence. The specimens were subjected to sectioning with a hard tissue microtome and the sectioned parts of the samples were then examined. The specimens were subjected to gold sputtering and visualizing beneath scanning electron microscope (SEM) at 2000× magnification for assessing the sealing capacity of the agents., Results: The highest sealing capacity was noted with the use of Biodentine at 0.96 ± 0.10, in pursuit by EndoSequence use at 1.18 ± 0.14 and MTA-Angelus use at 1.74 ± 0.08. The disparity amid the three groups was statistically significant with p < 0.001., Conclusion: In conclusion, it may be inferred that Biodentine exhibited the finest sealing capacity than EndoSequence and MTA- Angelus. It may thus be given consideration as a substance of preference for the repair of furcal perforation., Clinical Significance: Using biologically compatible substances may be suggested to amend perforations thereby decreasing the occurrence of inflammatory response in the neighboring tissues. The sealing capacity is a significant feature in supporting the result of a root canal treatment of a tooth.

Introduction: Iatrogenic furcal perforation is a procedural accident in endodontic treatments of primary/permanent teeth; prognosis may be favorable if a complete seal with biomaterial is immediately stablished. The purpose of this in vitro study was to evaluate microleakage of calcium enriched mixture (CEM) cement and ProRoot mineral trioxide aggregate (MTA) for sealing primary molar furcal perforations. Materials and Methods: This study was conducted on 38 extracted human primary molars. Furcation perforations were created in the pulp chamber floor. The teeth were divided randomly in two experimental groups (n=17) and two positive and negative controls (n=2). Perforations were then repaired with biomaterials. After 72 h, the teeth were submerged in 2% fuchsin dye solution for 24h. The samples were sectioned longitudinally and evaluated for dye leakage. Data analyzed statistically using ANOVA test. Results: The negative and positive controls behaved as expected. Dye microleakage was observed in all experimental samples; however, there was no statistically significant difference between the microleakage of MTA (4.411±2.042 mm) and CEM (3.647±1.040 mm) groups (P>0.05). Conclusion: Based on the findings of this in vitro study, CEM and tooth-colored ProRoot MTA have similar sealing ability for furcal perforation repair of primary molar teeth. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aim of the present study was to compare the effect of blood contamination on retention characteristics of white mineral trioxide aggregate (WMTA) and calcium-enriched mixture (CEM) in reconstructions of the furcation area. Methods: Furcal perforations, measuring 1.3 mm in diameter and 2 mm in height, were produced in 180 human mandibular first molars. The teeth were divided into 12 groups of 15. WMTA and CEM were used in groups 1–6 and 7–12, respectively, for perforation repair. In groups 1, 3, 5, 7, 9, and 11 the walls of the perforated area were contaminated with blood; normal saline was injected in the remaining groups. Push-out test was carried out in groups 1, 2, 7, and 8 after 24 hours, in groups 3, 4, 9, and 10 after 72 hours, and in the remaining groups 7 days after placement of the materials by using a Universal test machine. To evaluate the failure modes, the samples were sectioned at furcation floor area, divided in two in the vertical direction, and evaluated under a stereomicroscope at ×40 magnification. Data were analyzed with multivariate analysis of variance and post hoc Tukey tests. Results: The highest (6.75 MPa) and lowest (1.77 MPa) bond strength values were recorded in groups CEM/no blood contamination at 7 days and MTA/blood contamination at 24 hours, respectively. There were no statistically significant differences in bond strength between MTA and CEM (P < .05). However, there were significant differences in bond strength between blood-contaminated and uncontaminated groups in both materials (P < .05); time had exerted a significant effect on the bond strength of the study groups (P < .05). Failure patterns were of the mixed type in all the samples. Conclusions: Resistance of both WMTA and CEM to displacement was similar, and elapse of time from 24 hours to 7 days and contamination resulted in an increase and decrease in bond strength of these 2 materials to dentin, respectively. [Copyright &y& Elsevier]

Furcal perforations are significant iatrogenic complications of endodontic treatment and could lead to endodontic failure. Mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair, retrograde filling, pulp capping, and apexification. This case report describes a furcal perforation in a maxillary first molar, which was repaired using MTA. The tooth was endodontically treated and coronally restored with resin composite. After 2 years, the absence of periradicular radiolucent lesions, pain, and swelling along with functional tooth stability indicated a successful outcome of sealing the perforation using MTA. [ABSTRACT FROM AUTHOR]

