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The world today is literate enough about the basics of oral health conditions and available treatment options. Due to the availability of many resources on different platforms the urge to retain natural teeth rather than have extractions has increased. Dental catastrophes are sometimes unavoidable in everyday dental practice. The prime motive should be patient benefit while the general dental practitioner (GDP) identifies the risks associated with the case, availability of equipment and enhanced operator skill when deciding to the referral of the patient to a specialist. Most failed root canal treatment cases have one or more associated endodontic errors. This case report presents stepwise management of such a case of iatrogenic perforation that occurred during the initial endodontic management. It emphasizes the significance of evidence-based treatment planning, role of magnification, selection of the appropriate armamentarium for performing root canal treatment, use of bioactive materials that collectively demonstrate peri-apical healing following the repair of endodontic mishaps. It also emphasizes on the importance of recall in such cases where adequate healing can be tracked over a period.
CPD/Clinical Relevance: Knowledge of management of iatrogenic perforations is useful information for clinicians.
Article
Iatrogenic perforation is an unfortunate complication that can occur during the course of endodontic treatment.1 Perforations are artificial communications between the root canal system and the supporting tissues of the tooth or oral cavity that reduce the prognosis for the tooth, and can lead to extraction.2 A study has shown that iatrogenic perforations occur in 2–12% of endodontically treated teeth during the root canal treatment.3
Iatrogenic perforations can happen either during the instrumentation of the root canal or during the post space preparation after the root canal has been prepared.4 The prognosis for a perforated tooth depends on the location of the perforation, the length of time that the perforation is open to contamination, the feasibility of sealing the perforation, and the accessibility of the main canal.5 Although a perforation is known to reduce the prognosis for the treatment, the perforation itself may not cause irreversible inflammation and failure.2 However, when a bacterial infection and/or an irritative restoration material is superimposed on the trauma of the perforation, healing will not take place. If not treated in time, consequences, such as gingival down-growth of epithelium into the perforation area,5 inflammation, resorption and/or necrosis, may result.6,7 Repair of a perforation without peri-radicular inflammation can be carried out provided infection is avoided, and asepsis maintained during the treatment.8
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