Endod Deiu Trawmiiol !

W(i: 12: 255 264 Copyri};tit © Munt<Si;uard 1996

Prinied in Dcnnuiik . .Ill lii^lii.'i ic.scivnl
Endodontics &
Dental Traumatology
AV.S'A' 0109-2502

Root perforations: classification and

treatment choices based on prognostic
factors
Fuss Z, Trope M. Root perforations: elassifieation and treatment I. Fuss, M. Trope
choices based on prognostic factors. Endod Dent Tranmatol 1996; Department of Endodontology, School of Dental
12: 255-264. © Munksgaard, 1996. Medicine, Tel Aviv University, Israel, Department of
Endodontics, University of North Carolina School
of Dentistry, Chapel Hill North Carolina, USA
Abstract Root perforations are common complications of endo-
dontic treatment or post preparation and often lead to tooth extrae-
tion. Successful treatment depends mainly on immediate sealing of
the perforation and prevention of infection. Several factors afFeet the
Key words: root perforation: endodontic treatment:
achievement of these goals, most important of whieh are: time of endodontic complications
oeeurrence, size, and location of the perforation. A classiheation Zvi Fuss, Department of Endodontics, School of
of root perforations, based on the above factors, is presented to Dental Medicine, Tel Aviv University,
assist the elinician in the choice of the treatment jDrotocol which will Tel Aviv, 69978, Israel
give the best possible results when a perforation is diagnosed. Accepted June 12, 1996

Purpose inflammation and failure. However, when a baeterial

inleetion and/or an irritative restoratiN'e material is
The purpose of this paper was to review the factors superimposed on the trauma of the perforation, heal-
which affect the prognosis of root perforations, lo sug- ing will not take plaee. Consequences such as gingival
gest a classification reflective of these prognostic j^re- downgrowth of epithelium into the perforation area
dictons, and to suggest treatment protocols which will (5), inflammation, l:)one resorption and/or necrosis (6,
result in the higliest possible success rate. 7) can result (Fig. 3). Repair of a perforation vvilhoul
Artifieial comminiieation between the root canal periradicular inflammation may take plaee pro\ ided
system and supporting tissues of the tooth or oral cav- infection is avoided and asepsis maintained during
ity lowers the prognosis of endodontic treatment, and treatment (8) (Fig. 4).
often leads to extraction of the tooth (1). Ingle et al.
(2) have found that the second most common reason
for failure associated with endodontic treatment is
Prognosis
root perforation. Perforations can occur during oper-
ative procedures such as post preparation (Fig. 1), as Prognosis is de]:)endenl on the pre\ ention or irealmeut
well as during endodontic treatment (Fig. 2) (3). The of baeterial infection of ihe perforation site. In ad-
frequency of root perforations has been reported to dition, the use of a non-irritating material whieh seals
range from 3% to as high as 10% (2, 4). Howe\-er, the perforation will limit periodontal inflammation.
more dentists with vaiying degrees of training and Several laetors related lo infection of the perfor-
skill are now providing endodontie treatment and en- ation site aflect the prognosis of the treatment of root
dodontie cases for the specialist have beeome more perforations, the mosl important of w hich are: lime
difficult, so that an inereased frequency of perfor- between occurrence and Irealmenl, size, and loc ation
ations in the future is not an unrealistic expeclalion. of ihe perforation.
In addition, factors not related to operator mishaps
sueh as pathologieal jjrocesses like root resorption or
Time
earies may result in rool perforations.
Theoretically, a perforation into ihc^ supporting rhe time between the occurrence of the perforation
tissues alone might not necessarily cause irreversible and when appropriate trealmenl is performed has

255
 Fuss & Trope

Fig. ''). HislnloGjical ,sccti()n (if old (infccU'cl) liircalion jx-rforation,

rcsulliiii^ ill intlaniinatioii a n d h o n e rcsorplion a n d ^in,i;i\al cpilhcl-
iurn iJiolilcralion in (lie pcrCoi alion a r r a (H&M),

/'/». /. Radi()gra])li of manelibnlar lust molar with ]K-rforation of

h u f a t i o n d n i i n g |)ost p r e p a i a t i o n . Note the r a d i o l n c e n i y in the
lurcation area lold perforation). 'I'he prognosi.s for conservati\'e
treatment is poor.

