Q pin Amalgam pin Amalgam

APin amalgams with 1 or 2 mm of amalgam covering pins were

significantly stronger than those with pins exposed.

Q pin

APenetration into the Pulp and perforation of the External tooth Surface

Either penetration into the pulp or perforation of the external surface of

the tooth is obvious if:

1. There is hemorrhage in the pin hole following removal of the drill.

2. Also, if a standard or link series pin continues to thread into the tooth

beyond the 2mm length depth of the pin hole, this is an indication of

a penetration or perforation.

- A pulpal penetration might be suspected if the patient is anesthetized

and had had no sensitivity to tooth preparation until the pinhole is

being completed.

- Radiographs can verify that a pulpal penetration has not occurred if

the view shows dentin between the pulp and the pin. In contrast, a

radiograph showing a pin projecting out side the tooth confirms

external perforation.
1. In an asymptomatic tooth, a pulpal penetration is treated as any other

small mechanical exposure.

2. If the exposure is discovered following preparation of the pin hole,

control the hemorrhage, if any.

3. Then place a calcium hydroxide liner over the opening of the pin hole,

and prepare another pin hole 1.5-2mm away.

4. Although certain studies have shown that the pulp will tolerate pin

penetration when placed in sterile environment, it is not

recommended that pins remain in place.

If the pin were left in the pulp,

1. The depth of the pin into pulp tissue would be difficult to determine.

2. Postoperative sensitivity might occur.

3. Pin location might complicate subsequent root canal therapy.

The ideal treatment of a pulpal penetration for a compromised tooth

generally id endodontic therapy.

An external perforation might to occlusal or apical to gingival

attachment.
 Careful probing and radiographic examination must accurately

diagnose the location of a perforation.

Three options are available for perforations that occur occlusal to

gingival attachment:

1. Pin can be cut off flush with the tooth surface with no further

treatment.

2. Pin can be cut off flush with tooth surface and preparation for a cast

restoration extended gingivally beyond the perforation.

3. Pin can be removed, external aspect of pinholes enlarged slightly and

restored with amalgm.

For perforation apical to attachment

1. Reflect the tissue surgically, remove bone if necessary, enlarge the

pinhole and restore with amalgam.

2. Perform a crown lengthening procedure, place the margin of the cast

restoration gingival to the perforation.

The patient should be informed about pulpal or external perforation, and

the proposed treatment.