Surgical management of iatrogenic root perforation following endodontic therapy

Endodontic mishaps still occur despite technological advancements in the field of dental instrumentation and materials. Iatrogenic root perforations during access preparation, canal instrumentation or preparation of post space are not uncommon, and instrument fractures during filing or reaming, as well as root fractures during condensation, are also encountered. Many of these mishaps are hard to avoid because of the extreme variability in root canal anatomy, canal calcification, abnormal root shapes and curvatures. They occur most often during access preparation, root cleaning, shaping and preparation of post space, or when attempting to bypass fractured instruments. Procedural errors impede endodontic therapy, thus increasing the risk of treatment failure, especially in teeth with necrotic pulps and periradicular lesions. Clinicians often have difficulty diagnosing and treating root perforations and the treatment of such mishaps is very difficult, especially in posterior teeth and in the area of the mandibular furcation. We report on a case of root perforation in a mandibular first molar that was successfully treated by surgery without the use of additional biomaterials.