Perforations are defined as openings in the tooth or its root that provide a communication between the root canal system and the periodontal tissues. They may be pathologic as a result of resorption or caries, or they may be iatrogenic as a result of difficult access preparations, canal orifice location,and aggressive cleaning and shaping using large inflexible files.The factors that affect perforation prognosis are timing of the repair, location of the perforation, size of the perforation, and the repair material used. Having prior knowledge of the techniques and materials needed to repair perforations and ensure a good seal may allow the clinician to save a tooth which may otherwise be compromised with a poor prognosis and end up being extracted.
The permanent maxillary first molar is one of the most complex root canal system because of the possibility of having two or more mesio-buccal canals. With the help of modern technology, cone beam computed tomography (CBCT), can make it possible to determine the root canal morphology of the tooth. Understanding this morphology makes it easier for the clinician to do endodontic treatment and provide successful endodontic result.
Dr. William Ha obtained his Bachelor of Dental Science from the University of Queensland, Australia, in 2007. In 2017, he completed his PhD in endodontic biomaterials and began practicing restricted to endodontics. He has published 15 peer-reviewed articles, most of which are on endodontic materials. He is also an associate editor of the European Endodontic Journal. He is now completing his Doctor of Clinical Dentistry in Endodontics at the University of Adelaide, Australia.
Mineral trioxide aggregate (MTA) has a large body of evidence supporting its use for root-end fillings, perforation repairs, apical barrier placement and pulp regeneration. New MTAs and related ‘bioceramics’ are appearing, many with different compositions and handling to ProRoot MTA, the most well-known and researched product. Once limited to packable restoratives, modifications have produced endodontic sealers. All of these new cements will be compared and contrasted by their properties, clinical handling and evidence.