Fig 2. R a d i o g r a p h of niaxillaiy tirsi molar i m m r d i a l c l y after the

mcsiobucc-al root was p c i t o r a t c d by a small size cndotlontic instin-
mcnt (trrsh JK-Wbralionj in proximity to the Icwl of the c rcstal b o n e ,
'I'hc |)r()gnosis is nnccilain.
Fig. 4. Radiograph oCmaxillaiy Icfl latc^ral incisor which was perfor-
ated apical to the creslal bone and treated with (ai( inm hydroxide
tor 2 weeks and then obtvtrated with gntta-|iercha and Ketac IMUIO
t)een found to be an important faelor in healing (7 root (anal seal(-r ilvspe, Sccfeld, C;crmany). Three yeats following
9). Lantz & Persson (9) experimentally ]^rodueed rool treatment the tooth is asymjjtoniatic and no signs of a radiolncent
perforations in dogs and then treated the perforations area atljacent to the perfotation is apparetit.
either immediately or affer a delay. The most favor-
able healing oecurred when the j^erforations were
sealed immediately. Thus, reducing the likelihood of Seltzer et al. (7) followed 22 perforations in mon-
an infection being established resulted in a better keys that were treated at intervals ranging- from im-
periradicular environnaenl around the ]:)erforation. mediately to 10 naonths post perforation. 'I'he i)eri-
256
 Root perforations: classification and treatment

Fig. 5. D i a g r a m of m a n d i b u l a r m o l a r wilh di.slal a l t a c h m c n i loss.

Fig. 7. D i a g r a m of nKmdihnlar molar wilh pc-rforalion in llic iitiddlc
D c l c r m i n a l i o n of critical zone tor rool pcrtbrations in lerms ol'
third o\ lh(~ mesial rool. Tlu' |)rognosis for c o n s c r \ a l i \ c ircalmcnl is
prognosis shonlcl he atlrihiitcd to llic l c \ d of llic crcslal hone a n d
good hc{ aiisc ihc ])crforalion is lotatt'd apit'al to ihc critic al ( rcslal
c]:)ilhclial allachnicni a n d not lo llic loialion ol" ihc pcrforalion
zone.
along ihc rool. 'riicrcforc, in llic mesial rool ihc (rilical crcslal
zone is lonnd in the coronal ihird of llic root, whereas the iritiial
crcslal zone in die distal root is locatcti in ihc middle third o l t h c
rool. peidodotital healing' which was attributed mainly to
immediate obturation of the perforations and an
aseptic technique.

Size
The size of a perforation also has an important cfTcct
on the prognosis of treatment. A stnall jDerforation
is usually associated with less tissue destruction and
itinatiitiiation; thcrcibtv. healing- is more predictable.
Himel ct al. [\{)) ha\c e\'aluaicd the eflect of three
materials on the biological repair of a defect created
by perforating the J^ulp chatnbcr floor of mandibular
posterior teeth iti dogs. It was ibmid that the prog-
nosis of treatment was dirccih' j^roportional with the
size ofthe tooth: the larger teeth (with proportiotially
smaller perforations) had the best results. Since the
aim of obturating pcrlbrations is to pre\ cnt l)a( tcMia
from the oral ca\iiy Irom reaching the periradicular
tissues, and lo avoid irritation ol ihe j^criodontal

Ftg. (). D i a g r a m ol m a n d i h n l a r m o l a r wilh perforation in llic middle

Table t. Classification of root perforations according to factors which affect
l/iird n\ the dislal I'ooi. The prognosis for conscr\ atixc treatment is prognosis. To the left of the horizontal line are predictors suggestive of a good
])oor hccatisc o f t h e |)ro\imity to the critical (Mesial zone. prognosis while to the right are factors suggestive of a poor prognosis

Root perforation
Lateral or furcal
odontium was damaged in all the teeth in\-ol\'cd, but Fresh Old
the most severe destruction was found in the un- Small Large
treated perforations and in the leeth where Ueatmcnl Apical-coronal Crestal
was delayed.
Good prognosis Poor prognosis
Beavers et al, (8) reported a high success rale iu

257
 Fuss & Trope

Fig. fi. a. Photograph of maxillaiy left ccniral incisor showing a

sinns Iracl on ihc hnccal aspect ofthe looth in the eritieal ereslal
zone. 1). Photograph showing 2 orilices lo 2 eanals. The hiiecal
orifice leads lo a perforation of die rool and ihc palalal orifice
lo die loot (anal. c. Radiograph showing hxalion of endodontic
inslrtimcnl following determination of rool pcrforalion silc h\- elcc-
Ironic apex locator, d. Radiograph showing ohtLiration ofthe root
and perforation canal with giilta jx-ixha and sealer (CIRCS, Hyg-

