While non-surgical endodontic treatment is the of choice for teeth where infection and inflammation is present inside the root canal, it’s not always the end of the treatment required to solve the problem.

Sometimes, perforation can occur within the root canal, creating pathologic communications between the root canal and surrounding tissues. This will almost always lead to further infection, inflammation and pain, and often, the most reliable solution is non-surgical perforation repair.

What Is a Perforation in the Root Canal Space?

Simply put, a perforation in the root canal space is a hole in the tooth wall that exposes the material inside the tooth to the periodontal and osseous tissues outside the tooth.
This hole could be formed by caries or resorptive defects, or they may be iatrogenic, occurring during the preparation of the root canal space during a root canal procedure.
Whatever the cause of the perforation, the wall of the tooth is pierced, and once that barrier is removed, bacteria will be introduced, and infection and pain will occur.

What Happens When A Perforation Has Occurred?

It’s not always possible to determine exactly what caused a perforation to occur, but the progression after it has will usually follow the same pattern.
Contact between the tissue outside the tooth and the root canal will lead to infection and inflammation. Pain may be accompanied by the formation of an abscess, and there may be swelling and discoloration of the tooth and surrounding structures.

The longer the perforation goes untreated, the greater the chance that the tooth may become unstable in the surrounding bone and gum, and the lesser the chance that it can be repaired and saved. A perforation should therefore be treated as an emergency once diagnosed, and treatment sought as soon as possible.

What Is Non-Surgical Perforation Repair

Non-surgical perforation repair is similar to root canal retreatment, in that it is an endodontic procedure, accessing the root canal space through the crown of the tooth. In the event that the perforation was related to a root canal procedure, the gutta percha that has already been placed will be removed. If the perforation is due to decay or resorption, the process will resemble a root canal too, with the removal of the pulp within the tooth.

In both cases, the removal of the material inside the root canal will be followed by the cleaning and filling of the area of the perforation. Once this area has been repaired, the root canal can be placed or retreated, and the tooth restored.

Factors Affecting the Success of Non-Surgical Perforation Repair

The most important factors affecting the success of non-surgical perforation repair and the prognosis of the tooth are where the perforation is in the tooth, and how large it is. The larger the perforation is, the harder it is to create a hermetic seal.

The level of the perforation also affects the success of the procedure, with apical positions being the most likely to result in favorable treatment outcomes. Fortunately, the location relative to the buccal, lingual, mesial and distal aspects of the roots is not usually critical to treatment success by non-surgical means.

The sooner we see patients with perforations, no matter where they occur or how they were formed, the more likely it is that we will be able to save the tooth by non-surgical perforation repair, so it’s critical that referring dentists contact us as soon as possible after becoming aware of the problem.

For more information on non-surgical perforation repair, or to schedule an appointment with Dr. Tom Shackleton, please contact us at 403-242-9952 today.