Root repair and regeneration after miniscrew root damage

BackgroundRoot damage due to miniscrews can be a potentially serious complication. This case report describes a 21-year-old woman with bimaxillary protrusion and a congenitally missing mandibular left lateral tooth. Miniscrews were placed mesial to the maxillary second premolars.MethodsAfter placement of the miniscrews, it was discovered on a periapical radiograph that a miniscrew perforated the root of the left maxillary second premolar. On discovery of the perforation, the miniscrew was immediately removed and a new miniscrew was placed mesial to the first maxillary molar. The patient did not complain of pain or discomfort, and there was no evidence of inflammation or a periapical lesion. Because the pulp vitality test initially showed the tooth to be nonvital, root canal treatment was originally considered. However, because the source of trauma was removed immediately and only part of the root was affected, the root was simply monitored and root canal treatment was not performed.ResultsAt 10 months after perforation of the root, the tooth started showing vitality; there were positive readings during the third and fourth steps of electric pulp testing. At 2 years 6 months after the root damage, the tooth was completely vital, showing positive pulp tests during all four steps of the electric pulp testing. Additionally, the fractured part of the root embedded within the bone, reinstating a sound root form. Three years later, the root continued to demonstrate complete pulp vitality.ConclusionDespite root perforation extending into the pulp and causing root fracture, after immediate removal of the miniscrew, the damaged root repaired itself and regenerated without invasive treatment.