I i enic, Akron, OH, tJSA). c, Snrgcry performed to xrrify the seal of

258
 Root perforations: classification and treatment

Fig. !). a. Radi()gra])h of maxillary iirst p r e m o l a r with large crestal ]ierforation sealed with a m a l g a m . Xoie the extrusion o f t h e malerial
into the |5eriodonlal lissues. h. R a d i o g r a p h showing the same toolh :i \ c a r s after i r e a t m e n i . Periodonlal pockeling or disease is ahseiil in
spile ol the e.xlrnsion ol the a m a l g a m . T h e ( rown was pre]xncd siipragingi\aly lo a\-oid any jieriodonUil inxoKement wilh the perforation
site.

tissues by extrusion of scalitig matci^ials, ii ap]:)cars are most susceptible lo epithelial migration atid rapid
logical that small perforations lia\ c a better jirognosis pocket formalion, thereby having ihe lowest success
because they are easier to seal elVeciiNely witlioul forc- rale of rejDair (3, 6, 7, 9), Orthograde lillings are
ing the lining material into ihe surrounding tissties. usualK' not suflicienl lo prexenl infection originaling
from ihc gingixal sulcus, and surgical interxention is
Location recommended (1). Perforations which arc located api-
cal to the critical zone (Fig, 7) should have a good
The location ol" a pcrlbralion i.s piobably the most prognosis provided adequate eudodontic treatment is
iini^otlani lac ior aflecliiig trcattiietit ptxignosis. C'lose lTtidered, atid the tiiain catial is accessible (12, 13).
proximity ol the perforation to the gingixal sulcus can Perforations in ihe furcation area of mullirooted teeth
lead to contatnination of ilie peiforaiion with bacteria are regarded usually as cix^stal root perforations be-
from the oral eax'ity through the sulcus. Furthermore, cause of the proximity to the epithelial attachment
if the wound is large aiid not treated immediately, ihe and the gingi\al sulcus (3, 6, 9, 12 14), Seltzer et al.
proximity to the e]3itlu^lial altachmeni is critical and (7) ha\e stated that perforations of ihe lurca region of
apical tnigration of c])ithelium to the perlbfation site molars iwc especially troublesome because they cause
will create a periodouial delect ((S, 1 I), Thus a critical considerable damage aud frequently lead lo peri-
zone in tet-tns of prognosis is the lc\ el of the cresial odouial inxoK emenl of the fiuTalioti, Beavers et al.
bone and the e])ilhelial attachment (Fig, 5). Perfor- (8), however, showed a 100% success rale iu treat-
ations which arc located coronal lo this zone ha\e a uieut of furcation perforations. They studied peri-
good ]M-()gnosis, /Vccess lo the ]:)erforalion is aliaiu- c^dontal vvoinid healiug following intentional rool per-
able, and adequate sealing is j)ossible without peri- forations iu moukeys. Hard-selling calciuiii hydroxide
odonlal itivolvemenl, Crestal rool perforations (Fig. 6) and tellou dises were used to seal the perforations.
Asepsis was sti'ictly coulroUcci aud ziuc-oxide eugeuol
cement aud auialgam were used lo seal atid restore
the leiHh. All 24 furcaliou perforatious healed, dis-
die perforation rexcaled that t h e giilta-]M'r( h a filling w a s huated
])laying normal periodoulal coiilour with no epithelial
e x a ( t l y at tlie p e r f o r a l i o n s i t e a s in(li( a t e d h y t h e a | ) c x Kx a l o r r e a d -
migraliou lo the wouud site. The sludy detnoustrates
i n g . I. I h e p e r l o r a l i o n s i t e w a s s e a l e d w i l h l i g h t e n r e d (omposite
iliai wounds creaied iulo the periodoutal ligameut be-
rcsiii after a(id euhing iPcrlac. lvSPlv Scclcld, Cicrmany). g.
P l i o l o g r a | ) l i s h o w i n g ( i i n i ( a l follo\v iip 12 m o n i l i s a f t e r irealnienl.
low the le\-el of the epithelial attachment IVoui the
I h e s i n i i s t r a c t ts closi-d a n d tlic g i n g i x a is h c a l t i n with a p r o h i n g pulp chamber iiiay heal without j^eriodoutal involve-
( l c | ) l h o f 1-2 m m in t h e a r e a o f t h e pcrfdiation. meul, Furtheruiore, the authors show liealiu" iu a

