Int J Dent Case Reports 2013; 3(1): 105-108

IJDCR 2013. All rights reserved

www.ijdcr.com


REPAIR OF LATERAL ROOT PERFORATION OF MANDIBULAR CENTRAL INCISORS WITH
BIODENTINE A CASE REPORT
Padma Gandi
1
, Abhishek.L.
2
, Dileep S.K.
3
, Kishore D.
4
1
Professor & Head, Depart ment of Conservative Dentistry & Endodontics, S.V.S.Institute of Dental Sciences,
Mahabubnagar, Andhra Pradesh, India
2
P.G. Student, Department of Conservative Dentistry & Endodontics, S.V.S.Institute of Dental Sciences,
Mahabubnagar, Andhra Pradesh, India
3
P.G. Student, Department of Conservative Dentistry & Endodontics, S.V.S.Institute of Dental Sciences,
Mahabubnagar, Andhra Pradesh, India
4
P.G. Student, Department of Conservative Dentistry & Endodontics, S.V.S.Institute of Dental Sciences,
Mahabubnagar, Andhra Pradesh, India
Address for correspondence
Dr. Padma Gandi M.D.S
Prof. & Head, Dept. of Conservative Dentistry & Endodontics,
S.V.S.Institute of Dental Sciences,
Mahabubnagar, Andhra Pradesh, India.
Phone no +919849855949
Email Id padmagandi@gmail.com

ABSTRACT
Biodentine is new bioactive cement with dentin-like mechanical properties, which can be used as a dentin substitute
on crowns and roots. Its crown applications include pulp protection, deep caries management, cervical filling, direct
and indirect pulp capping and pulpotomy. Its use in roots includes managing perforat ions of root canals or the pulpal
floor, internal and external resorption, apexification and retrograde root canal obturation. Biodentine cement
simplifies clinical procedures due to its handling properties .
A patient presented to Depart ment of Conservative and Endodontics, with chief complaint of pain in the lower front
teeth region of jaw. Radiographic examination revealed incomplete obturation of mandibular centrals and lateral
root perforation on 31 distal aspect and 41 mesial aspect.
This case report explains the treatment modalit ies and surgical closure of perforation defect with Biodentine which
significantly improved the prognosis of tooth.

Key words: Biodentine; MTA; root perforations

Gandi, Abhishek, Dileep, Kishore Root Perforations
106
Int J Dent Case Reports March 2013, Vol.3, No. 1

INTRODUCTION
Perforat ions may occur during endodontic treatment
and bring about difficulties for its completion. The
material employed for sealing is one of the important
factors for prognosis that directly interfere with the
repair of these defects (1). Several materials have
been proposed for sealing of perforations. However
the divergent outcomes have demonstrated that so far
no ideal sealing material has been achieved by a
material that may provide optimal sealing, easy
manipulation, biocompatibility and ability of
induction of osteogenesis and cementogenesis . (2, 3,
4)
Initially proposed for retrograde obturation of root
canals using MTA in endodontic surgery, Calcium
silicate cements have gradually become the material
of choice for the repair of all types of dentinal defects
creating communicat ion pathways between the root -
canal system and the periodontal ligament (5). With
their proven biocompatibility and ability to induce
Calcium-phosphate precipitation at the interface to
the periodontal tissue, they play a major role in bone
tissue repair (6, 7, 9, 10). The high quality of the
material-dentin interface which improves over time
secures long-term clinical success and reduces the
risk of marginal percolation. The main drawbacks of
this material so far have been slow setting kinetics
and complicated handling, which rendered these
technique sensitive procedures even more difficult
and restricted their use to specialists. (8)

BioDentine cement is part of a new approach seeking
to simplify clinical procedures. A modified powder
composition, the addition of setting accelerators and
softeners, and a new predisposed capsule formulat ion
for use in a mixing device, improves the physical
properties of this material making it much more user-
friendly


Case Report
A male patient presented to the Department of
Conservative Dentistry and Endodontics with the
chief complaint of pain in the lower right and left
front tooth region of jaw since 1 month. Pat ient gave
a history of undergoing root canal therapy with a
local pract itioner 3 months back.

Figure 1- Pre operative radiograph

The lower left and right central incisors exhibited
pain on percussion, and radiography showed
periapical lesions in regions of 31 and 41 from
previous insufficient management with iatrogenic
lateral root perforat ion of 31(figure 1). Iatrogenic
lateral root perforation with incomplete obturation
was diagnosed, and with the patients consent an
attempt was made to preserve the tooth by sealing the
endo-perio communication. Retreat ment was
performed in t wo sessions, with intracanal
medication between sessions. After removal of the
filling, with the help of endodontic microscope 2
canals buccal and lingual were located in 31 and 41.
Both the canals were instrumented to 35 no k file,
Gandi, Abhishek, Dileep, Kishore Root Perforations
107
Int J Dent Case Reports March 2013, Vol.3, No. 1

calcium hydroxide mixed with 2 % chlorhexidine
was used as an intracanal medicament for 4 weeks
with weekly change of medicament.

