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A 43-year-old male reported with pain and swelling in the maxillary anterior region as a result of iatrogenic perforation of his right maxillary central incisor tooth. After attempted internal repair, surgical management was required due to repair material extrusion. Removal of the extruded material preceded repair of the perforation site with biosilicate cement which had a short initial setting time. The set repair material then allowed Guided Bone Regeneration (GBR) to be performed to reduce the risk of recession in a single surgical process. At 24-month recall, the patient was asymptomatic with no clinical or radiographic evidence of ongoing disease. Additionally, the patient presented with excellent aesthetics after surgical management.
CPD/Clinical Relevance: Comprehensive management of endodontic perforations, especially in the anterior dentition, should stretch beyond tooth survival and include the need to maintain and improve the patient's aesthetics.
Article
A lateral perforation is an iatrogenic injury that may occur during endodontic treatment. Such perforations are artificial openings in the root canal wall that result in a communication between the pulp space and periodontal tissue. Although a perforation may occur due to resorption processes or caries, the most frequent cause is iatrogenic in nature. Planning for endodontic access should be as precise as possible.1 When this is not the case, it may occur during access preparation, instrumentation of the root canal anatomy or during post space preparation. This may predispose to hypochlorite accidents, cause inflammation of the periodontal tissue, infection and eventual loss of the tooth.2
The management strategy for perforations depends on a number of factors, including perforation size, accessibility of perforation, periodontal condition, patient motivation, strategic importance of tooth, quality of the root canal therapy and operator factors, including experience. The main options for treatment are:
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