The Main Tactic by Dentists at the Complicated Endodontic Treatment – Perforation of Tooth

In modern conditions of development of dentistry, despite the introduction of new methods of prevention, high-tech diagnosis and treatment, complicated forms of caries have significant distribution, determines the prevailing structure in modern dental care endodontic procedures. Among the complications of endodontic treatment, such as broken tools, ledges which were formed in root canals, and all these factors imped their obturation, removing the mass of the filling material in the periodontal surrounding bone and anatomic structures of the jowl (mandibular canal, mental foramen, maxillary and nasal sinuses) one of the most common complications is perforation of the hard tooth structure because of medical error: the bottom of the pulp chamber, the walls of the root of the tooth, cavity walls - especially in the cervical area. One of the commonly used treatments for patients with complications of endodontic treatment is to remove the tooth, indications for which are - perforated bottom of the pulp chamber of multi tooth, the resorption of the interradicular septs, localization of perforation in the middle third of the root and its top portion with the impossibility to use an endodontic technique, excretion the perforated hole with fragments of endodontic instruments, the sealing mass, the devitalizing pastes, which often leads to the development ofosteomyelitis of alveolar bone or mandibular, an inefficiency endodontic retreatment of perforated tooth structures. In most cases, removal of compromised teeth is associated with a high risk of root fracture in the area of the perforation and the need for methods such as alveoleсtomy for a complete removal from the wells of the damaged tooth root - that is, atypical removal followed by a high probability of alveolitis, and as a consequence, the loss of volume of the bone and soft tissue, forcing resort to surgical intervention augmentation in preparation for the rehabilitation of the patient by non-removable prosthetics and prosthetic dental implants. In order to study and systematize the reasons of complications of endodontic treatment - perforation of hard tissues of the tooth, and to find an algorithm for dentist for prevention these complications and find tactics for surgeon to eliminate we have analyzed 45 medical case-records of dental patients, examined and treated 65 patients of both sexes between the ages of 18 to 58 (all patients had the complications of endodontic treatment. We had established the most frequent causes of perforation or teeth and had provided a diagnostic algorithm of prevention of these complications. In order to prevent the fracture of the roots of perforated teeth during surgery removing and avoiding alveolectomy we used periotomy - luxator.