Figure 2 - Obturation

After 4 weeks, the tooth was asymptomatic and the
canals were dry. The corresponding size of master
cone was selected and obturation was completed
using lateral condensation technique (figure 2).

Figure 3- Exposure of defective site

Surgical closure of perforation defect with
Biodentine was planned on the same day of
obturation. Full mucoperiosteal Trapezoidal flap was
reflected and defective site was exposed (figure 3).
The temporary restoration protruding from the
perforation site was removed with a sharp Gracey
curette (Hufreidy) and the dentin defect was filled
with Biodentine. Biodentine was manipulated in an
Amalgamator for 30 seconds and the material was
carried to the defective site using an amalgam carrier.
The material was then adapted to the cavity with a
cotton pellet without pressure. Once the material had
set any excess material was stripped off with a curette
and carved to remove the overhangs. At the end of
the session, the hardened material was shaped with a
bur to reproduce the root anatomy for the future
restoration of the tooth (figure 4). Follow up at three
months showed no clinical signs, and the X-ray
confirmed complete healing of the apical and
perforation site (figure 5).


Figure 4- Restoration with Biodentine

DISCUSSION
Biodentine is a new dentine substitute composed
mainly of t ricalcium silicate. The biocompatibility of
this material was recently proven in invitro and in
vivo studies. The endodontic indications of
Biodentine are similar to the usual calcium silicate
based materials, like the Portland cements.
However, Biodentine has some features which are
superior to MTA.
Gandi, Abhishek, Dileep, Kishore Root Perforations
108
Int J Dent Case Reports March 2013, Vol.3, No. 1

Biodentine consistency is better suited to the
clinical use than MTAs.
Biodentine presentation ensures a better handling
and safety than MTA.

As the setting is faster, there is a lower risk of
bacterial contamination than with MTA. Adding to
its ability to be used as dentine substitute, Biodentine
could safely be used for each indication where
dentine is damaged. Therefore, it is an advantage for
the clinician and the patient.

Figure 5 - Three months post operative radiograph

CONCLUSION
Validated experimentally, the efficacy of Biodentine
as a dentin substitute is yet to be clinically proven for
each of its therapeutic indications. The short and
medium-term results of clinical studies conducted in
endodontic as well as restorative fields of application
are in the re-evaluation phase, and will be published
as evidence in scientific art icles in a few months. The
first results observed in a private practice since the
material was launched a year ago, are ext remely
promising.

REFERENCES
1.Bramante CM, Berbert A, Bernardineli N, Gomes de Moraes
I,Garcia RB. Acident es e complicaes no t rat ament o endodnt ico:
solues clnicas. 2a.ed. So Paulo: Ed. Sant os; 2004.

2.Bernab PFE, Holland R. Cirurgia paraendodnt ica: como
pract ical com embasamento cient fico. In: Est rela C. Cincia
endodnt ica. So Paulo: Art es Mdicas; 2004. p. 657-797.

3. Hart well GR, England MC. Healing of furcat ion perforation in
primat e teet h repair wit h decalcified freeze-
dried bone. J Endod. 1993;19(7):357-61

4. Silva Neto UX. Capacidade seladora e adaptao marginal
proporcionadas por alguns mat eriais quando ut ilizados em
perfuraes na regio de furca de molares humanos. Bauru; 2002.
[Dissert ao(Mest rado) Faculdade de Odontologa de Bauru da
USP].

5. Bogen g & Sergio Kutt ler S. Mineral Trioxide Aggregat e
obt urat ion: A Review and Case.Series. J Endod. 2009;35:777790.

6. Laurent p, Camps j, De Meo M & About I. Induct ion of specific
cell responses to a Ca3SiO5-based posterior restorat ive material.
Dent Mater. 2008;24 :1486-1494.

7. Parirokh M & Mahmoud Torabinejad M. Mineral Trioxide
Aggregate: A comprehensive lit erat ure reviewPart I: Chemical,
Physical, and ant ibact erial propert ies. J Endod. 2010;36:1627.

8. Parirokh M & Mahmoud Torabinejad M. Mineral Trioxide
Aggregate: A comprehensive lit erat ure reviewPart III: Clinical
applicat ions, drawbacks, and mechanism of act ion. J Endod.
2010;36:400413.

9. Reyes-Carmona Jf, Felippe Ms, Felippe Wt . Biomineralization
ability and int eract ion of mineral trioxide aggregat e and whit e
port land cement wit h dent ine in a phosphate cont aing fluid. J
Endod. 2009;35:731-736.

10. Tay Fr, Pashley Dh, Rueggeberg Fa, Loushine Rj & Weller Rn.
Calcium phosphat e phase transformat ion produced by the
int eract ion of the port land cement component of white mineral
t rioxide aggregate with a phosphat e-containing fluid. J Endod.
2007;33:1347-51.