Prognostic Factors and Primary Healing on Root Perforation Repaired with MTA: A 14-year Longitudinal Study

• Published in: Journal of endodontics Vol. 48; no. 9; pp. 1092 - 1099
• Main Authors: Gorni, Fabio G., Ionescu, Andrei C., Ambrogi, Federico, Brambilla, Eugenio, Gagliani, Massimo M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2022
• Subjects: Adolescent; Adult; Aged; Aluminum Compounds - therapeutic use; Calcium Compounds - therapeutic use; Drug Combinations; Female; Humans; Iatrogenic; Longitudinal Studies; Male; Middle Aged; MTA; Oxides - therapeutic use; perforation; Prognosis; Prospective Studies; Root Canal Filling Materials - therapeutic use; root canal treatment; Silicates - therapeutic use; treatment failure; Young Adult; Iatrogenic; MTA; perforation; treatment failure; root canal treatment
• ISSN: 0099-2399; 1878-3554
• DOI: 10.1016/j.joen.2022.06.005

Few data are available on the long-term efficacy of mineral trioxide aggregate (MTA) in treating root canal perforations. This prospective cohort study builds on a previously reported trial to determine the outcome for teeth with root perforations treated with orthograde MTA after longer follow-up and identify potential prognostic factors. A prospective cohort study was performed, enrolling (1999–2009) patients with a single dental perforation treated with MTA. Preoperative, intraoperative, and postoperative information was evaluated, and the outcomes were dichotomized as healed or nonhealing. Patients were followed up yearly until 2018 for a maximum of 17 years after treatment, with controls carried out until 14 years. Clinical and radiographic outcomes were evaluated using standardized follow-up protocols. Of the 124 entrolled patients (median age = 36.5 years, 53.2% male), 115 were healed at the first (n = 110, 89%) or second (n = 5, 4%) annual posttreatment checkup, while 9 subjects (7%, 4 females, 18–65 years old) did not heal. Characteristics significantly associated with nonhealing were gender, positive probing, size, and perforation site. Perforations recurred in 48 teeth during the follow-up with the estimated probability of reversal at 5, 10, and 14 years of 6% (95% confidence interval [CI], 2%–10%), 30% (95% CI, 20%–38%), and 62% (95% CI, 46%–73%), respectively. Positive probing had a higher reversal risk (hazard ratio = 3.3, P ≤ .001), and perforations >3 mm were more likely to have a reversal (hazard ratio = 4.1, P < .001). The risk of reversal for healed MTA-treated root canal perforations, initially relatively low, vastly increases over time.