259
Fuss & Trope

fication "fresh" is assoeiated with a perforation at the

same visit, whic h if treated immediately and with an
aseptic technique has a good prognosis. "Old" perfor-
ations are associated with previously untreated acci-
deutal operative procedures where a bacterial infec-
tion may be established.
Small perforations are those which occiu^ with en-
dodontic instruments of size 15 or 20. Since the ma-
chatiical damage to the tissue as a result of these pet^-
forations is minimal and the chance that the perfor-
atioti occurred uuder the aseptic conditions icciuired
of endodontic treatment (rubber dam, sodium hypo-
dilorite iirigation etc.) fairly good, infection is less
likely. For these reasons small perfor;itions are ]Dlaeed
in the good prognosis eategoiy A large perforation
such as that which occurs iu post preparatiou resulls
iu significant tissue damage atid the chances of inlee-
I'lg. ID. a. Radiograph of mandibular canine with a lateral perfor- lion frcMiT saliva or leakage are much greater. 1 here-
ation apparently as a rcsnlt of apical surgery performed on tlie fore, the proguosis in these cases is considered poor.
lateral incisor, Radiolncencies are present on hotli teelh. t). Alter Ill this elassification, the position ofthe perforalion
IH months o( cateium hydroxide therapy, a hard tissue Ijairicr has
in relation to the supporting tissues (and not only its
formed at the pci'foration site ofthe canine allowing ohuirati(jn of
position on the root location) is taken into account
the (anal with minimal exlrnsicjn of giilla-]:)ercha and/or sealer.
(From iVojie M, Tronstad L. Long-term (ahium hydroxide Ireat-
(Fig. 5-7).
ment of a tooth with ialrogenic root perforation and lateral peri- Thus CORONAL=coronal to the crestal bone
odontitis. iMidod Denl Traumatol 1985; 1: 35 8.) and epithelial attaehment atid has a good prognosis.
GRESTAL=at the level of the epithelial attachment
and crestal bone and has a poor prognosis. API-
.similar fashiou in 23 additional lateral root j^erfor- CAL=apical to the erestal bone and epithelial attaeh-
alions (8). According to the graphical illustrations of tnent and has a good prognosis. In Fable 1, lateral is
the publication, it appears that the location of the placed in the good prognosis and fureation iti the
furcation perforatious were apical to the level ol the poor prognosis colutntis since the lurca is usually close
crestal bone. Therefore, it is conceivable that the high to the crestal bone while lateral could be eoronal or
rate of repair reported iu this study is related to the apical as well.
aj:)ical location of ihe perforation, iu addition to the
fact that the time lapse between the occurrence ofthe
Treatment
perforatious aud treatmeut was short, aud thai slriet
asepsis was maiutaitied. Hart well & I'^ugland (11) also Since we choose oin' treatment method based on the
evaluated the repair of iurcatiou perforations in mon- position of the perlbration relative to the crestal bone
keys, aud showed a elinieally high success rate usitig and attachment apparatus it is imperative to accu-
freeze dried bone to fill the bony furcation defect. rately locate the perforation.
Howev^er, e]:)ithelial lissue was seeu betweeu the per-
foration site in the floor of the ]3ulp chamber and
Localization of fhe perforafion
the couueclive lissue layer in evei')' case. The authors
attributed the presence of the epithelium (o the Diagnosis and localization of tJie root perforation is
trauma that occurred during the preparation of the frecjuently a dillicult task. Wheu loeated on the buccal
bony perforation defect, resulting in stimulation oi the or lingual aspects ofthe root, the perforation is super-
periodontal ligament tissue adjaceut lo the perfor- imposed radiographically on the root surface. 'Fhe
ation site. Frotn the radiographs presented in ihe clinician should probe the gingival sulcus to evaluate
paper, it seems that the perforation defects were possible communication with the oral cavity. An apex
located at the crestal bone level, and thus were sus- locator (15,16 ) is helpful in locating the exact position
eeptible to epithelial migration and pocket formation. of the commiuiication with the periodontal ligament.
Once the apex locator has indicated when the peri-
odontal ligament has been reached, it is prudent to
take a radiograph to assess its relationship to the criti-
Classification
cally important level oi" the crestal bone (Fig. 8 e).
'Fhe classification shown in Fable 1 is based on the Generally, nonsurgieal treatment is indicated in the
j)rognostic factors j^reviously discussed. In ihis classi- management of root perforations, while surgieal inter-

