Root canal therapy: the treatment of perforation and how to prevent perforation

The three principles of perforation treatment are timely, aseptic and strict, that is, the perforation site should be repaired as soon as possible, the perforation site should be prevented from infection and the perforation repair should be dense. Perforation therapy 1. After finding paramedullary puncture, the main root canal should be searched again to complete root canal filling. Then cleaning, rinsing and stopping bleeding the perforated part, and finally filling with amalgam or zinc oxide clove oil cement powder. Second, the perforation of pulp chamber floor should be closed immediately before root filling, washed with normal saline, stopped bleeding and sucked dry, and then closed with zinc oxide clove oil cement powder. Small holes can also be directly filled with amalgam, while large holes can be filled with indium foil first and then with amalgam to prevent overfilling. When filling with amalgam, don't forget to insert the dilating needle or paper tip into the root canal to prevent amalgam from filling the root canal. For the old large perforation of pulp floor, when conservative treatment fails, half tooth removal, root cutting and half tooth separation can be used, and the affected tooth should be extracted in severe cases. 3. Perforation of lateral wall 1 and root canal crown 1/3: adjust the expansion direction, find the main root canal again, fill the main root canal by stages, and then close the pulp chamber bottom to seal the perforation. You can also fill the main root canal routinely, then take out gutta percha of root canal crown13, and then close the perforation. 2. Endodontic 1/3 perforation: If the perforation is located on buccal side or near middle or far middle, it can be repaired by surgery. The method is to cut the mucoperiosteum, chisel off some bones and find the root surface of the perforation. Insert the largest expanding needle into the main root canal, fill the perforation with silver tip or amalgam, and then do root canal treatment. Because of the inconvenience of operation, the perforation of lingual palatine side often needs to be removed. 3. Lateral penetration of root canal tip 1/3: If lateral penetration occurs near the root canal tip, hot gutta-percha filling method can be used during root canal filling, and the filling material can be pressed into the root canal and perforated part under pressure. Perforation can also be used as an auxiliary root canal, which can be cleaned, trimmed and filled like a root canal (Figure -A above). Sometimes, due to the bending of the apical part, the perforated part is on the line of the long axis of the root canal crown 1/3, and it is almost impossible to return to the main root canal in the apical area and fill it. At this time, the perforated part can be used as the main root canal. The main root canal in the original apical area can be regarded as root canal under-filling. If it is less than 2mm, it can be observed for a period of post-treatment. If it is greater than 2mm, apical resection should be performed (Figure -B above). In order to prevent perforation, X-ray dental films should be taken routinely before operation, and the films should be read carefully to understand the hole shape, pulp angle, the position and characteristics of pulp top and bottom, as well as the distance between the two surfaces, and pay attention to the bending, stenosis and calcification of root canals. The direction, depth and contour of pulp opening should be mastered according to the X-ray film. For teeth with incorrect position, more attention should be paid to the direction of pulp opening. Attention should be paid to distinguish the pulp angle from the root canal orifice to prevent grinding through the pulp floor or grinding off the anatomical form of the pulp floor. Pay attention to the contour design, and the holes made according to the good contour design can save a lot of trouble for the subsequent root canal preparation. For curved root canals, by opening the crown end of the root canal in the process of root canal preparation, the curvature can be reduced and the bending radius can be increased, so that straight or large instruments can easily enter the curved root canal tip. You can't skip the number when using the instrument. It is recommended to use flex-R and CM instruments with no cutting function at the tip. This article comes from the statement of Aikouqiang (ID:ikouqiang): The above content comes from the Internet, and the copyright belongs to the original author. If there is any infringement of your original copyright, please let us know and we will delete the relevant content as soon as possible.