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Artificial Floor Concept for

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Traumatic Perforations Usually occur due to inattentive access ... following an apparently adequate endodontic therapy may ... to the oral cavity. – PowerPoint PPT presentation

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Title: Artificial Floor Concept for


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Artificial Floor Concept for the Repair of
Furcation Perforation
Hatem A. Alhadaiy
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Background
Root Perforation
  • Artificial opening occurs in the pulp wall
    creating communication between the pulp and the
    exterior.

4
Traumatic Perforations
  • Traumatic (iatrogenic) perforations are due to
    lack of attention given to details of dental
    anatomy and failure to consider its variations by
    the clinician.

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Causes
  • Usually occur due to inattentive access opening.
  • Perforation of a pulp chamber floor may result if
    the bur is not properly angulated in relation to
    the long axis of the tooth.

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How to avoid traumatic perforations
  • A thorough knowledge of the internal anatomy and
    the possible anatomical variations of root canal
    system.
  • Proper case selection and treatment planning

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  • Obtaining adequate straight access to the root
    canal with total removal of the pulp chamber
    roof.
  • When a root-filling material is removed during
    post preparation, the canal should be
    periodically cleaned and examined to ensure that
    the cutting action of the bur end is confined to
    the root canal space.

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Diagnosis
  • Direct observation (magnification)
  • b) Paper points
  • c) Radiographs
  • d) Electronic apex locators
  • e) Symptomatic findings

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  • Existing perforation
  • The presence of serous exudate in the site of the
    perforation
  • Sensitivity of the involved tooth to percussion
    Chronic inflammation of the gingiva
  • The presence of a sinus tract or the appearance
    of localized problems such as pocket formation or
    furcation involvement following an apparently
    adequate endodontic therapy may indicate the
    existence of perforation.

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Factors affecting prognosis
  • 1) Time lapsed before obturating the defect
  • 2) Location of the perforation
  • 3) Size of the perforation
  • 4) Adequacy of the perforation seal
  • 5) Repair material.

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Surgical repair
  • Reflecting a flap at the perforation site and
    packing a repair material into the defect.
  • Preparing the perforation site using ultrasonic
    handpiece with the aid of surgical microscope.

12
  • Bicuspidization is a process of molar tooth
    sectioning and maintaining of both sections
    followed by their crowning to serve as two
    premolars.
  • Root amputation is a process of removal of the
    defected root after molar sectioning, keeping the
    sound root intact.
  • Surgical-nonsurgical approach

13
Nonsurgical repair
  • Surgical approach often leads to loss of
    attachment, chronic pocket formation, and
    periodontal furcation involvement.
  • Furcation perforations are usually less
    accessible for surgical approach especially if
    the perforation is lingually situated, or if it
    is located in the furcation area of a maxillary
    molar.
  • Perforations coronal to gingival attachment may
    be conventionally repaired with a restorative
    material or a crown.

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  • Different materials have been used for
    nonsurgical repair of perforation defects
  • amalgam,
  • gutta percha,
  • calcium hydroxide,
  • Cavit (Premier dental produclx. Philadelphia).
  • MTA
  • Others

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  • Repair material extrusion into the periodontal
    space
  • using bioinert matrices
  • indium foil matrices
  • Dentin chips and calcium hydroxide
  • Perforations to be filled with blood and
    obturated the orifices with either calcium
    hydroxide or Teflon discs.
  • Hhydroxyapatite or tricalcium phosphate matrix.
  • MTA (Mineral trioxide aggregate) used without
    internal matrix.

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Objectives
  • The objectives of repairing furcation
    perforations are to seal the dentin defect and
    provide suitable conditions for formation of a
    new periodontal attachment.

17
  • Some materials may provide adequate seal but may
    interfere with the formation of periodontal
    reattachment due to their extrusion into the
    furcation area.
  • Periodontal reattachment did not occur when
    materials like amalgam, gutta percha, or calcium
    hydroxide were used for perforation repairs.

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  • Materials such as hydroxyapatite or plaster of
    Paris may initiate formation of new bone and
    periodontal attachment but can not adequately
    seal the dentin defect. This may result in
    leakage of bacteria and then by-products into the
    lesion and failure, especially the perforation is
    connected to the oral cavity.

19
  • Since the furcation perforation involves
    differenl types of inter-related tissues, each
    tissue within the defect should be considered
    separately.
  • Alhadainy et al. suggested the use of artificial
    floor technique for repairing furcation
    perforations considering the periodontal wound
    and the dentinal wound as separate identities.

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Artificial Floor Technique
Artificial floor versus internal matrix
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  • Calcium sulfate (plaster of Paris ) was used
    under glass ionomer to repair furcation
    perforations.
  • plaster of Paris is stable, biocompatible,
    readily available, easily sterilizable, and shows
    rapid rate of resorption coinciding with the rate
    of new bone growth. It also accelerates the rate
    of mineralization of the new bone by providing a
    ready source of calcium ions for early
    mineralization process.Calcium sulfate acts as
    bone barrier, aids guided bone regeneration and
    excludes epithelial tissue from the site of bone
    formation. This may help in avoiding the
    formation of periodontal pockets and allows for
    periodontal reattachment.

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Thank You
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