260
 Root perforations: classification and treatment

Lig. 11. a. R a d i o g r a p h ol m a n d i h u l a r lirsl m o l a r w i l h o l d a n d l a r g e fnr(ati(Mi p c r f o r a l i o n . The ])rognosis was c o n s i d e r e d iineertain. .\fler

r e m o v a l ol t h e p o s l d i e a r e a w a s i r r i g a t e d g e n t h with saline a n d d r i e d with ( d l l o n |)ellets. ( I h e o l o n S i h c r lvspe', w a s m i x e d o n a slah,
j:)la('ed g e n l l y o n t h e p e r i p h e r y ol t h e dcf(X't a n d u s e d ( | u i ( k l \ ' l o c o v e r t h e d e f e c t u s i n g a s m a l l r o u n d a j i p l i c a l o r , i 2 2 2Ti. The c e m e n t set
w i t h i n live m i i u i l e s a n d s e r v e d a s a n e x ( ( ' l l e n t h a r r i e r l o a v o i d c o n l a m i n a t i o n o r i r r i l a l i o n d u r i n g r e l r e a l m e n t ol t h e r o o t ( a n a l s . h . 1 hree
y e a r s a f t e r i h e r e t r e a l m e n l , t h e r a d i o l i u e t i l arc-a in t h e lure a l i o n h a s he.iK-d in s]iit(~ o f t h e p r e s e i u e o f a s m a l l j i a r l o f d i e p o s t d i a l v\as
pushed iulo die perioflonlal tissues d u r i n g t r e a l m e n l . N o l e i h e glass i o n o m e r ( e m e n i al t h e p e r f o r a t i o n sile. T h e r e is n o c e m e n l in i h e
liir(ation area.

venlion is leserved fbi' cases not ameuable to, or those iouomer cctncnls may be used iu anterior teelh,
that have failed iu respouse to nonsurgieal Ireatuieul whereas amalgam is an additional option in posterior
Ol- w here a concomitaut management of the peri- teeili,
odontivnii is indieated. This section will focus ou con- Crcslal perjoralioiis - Cresial root perforations are the
ser\ati\'e Ireatmeut. uiost difficult to manage beeause ol their ]:)roximity tco
the epithelial attachment, and possible comtninii-
cation with the gingival snleus, \\ ith large crestal per-
Nonsurgieal treatment
foralious whether fiesh or c^ld, surgical inlen'ention
The rationale for uotisurgieal treatment of rool per- will usually be ueeessaiy iu order to seal the defeets
forations is ihe same as that of a conscr\ ali\ c endo- exterually (Fig. 8 a-g). A furtlier possibility is ortho-
dontic ])rocedure, namely, the prevention or lieat- doulic extrusion ofthe toolh to bring the perforation
meut of periradicular iufiammalion. Ihis is to a coronal position where it can be sealed without
achieved by ensuring that the |)erfoi"aiion site is surgical intcr\cntic:)n. However, sitice the differential
either nol infeeled or clisinli-ctecl al the lime of diagnosis of apical and crestal perforations often is
treatmeut, thai llie malerial used to tieat tlie pei'- dilliciih, one should tr\' a uonsurgical a]oproach in un-
foration j^rovides the best possible seal to baeterial certain eases, pro\ided the periodonlinm is healthy.
penetration and thai tlie tnaterial is itself" not irritat- 'Fhe material used for the non-surgical tt^attnetit of
ing tc3 the surroiuiding tissites. 'Fhe following proto- these cases has varied. Amalgam has been used iu the
col for treatinctil ol perforatioiis is based on this l^asl wiih some success (Fig. 9), Any biocotnpatiblc
rationale, and is in accordance wilh the classifi- material, with a short selling time, should be selected
cation presented in this paper. for such cases to minimize the eflect ofthe iniset ma-
lerial on ihe ])eriodoiiial lissue wilh \vhich ii is in con-
tact
1. Lateral perforations
Apical jicrfoyalious Apical perforatious should be
Corona/ /H'r/oralioii.s Coronal root perforations should treated accordiug to routine endodoniic principles fbr
not be difficult tc:) seal externally, aud the material regular root cauals. A uiaiu difliculty usually will be
selected for sealiug will depend on esthetic consider- to access aud adeqtiately treat the main root catial.
ations. Acid elch bonded eomposite resins or glass Apical, small and fresh i)erforalious should preferably