Like other complex disciplines of dentistry, an endodontist may encounter unwanted, unforeseen situations during root canal therapy that can affect the prognosis. These mishaps are collectively termed procedural accidents. However, fear of these procedural accidents should not deter a practitioner from performing endodontic therapy. Instead a proper case selection and adherence to the basic principles of access preparation, cleaning, shaping, obturation and post preparation can minimise such chances. Moreover, a clinician can overcome these procedural accidents with the advent of better restorative materials and magnification. Here, a case of retreatment of furcation perforation repair with MTA under magnification has been described. [ABSTRACT FROM AUTHOR]

Anatomic variations can significantly contribute to the incidence of endodontic mishaps. Perforations and separated instruments form the bulk of such mishaps. Furcal perforations are undesired complications of endodontic treatment, which result in the loss of integrity of the root and further destruction of the adjacent periodontal tissues. Mineral trioxide aggregate (MTA) is a promising material that has been successfully used to repair perforations. This clinical case demonstrates the use of MTA as a repair material for furcal perforation due to an iatrogenic error in radix entomolaris in the mandibular first molar. It also describes the application of ultrasonic technique in the retrieval of separated instrument from the same. Both clinical and radiographic follow-up showed a stable condition without any probing defect, ongoing root resorption, or furcal pathosis. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of treating furcal perforation is to seal the artificial communication between the endodontic space and the periradicular tissue to prevent alveolar bone resorption and damage to the periodontal ligament. These complications are not infrequent in cases of furcal and/or old perforations, which show a worse prognosis than fresh, small, coronal, and apical perforations. Mineral trioxide aggregate (MTA) is widely used to seal perforations because of its biocompatibility and sealability. Ten cases of furcal perforation were selected at the department of Endodontics, University of Florence. All the perforations were cleaned with NaOCl, EDTA, and ultrasonic tips and sealed with MTA without internal matrix. Finally, the teeth were endodontically treated and coronally restored. Clinical and radiographic follow-ups were done at 6 months, 1 year, 2 years, and 5 years. After 5 years, the absence of periradicular radiolucent lesions, pain. and swelling along with functional tooth stability indicated a successful outcome of sealing perforations in 9 out of 10 teeth. One patient dropped out of the study after the 1-year follow-up and could not be contacted for further recalls. The results confirm that MTA without matrix provides an effective seal of root perforations and clinical healing of the surrounding periodontal tissue. [Copyright &y& Elsevier]

Furcal perforations may occur during access opening of the pulp chamber or cavity preparation. The perforation can cause an inflammatory reaction in the periodontal ligament. Management of these iatrogenic accidents can pose a significant clinical challenge, mainly when they occur in primary teeth. Current developments in the techniques and materials utilized for root perforation repair have enhanced this procedure's prognosis. Recently, mineral trioxide aggregate (MTA) has been used for several dental purposes. This biocompatible material promotes bone healing and elimination of clinical symptoms. The purpose of this case report was to describe the treatment of a furcal perforation using mineral trioxide aggregate (MTA) in a primary molar tooth. After 20 months, the tooth was asymptomatic. The radiolucent image had disappeared and bone formation at the furcation area had been observed, suggesting healing of the underlying periodontal tissues. Therefore, MTA may be considered an alternative option for the repair of furcal perforation in primary teeth, prolonging the longevity of these dental elements. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the pushout bond strength of three calcium silicate-based materials used as furcal perforation repair materials and the effect of root canal irrigants on the pushout strength of the tested repair materials., Materials and Methods: Furcal perforations measuring 1.3 mm in diameter were made in the center of the furcation area of 90 extracted human mandibular molars. The teeth were then randomly divided into three groups ( n = 30) according to the repair material: Biodentine (Septodont, St-Maur-des-Fossés, France), PD-MTA White (Produits Dentaires, Vevey, Switzerland), and K-Biocer (REKITA, Lebanon). The specimens were stored at 100% humidity at 37°C for 72 hours. They were later divided into three subgroups ( n = 10) based on the irrigation protocol: 2.5% sodium hypochlorite, BioAKT (Metabolic substrate, New Tech Solutions s.r.l., Brescia, Italy), and a control group. After incubation for 48 hours, the dislodgement resistance of the samples was measured using a universal testing machine., Results: The mean bond strength was significantly different between repair materials in the irrigation control group ( p -value <0.001). With PD-MTA White and K-Biocer, the mean bond strength was not significantly different between irrigation groups ( p -value = 0.681). The mean bond strength of Biodentine was significantly different between irrigation groups ( p- value = 0.002); it was the highest with BioAKT., Conclusion: Biodentine showed a high performance as a perforation repair material and its resistance to dislocation increased after being exposed to BioAKT. K-Biocer had the lowest pushout bond strength. PD-MTA White showed intermediate bond strength and was not affected by the tested irrigants., Clinical Significance: The bond strength of endodontic materials to root dentin is an important factor to consider for long-term clinical success since the teeth are constantly subjected to masticatory forces.

