Iatrogenic Root Perforations: Case Report

Abstract

Root perforation, a connection between the root canal system and tooth surface, is a common cause of endodontic therapy failures. Caused by pathological conditions or operative errors, it can occur during access cavities, root canal preparation, or post-preparation. A 28-year-old patient was diagnosed with a vestibular medium-sized infra-osseous perforation during root post realization. Despite no systemic disorders, the patient showed physiologic movement and was slightly sensitive to pressure. A flap surgical treatment was chosen to remove excess material and enable tissue regeneration. Biodentine® was used to prevent future discolorations. The patient underwent an intrasulcular incision, flap raised, cavity cleaned, disinfected, revised, and sealed using an anterior Schilder plugger. Root perforations are common errors caused by factors like anatomy, caries, pulp calcifications, and intracanal posts. Diagnosis is based on clinical signs, radiographic examinations, and imaging techniques. The prognosis depends on preventing bacterial infection. The ideal reparation material should stimulate bone formation, be biocompatible, maintain sealing, and not disintegrate in tissue fluid. Equivalent materials like Biodentine® offer advantages in protocol, antibacterial power, and bioactive properties. Radicular perforations, a significant dental issue, can be prevented through early management using modern techniques and clinical training, ensuring long-term success in endodontic treatments.