261
Fuss & Trope

a
Fin. 12. a. R a d i o g r a p h ormaii(lil)iilar first m o l a r with old and \i\rs,c furcation ]5rr(oialion. T h e prognosis was regarded as uncc-rtain bccau.sc"
no ]:)r()l)ing lo llic liu'cation was di'iei ted. Vhv a m a l g a m was gently r e m o v r d t l n o u g h the root canal and the large pcifoiation was scaled
in the m a n n e r described in Fig. I I . IJ, 30 m o n t h s following treatment repair in (he lurcation is evident. Note tha( the material has not
been p u s h e d into the p e r i o d o n t a l tissues in sjjitc ol the large extent of the ])erforation.

/')X'. /.V. a. Radiografjh of m a n d i b u l a r lirst uiular NAIIII old and large IUK ation pcrl()i ation. 'ITic progn(;sis for conscr\ atixc trcaimcnt is p o o r
because of the presence of a periodontal pocket atid ])robing (o ihc (uicatioti atca. b. i l a d i o g r a p h taken three years alter removal of the
mesial rf)(>t . 1 he distal I'oot is a s y m p t o m a t i c and is used as a brtdgc a b u t m e n t .

be completed in one visit, and the perforation scaled Apical, large and old or fresh perforations should be
witb gutta-pcrcba and root canal sealer. Tbe use of treated like leetb witb immature apices i.e. witb long-
an aseptic tecbniquc is essential. Apical, small and old term calcium hydroxide treatment. Calcium hydrox-
perforations have to be treated witb an antibacterial ide is used as an intracanal medicament for several
intracanal medicament sucb as calcium hydroxide, montbs until a bard tissue barrier is forniecl and reg-
and sealed with tlic main canal at the second visit. tilar root canal obttn^alion can be carried out (Fig.

262
 Root perforations: classification and treatment

10). In cases where tbe original catial is tiot accessible, pcudcut ou the preveutiou or trealmcut of iuicctiou
and apical pcriodonlitis develops, root end resection of ibc peribratiou site. 'Fbis pajscr bas aUicmplcd lo
is indicated. classiiy rool perforatious according to prognostic fac-
tors. Using ibese prognostic factors, treatment choices
2. Furcation perforations arc suggested wiiicb wili resuit iu the iiigbesl success
rate ibr tiiese dillicitll diuical cases.
Perforations of the furcal region of molars are es-
pecially troublesome because they cause considerable
mechanical damage and frequently lead to communi-
cation witb tbe sulcus. Ncvcrtbcless, Beavers et al. (8) References
have dcmonslraled the ]Dotcnlial ibr healing of peri- 1. GuTM.\NN j L , H.vRiitsoN JW. Surgical l'.ndodontics. Boston;
odontal tissues surrounding iitrcalion peribrations, Blackwell," 1991; 409 22. "
provided adequate treatment is rendered. Apical- 2. INGLE J I . Endodontics. '.]\x\ cd. i'hiladdphia; i_.ca & l-Vbiger,
small furcation perforations, if sealed l)y a last setting 1985; 35 7.
3. KvtNNSLANO 1, OSWALD RJ. HALSK A, GRONNi\'GS.\F;rER AC!.
material will bave a iavorable prognosis. However, Cllinical and rocntgcnological study of 55 cases of tooth jicrfor-
large furcation perforations make control of the repair ation. till Endod J 1989; 22: 75-84.
material clifTicult, and extrusion of the filling material 4. SELIZKR S, BENDER IB, SMITH J, FREEDLANt) I, NAZEMO\' H .
into tbe periodontal ligament space is common. Dif- lMidodontic faiknrs; an analysis based on clinic al radiographic
ferent materials have been used experimentally to seal and histologic findings. Oiid Sing Oral Path Oral .\ted 19()7; 2J:
500 30.
large furcation perforations. Grossman (17) found 5. BALLA R , LoMoNAeo C | , SRRIBNKR J, LIN L M . Histological
amalgam to be a ia\'orablc material, aud it is still study of furcation perforations treated with tricalcinm plio.s-
widely itscd for tbis jDurposc. Aguirre et al. (18), sug- ])hatc, hydro\ylai)atitc. amalgam, and Life, "j Endod 1991; 17:
gests the use of indium foil for tbe repair of extensive 234 H.
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