Tratamento de perfuração iatrogênica com cimento reparador de silicato tricálcico: relato de caso

Abstract

Root perforation is a communication between the root canals and the structures surrounding the tooth, such as the periodontal ligament and alveolar bone. It can result from pathological processes or human error during treatment. Diagnosis involves a combination of clinical and imaging examinations, and the prognosis is influenced by factors such as the timing, extent, and location of the perforation. The recommended treatment involves the use of bioceramic materials due to their biocompatibility and bioactivity, contributing to effective sealing through expansion and the formation of mineralized tissue. The objective of this study is to report a clinical case of iatrogenic root perforation involving tooth 24, which was treated with Biodentine® (Septodont), demonstrating that with proper technique and appropriate materials, a favorable clinical outcome can be achieved. The patient's treatment was divided into four sessions. In the first session, calcium hydroxide was used as intracanal medication to control inflammation and promote healing. In the second session, the perforation was sealed with Biodentine, and flowable resin was used to seal over the bioceramic. For chemo-mechanical preparation, 2.5% sodium hypochlorite gel was used as the main irrigating solution, along with mechanized files (Univy®). Eleven months after treatment completion, the patient continued to report postoperative sensitivity. A cone beam computed tomography (CBCT) scan was requested, which revealed a fracture extending from the cervical to the occlusal region, leading to the indication for tooth extraction. The patient was informed about the need for functional rehabilitation. The approach used in this case was effective in managing the root perforation, highlighting that the use of appropriate materials combined with advanced technology enables efficient sealing and tissue repair.