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Case Report: Overhanging Fillings in Restorative Dental Treatments and

Endodontics

Article  in  International Journal of Science and Research (IJSR) · November 2017

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 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391

Case Report: Overhanging Fillings in Restorative

Dental Treatments and Endodontics
Caner Selami Güner1, Pınar Yılmaz Atalı2, Faik Bülent Topbaşı3
1
PhD Student, Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, İstanbul, Turkey
2
Associate Professor, Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, İstanbul, Turkey
3
Professor, Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, İstanbul, Turkey

Abstract: Conservative dental treatments and endodontic treatments constitute a large portion of the operative professional practices of
dentists. Operative dentistry involves risk of complication by its nature. However, inappropriate or careless approaches of dentists in
some cases may result in undesired outcomes such as malpractice. One of the most frequently seen malpractices in conservative
dentistry and endodontics is overhanging filling. Two cases are presented in this paper as examples to the clinical conditions
overhanging fillings may lead to. Information was provided also on treatment processes and follow-up statuses of the patients.

Keywords: Overhanging filling, localized periodontitis, radicular cyst, malpractice

1. Introduction emerge in patients due to the overhanging material and the

relationship of the treated tooth with anatomic formations.
Overhanging fillings constitute a part of malpractice cases Besides the specified dimensions to be worked on, the
encountered in conservative dentistry and endodontics. We ingredients of the material overhanging from the root canal
will discuss in this study the treatment approaches for two system are also important for the severity of the clinical
cases involving overhanging fillings from restorative and condition that may occur (5). Studies and case reports have
endodontic viewpoints. pointed out that a part of the canal filling materials that
overhang from the canal system fails to resorbe and causes
While restorations closest to natural contours can be cystic formations, aspergillus infections, pain, swelling,
achieved owing to the innovations in the matrix systems in paresthesia, or hypoesthesia in the neighboring anatomic
restorative dentistry, the detection of margin misalignments regions (7).
has also become easier with the widespread use of advanced
diagnostic radiographies (1). Despite all these 2. Cases
developments, overhanging margins of restorations still
exist. The misaligned end margins at the places of 2.1. Case 1:
connection of the tooth and the restoration affects
periodontal health negatively. Moreover, a positive Unsuccessful restoration of the tooth numbered 25 with OD
relationship has been reported between the degree of bone cavity due to overhanging filling.
loss and overhanging margin (2). It becomes more difficult
to remove an overhanging margin plaque of a tooth if it has A 30-year-old female patient presented to our clinic with
a periodontal disease. Alongside misalignments of a complaints including local pain, bleeding diathesis, and
restoration, the properties of the restorative material used halitosis. Her intraoral and radiographic examinations
are also associated with periodontal disease and advancing revealed that the cause of her complaints was the OD
tooth decay (3). The treatment approach for repairing amalgam restoration with overhanging contours in her upper
misaligned contours involves reconstruction of the left second premolar tooth (Figure 1).
unsatisfactory part of the restoration or renewal of the whole
restoration (4).

Overhanging canal filling is the most commonly seen

malpractice after a root canal treatment (5). Overhanging
canal filling is the overlapping of gutta-percha or canal path
with periapical tissue. Patient complaints disappear in a
short time in the root canal fillings that were finished in an
overhanging way using resorbing canal filling materials.
However, non-resorbing filling materials may lead to
various complications. The preparation of a root canal and
the filling stages of it then become important for the success Figure 1: Inıtıal panaromic graphy to oral diagnosis
of the endodontic treatment. Correct determination of the
root canal dimensions is the first step in endodontic success The overhanging amalgam restoration, which was not in
(6). Overhanging biomechanical preparation or overhanging alignment with the natural contours of the tooth and the
filling affects the prognosis adversely. Some symptoms may periodontal tissues in the interproximal region, was thought
Volume 6 Issue 11, November 2017
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Paper ID: ART20178257 DOI: 10.21275/ART20178257 1194
 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391
to result in periodontal complaints by causing plaque The anamnesis of a 15-year-old male patient who presented
retention and foreign body reaction. to the clinic complaining about a swelling at his left anterior
maxillary region revealed that a swelling occurred at his left
As a treatment approach, we decided to replace the anterior maxillary region 3 years after he had suffered a
overhanging contoured OD restoration with a composite trauma at the age of 9. He consulted a dentist due to this
restoration that is in alignment with the periodontal swelling and the dentist administered a canal treatment to
structures and has natural contours. While replacing the his left maxillary central tooth. The radiological and clinical
filling, pulp perforation occurred and its endodontic examinations we carried out in our clinic showed that there
treatment was completed in the same session (Figure 2). The was an overhanging gutta-percha in his left maxillary central
restoration above the canal was completed with a composite tooth and a radicular cyst affecting his central, lateral and
material (Spectrum TPH3, Dentsply Maillefer, Ballaigues, canine tooth (Figure 5).
Switzerland) and a total-etch adhesive system (Prime &
Bond NT , Dentsply Maillefer, Ballaigues, Switzerland).
The polishing (OptiDisc, Kerr, Canada) procedure was
completed in the same session (Figure 3).

Figure 5: Initial Panaromic Radiography

Considering the etiology of the occurrence of a radicular

Figure 2: Root Canal Treated Number 25 cyst, we can hold responsible the assessment of post-
traumatic symptoms without taking radiography and the
overhanging canal filling material used in the treatment.