Iatrogenic procedural accidents occurring during the root canal procedure may lead to failure of the root canal treatment and removal of the teeth. Advances in dentistry as well as increased desire of patients to maintain their dentition have led to the treatment of teeth that once would have been removed. Hemisection maneuver has given the dentist the choice to preserve the maximum toot structure with good retention in future. This case report describes the preservation of mandibular molar through hemisection after iatrogenic furcal perforation and ledge formation. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of furcal perforation treated with iRoot BP. Methods Forty newly extracted human maxillary and mandibular molars were collected. Holes in diameter of 2 mm were prepared at the roof of the central pulp cavity of 36 samples with high speed round ball diamond in order to make perforated model, and then equally and randomly divided them into two groups. The other intact four samples were used as the negative controls. In the experimental groups, group A were repaired by iRoot BP, group B were repaired by mineral trioxide aggregate (MTA). Three samples in each group were observed under scanning electron microscope (SEM), and micro- leakage of others was tested by measuring the concentration of leaked glucose with the enzymatic glucose oxidaseperoxidase (GOD-POD) method. Results Microleakage of group B was higher than group A and had statistical difference (P<0.05). The dentin and iRoot BP contacted more closely in group A, some gaps existed between the dentin and MTA in group B. Conclusion For repairing furcal perforation, the effect of iRoot BP is better than that of MTA. [ABSTRACT FROM AUTHOR]

Brief Background: Furcal perforations result in the loss of integrity of the root leading to destruction of the adjacent periodontal tissues. Mineral trioxide aggregate (MTA) is a material used to repair perforations. Materials and Methods: This clinical case demonstrates the management of compromised mandibular first molar by sealing furcal perforation and distolingual perforation with MTA. Discussion: Immediate sealing of the perforation is discussed which could significantly improve the outcome of conservative treatment. Summary and Conclusions: Prognosis of the accidental root perforation depends upon its proper management. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to comparatively evaluate the effect of Chloroquick irrigating solution on push-out bond strength of Endoseal mineral trioxide aggregate (MTA) and endosequence root repair material (ERRM) when used as furcal perforation repair materials., Materials and Methods: Forty human extracted mandibular molars were collected. A standardized endodontic access cavity was prepared in 40 samples, and intentional perforation of 1.32 mm in diameter was created on the pulpal floor. Teeth were randomly divided into four groups: Group A: EndoSeal MTA with irrigation, Group B: ERRM with irrigation, Group C: EndoSeal MTA without irrigation (Control group), and Group D: ERRM without irrigation (Control group). The samples were subjected to universal testing machine then examined under a stereomicroscope at × 40 to determine the nature of the bond failures., Results: EndoSeal MTA with Chloroquick irrigating solution irrigation showed the highest push-out bond strength (MPa) with a statistically significant difference among all the groups ( P = 0.003). The majority of the samples exhibited cohesive and mixed types of failures., Conclusion: Chloroquick irrigating solution irrigation has no adverse effect on the push-out dentin bond strength of Endoseal MTA and ERRM., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Conservative Dentistry.)

Perforations are common complications of root canal therapy. In clinic, perforations that were improperly and untimely repaired can seriously affect the prognosis of teeth after root canal treatment. At present, the status of perforation repair in our country is worrisome. This paper focused on the progress of perforation repair in the country by discussing the current situation of repair methods and materials. This review aims to improve knowledge and aid clinical doctors in the sophistication of perforation repair in order to improve the retention rate of root-canal-treated teeth.

