Outcomes of furcal perforation management using Mineral Trioxide Aggregate and Biodentine: a systematic review

Abstract Furcal perforation is an iatrogenic or pathologic communication between the pulp chamber floor and the alveolar bone. The outcome of perforation sealing depends greatly on the tissue compatibility and bioactivity and sealing properties of the repair materials. Mineral trioxide aggregate (MTA) and Biodentine are currently the most used materials to treat this condition. The present systematic review aimed to report the treatment outcome of repaired furcal perforation using MTA and Biodentine and identify which material would yield a better outcome. Methodology: A comprehensive search was conducted using the PubMed database to identify experimental studies and case reports that describe treatment of furcal perforation. Studies and case reports that evaluated the outcome of repaired furcal perforations using MTA and Biodentine, published in English from 2018 to April 2022, were identified. Unavailable full texts were excluded. Results: Initial screening of 724 articles (670 studies and 54 case reports). After discarding the duplicated studies, we reviewed 50 studies, selecting 13 for abstract analysis. We retrieved and evaluated full texts of eight studies and five case reports. Both materials had an equivalent success rate in the first three months but by 12 months Biodentine performed better than MTA clinically and radiographically. Conclusions: Repair of furcal perforation with Biodentine yields a better outcome compared to MTA.

Repair of an Iatrogenic Furcal Perforation with Mineral Trioxide Aggregate: A Case Report with 6-Month Follow-Up

Furcal perforations are significant iatrogenic complications of endodontic treatment and could lead to endodontic failure.Successful treatment depends on the immediate sealing of the perforation and prevention of infection. Several materials usedinitially to repair the perforation were considered inadequate due to their bacterial leakage and lack of biocompatibility to theunderlying tissues. Recently, mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair,retrograde filling, pulp capping, and apexification. Successful management of an iatrogenic furcal perforation using MTA onmandibular first molar is described in this case report. The tooth was endodontically treated and coronally restored with resincomposite. After 6 months, the absence of periradicular radiolucent lesion indicated a successful outcome of sealing the furcalperforation using MTA.

Current situation and strategy on perforation repair / 华西口腔医学杂志

Perforations are common complications of root canal therapy. In clinic, perforations that were improperly and untimely repaired can seriously affect the prognosis of teeth after root canal treatment. At present, the status of perforation repair in our country is worrisome. This paper focused on the progress of perforation repair in the country by discussing the current situation of repair methods and materials. This review aims to improve knowledge and aid clinical doctors in the sophistication of perforation repair in order to improve the retention rate of root-canal-treated teeth.

Experimental Furcal Perforation Treated with MTA: Analysis of the Cytokine Expression

The aim of this study was to evaluate mineral trioxide aggregate (MTA)-induced cytokine expression in mice after experimental furcal perforation. BALB/c mice (n=5) were subjected to induced furcal drilling of the maxillary first molar followed by MTA sealing in the left side (experimental group) and paraffin sealing in the right side (control group). Animals were euthanized at 7, 14 and 21 days after sealing the perforations. The expression levels of the IFN-γ, TNF-α, IL-10, IL-4, TGF-β and RANKL genes were investigated by real time polymerase chain reaction (PCR) in the teeth and surrounding tissues. In the experimental groups, after the 7th day, there was a down-regulation of the mRNA levels of TNF-α and IL-4 compared to the 14th day (p<0.05). In these groups, the mRNA levels of RANKL, IFN-γ and TNF-α were statistically higher after 14 days compared to 21 days post-MTA sealing (p<0.05). The level of IL-10 mRNA was increased at the 21st day (p<0.05). The mRNA expression of TGF-β did not exhibit any statistically relevant results. There was a statistical down-regulation of IL-4 gene expressions when control and experimental groups were compared at days 7 and 21. In conclusion, MTA sealing favored the expression of pro-inflammatory cytokines in the intermediate phase of the immuno-inflammatory response (14th day). The reduction of these cytokines in later phase of the response was probably due to immunoregulation by IL-10.

O objetivo desse artigo foi avaliar a expressão das citocinas induzidas por MTA após a perfuração experimental de furca, em camundongos. Camundongos Balb/c (n=5) foram submetidos à perfuração induzida da furca do primeiro molar superior, seguido pelo selamento da mesma com MTA no lado esquerdo (grupo experimental) e com parafina no lado direito (grupo controle). Os animais foram sacrificados 7, 14 e 21 dias após o tratamento da perfuração. A expressão gênica dos níveis de IFN-γ, TNF- α, IL-10, IL-4, TGF- β e RANKL foram investigadas por PCR em tempo real nos dentes e tecidos adjacentes. No grupo experimental, após 7 dias, houve uma diminuição da expressão dos níveis de TNF- α e IL-4 comparados ao 14° dia (p<0,05). Nesses mesmos grupos, os níveis de mRNA de RANKL, IFN- γ e TNF- α foram estatisticamente maiores após 14 dias comparados a 21 dias após o tratamento com MTA (p<0,05). Os níveis de IL-10 estavam aumentados no 21^o dia (p<0,05). A expressão de mRNA do TGF- β não apresentou alteração estatisticamente relevante. Houve uma redução estatística da expressão gênica da IL-4 quando os grupos controle e experimental foram comparados nos dias 7 e 21. Em conclusão, o selamento com MTA favoreceu a expressão de citocinas pró-inflamatórias na fase intermediária da resposta imuno-inflamatória (14^o dia). A redução dessas citocinas, na fase tardia da resposta, ocorreu provavelmente devido à imunoregulação da expressão de IL-10.

Furcal-perforation repair with mineral trioxide aggregate: Two years follow-up.

Furcal perforations are significant iatrogenic complications of endodontic treatment and could lead to endodontic failure. Mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair, retrograde filling, pulp capping, and apexification. This case report describes a furcal perforation in a maxillary first molar, which was repaired using MTA. The tooth was endodontically treated and coronally restored with resin composite. After 2 years, the absence of periradicular radiolucent lesions, pain, and swelling along with functional tooth stability indicated a successful outcome of sealing the perforation using MTA.