The treatment started with the removal of the overhanging

gutta-percha, extirpation of the canine’s pulps and
biomechanical preparation of the effected 3 teeth. K- and H-
type stainless steel canal files (Mani, Japan) were used.
Sodium hypochlorite irrigation was performed after each
filing procedure and calcium hydroxide dressings were done
in 2-week periods until the surgical operation where
cystectomy and apical resection were to be performed. Two
months after starting the treatment, the canal fillings were
Figure 3: Natural Countered Coronal Restoration
completed using gutta-percha cones (Dia-Dent ML o29,
Republic of Korea) and Endomethasone N (Septodent,
During the 3-month follow-up of the patient, the composite
France) by way of the lateral condensation of the canal path
restoration in alignment with the periodontal tissues was
method.
observed to enable protection of the patient’s oral hygiene,
resulting in the elimination of local periodontal complaints
After finishing the endodontic treatment, the cystectomy and
(Figure 4).
apical resection procedures were applied and the teeth were
apexificated retrogradely with MTA (Proroot, Dentsply
Maillefer, Ballaigues, Switzerland) (Figure 6).

Figure 4: Oclusal View of The Coronal Restoration

2.2. Case 2
Figure 6: Control Panaromic Radiography after Cyctectomi
Unsuccessful treatment of a radicular cyst that occurred due
to a trauma in the left maxilla, which affected the central,
lateral, and canine tooth.
Volume 6 Issue 11, November 2017
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Paper ID: ART20178257 DOI: 10.21275/ART20178257 1195
 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391
During the 3-month follow-up after the operation, a important in solving this type of a problem. Generally,
reduction in the extraoral swelling of the patient and an renewal of a poor restoration is the best intervention, but if
increase in opacity indicating osseous recovery in the the overhang is at a minimal level and reachable, cheaper
radiolucent area in the radiography were observed showing alternatives such as correcting the overhang or performing a
both clinical and radiographic remission (Figure 7). marginal repair can be preferred. After assessing the
magnitude of the overhang in the amalgam restoration,
marginal misalignments and unaesthetic appearance of the
tooth, it was decided to change the tooth color with a
composite restoration. A secondary decay was detected
during the treatment and pulp perforation occurred while the
decay was being cleaned. For this reason, the composite
restoration was performed directly after the canal treatment.

3.2. Case 2

The success of an endodontic treatment depends on various

factors including correct diagnosis, proper entry to the root
canal system, adequate biomechanical preparation, and
obturation of the root canal system (12)(13)(14). It is
understood from the patient’s anamnesis that the necessary
radiological and clinical examinations were not performed
at the clinic to which he presented after the trauma.

Panoramic and periapical radiography is an important

method in planning the dental treatment (15, 16). Two
dimensional imaging methods have disadvantages such as
lost details due to superposition and malocclusion.
Figure 7: Three-month Follow-up X-ray
Panoramic x-ray, on the other hand, is an important imaging
method in determining vertical bone level and diagnosing
3. Discussion decays and periodontal diseases (17). Panoramic x-ray is the
most widely used imaging method when routine clinical
3.1 Case 1 examinations are being performed (18). In this case where a
diagnostic x-ray was not taken, endodontic treatment was
Pain is an important physiological function for the organism applied under suboptimal conditions, to a tooth whose
(8). Pains originating in the inner mouth can be felt at other apexification did not materialize. The overhang of the gutta-
intraoral regions as well as at neighboring regions outside percha used after an inappropriate biomechanical
the mouth. Mostly originating from the pulp, pain may preparation could be clearly seen in the diagnostic
spread to the teeth or other regions, or just the opposite may panoramic x-ray taken in our clinic.
occur; systemic diseases or soft tissue diseases may cause
pain in the chin and even in the teeth (9). The cause of We decided on the treatment plan after vitalometric
localized and moderate periodontitis is the overhanging examinations of the teeth involved in the radicular cyst
filling edges or tooth decays that result in local plaque lesion and the teeth numbered 11, 12, and 13 were included
retention (10). Pack et al.4 detected 74% of all aproximal in the treatment plan because they had necroses. There are
overhanging fillings with the radiographic method and 62% evidences that, in the presence of irregular apical narrowing
of them clinically and reported that their knowledge and broad periapical lesions, filling the roots, which were
suggested that both of these diagnostic methods should be apexificated hermetically using gutta-percha, with MTA
used together. An anamnesis assessed without using retrogradely after cystectomy results in a more successful
radiography may lead to an error in the diagnosis of the recovery (19). In this case, we performed cystectomy, apical
dentist resulting in implementation of pulp-related resection, and retrograde MTA following the endodontic
procedures for the purpose of relieving pain. The clinical treatment of the teeth.
complaints of our patient indicated a localized periodontal
ailment and the assessment of the panoramic x-ray taken
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Volume 6 Issue 11, November 2017

www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Paper ID: ART20178257 DOI: 10.21275/ART20178257 1196
 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391
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Author Profile
Caner Selami Guner graduated in 2010 from
Marmara University, Faculty of Dentistry. After the
graduation he was accepted to PhD program to
Restorative Dentistry Department in Marmara

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Paper ID: ART20178257
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