Aim: The aim of this study was to compare the sealing ability of mineral trioxide aggregate (MTA), Portland cement (PC), Biodentine(TM) and Tech biosealer in repairing furcal perforations in primary molars using the fluid-filtration technique., Materials and Methods: Fifty freshly extracted maxillary second primary molars were sectioned horizontally at the furcation region to create dentin disks of 1.5 mm (+ 0.1 mm) thickness. Five disks were not perforated and served as negative controls. In the remaining 45 disks, furcation perforations were prepared. Five disks did not receive furcation repair and served as positive controls. The remaining 40 disks were then randomly divided into four equal groups (10 disks in each group). Perforations were repaired with: MTA, PC, Biodentine(TM) or Tech Biosealer. The sealing ability of the tested materials was evaluated by measuring microleakage for each disk after four different storage periods: 24-hour, 1-month, 6-month and 1-year storage using fluid-filtration. Comparisons between the four materials and the four time periods were done using the two-way analysis of variance and the Scheffe multiple comparisons test., Results: There was no significant difference between the mean microleakage values obtained in the four tested materials after 24 hours, 1, 6 month and 1 year. However, microleakage values for each individual material were significantly higher at 24 hours than at the other time intervals., Conclusion: Mineral trioxide aggregate, PC, Biodentine(TM) and Tech biosealer showed similar capabilities in sealing the furcal perforations of the primary molars, where the sealing ability improved over time for each individual material.

Statement of problem: Root perforation is a procedural error that can have a profound effect on treatment prognosis. Treatment prognosis is dependent on the prevention or the treatment of bacterial infection at the perforation site. Therefore, using a biocompatible material to completely seal the perforation is of paramount importance. Purpose: The purpose of this study was to evaluate and compare the ability of Pro Root MTA and Portland cement to seal furcal perforations in the extracted human molar using dye penetration. Materials and Method: In this experimental in vitro study, 70 human permanent mandibular molars with well developed, non-fused, minimum caries and without anomalies were used. Access openings and furcation perforations were prepared in the pulp chamber floor. Ten teeth were assigned as controls and divided into two groups of five teeth each as positive and negative control. The positive group was accessed and perforated similar to the experimental group while the negative controls were not prepared. The remained 60 teeth were divided into two groups of 30 teeth each. Group A1 was repaired with Pro Root MTA and group A2 was repaired with Portland cement. The teeth were submerged in Indian ink for 4 days. Finally, the samples were sectioned and evaluated for linear dye penetration at 6x magnification and then the data were statistically analyzed by Mann-Whitney test. Results: The result showed that the sealability of Pro Root MTA and Portland cement in furcation perforations was not statistically different ( p >0.05). Conclusion: In accordance with high expenses of Pro Root MTA and the same ability of Portland cement and Pro Root MTA in sealing of furcation perforation, the Portland cement could be a good alternative for Pro Root MTA for this purpose. [ABSTRACT FROM AUTHOR]

Statement of Problem: One of the most challenging procedural accidents during pulpotomy of primary molars is furcal perforation. To prevent bacterial invasion, the perforation site should be sealed as soon as possible., Purpose: The aim of the current study is to investigate the ability of the pro-root MTA and new endodontic cement (NEC) in repairing the furcation perforations of primary molar teeth., Materials and Method: In this in vitro study, 42 extracted primary molars were selected. Their roots were sectioned horizontally and standard access cavity was prepared. The orifices and the root apices were sealed with two layers of resin composite.The samples were randomly assigned into 2 groups. 6 teeth were considered as the positive and the negative controls. In the experimental groups; perforation was made. In group 1 and 2, perforation site received pro-root MTA and NEC respectively. The teeth were covered by two layers of nail polish except for the external surface of the perforation site. The negative control group received no repairing material. All teeth were mounted and sterilized for 24 hours. Lower chambers were filled with sterilized Muller Hinton broth. Bacterial suspension of Enterococcus faecalis in 0.5 McFarland was prepared. The repaired site was then exposed to the bacterial suspension of Enterococcus faecalis every 3 days. All samples were inserted in an incubator at 37(o)C and 100% humidity. The turbidity of the samples was detected for a period of 30 days. Data were analyzed by Chi- square test., Results: 44% of samples in Pro- root group, 50% of the samples in the NEC group showed contaminations during 30 days. There was no significant difference between these two groups (p= 0.799)., Conclusion: With limitations of this study, Pro- root MTA and NEC showed similar capability in sealing the furcal perforations of the primary molars.