Fig. 1

Referred case for management of calcification as he said, and he went to more than one dentist and hey advice him to extract the tooth  

At 1st we requested CBCT For Acurate Assessment

On CBCT : 2 Perfrations " Distal wall in ML Canal , Buccal wall Apically in MB Canal "

Separated inst. in MB Canal

So, we decided to take the risk, manage & try to save it 

Fig. 2

1st : ICM For 2 weeks , then obturation of the Distals " only patent Canals "

Fig. 3

Sealing of Perforation in ML Canal " Distal wall at Cervical area " by Putting the GP Cone in the Canal in order to avoid any sealing material escape in Canal and then blocking it

Application of MTA Using MAP System

Perforation Site " Distal wall at Cervical area related to ML Canal " & Sealing it as we disscussed by Putting the GP Cone in the Canal in order to avoid any sealing material escape in Canal and then blocking it

Application of MTA Using MAP System 

NB: the approximation of the canal and perfo. site

Fig. 4
  • After Sealing the Perforation , ML Canal was Calcified till the apical Portion so, we decided to use US tip " ED6 " to remove the calcificationAll the time , checking the pathway of the canal by xray to avoid any ledge or transportation

    Also , we used Non active St. St. Files " DFinder Files " to Scout the Canal

Fig. 5

Prepartion of the canal till 25/4
Cone fit
Obturation
ICM in MB Canal

Obturation of ML Canal 

Fig. 6

Sealing of the perforation & Obturation of the MB Canal using BC Putty

The Location of perforation & Canal Pathway 

Sealing of the perforation & Obturation of the MB Canal using BC Putty

Fig. 7

Backfilling of MB & Ml Canals Using Thermoplast. GP
GP + MTA + GP = Sandwich Tech.

Tooth restored with Composite resin 

Fig. 8

Personal Data

Data of Birth : 11/9/1994 Place of Birth : Egypt , Luxor Marital Status : Engaged

Nationality : Egyptian

Education

2012 - 2017
BDS 2017 , Faculty of dentistry ,

October 6 University

2019
Indirect Restorations Course

2020
One 2 One Course of Broken INst.

Retrieval

Work Experience

Endodontic Specialist at Kareem Elkabany Dental Clinic Since 2019

Microscopic Practionner Since 2020 at Amin Dental Clinic

Conclusions

An accurate assessment of the clinical and imaging diagnosis, comprehensive knowledge of the anatomy of the tooth and concerning the instruments being used, as well as consistently relying on the operating microscope can provide significant means in order to avoid a troublesome experience and perform the best endodontic treatment possible

Bibliography

1.Gluskin AH. Mishaps and serious complications in endodontic obturation. Endodontic topics. 2005 Nov;12(1):52-70.

2. Torabinejad M. Endodontic mishaps: etiology, prevention, and management. The Alpha omegan. 1990;83(4):42.

3.Clauder T, Shin S-J. Repair of perforations with MTA: clinical applications and mechanisms of action. Endodontic Topics 2006;15:32–55.

4.Management of ledge formation in root canal treatment . Aravind.N, Pradeep.S. International Journal of Current Advanced Research. 2017

5.CohenS, Burns RC. Pathways of the pulp. 8th ed. St Louis: Mosby, 2002

6.Jafarzadeh H, Abbott PV. Ledge formation: review of a great challenge in endodon- tics. J Endod 2007;33:1155–62.

7.Green KJ, Krell KV. Cilinical factors associated with ledged canals in maxillary and mandibular molars.Oral Surg Oral Med Oral Pathol 1990; 70: 490-7.

8.Fabio G. Gorni, DDS  Andrei C. Ionescu, DDS, PhD, Federico Ambrogi, MSc, PhD Eugenio Brambilla, DDS  Massimo M. Gagliani, MD, DDS Prognostic Factors and Primary Healing on Root Perforation Repaired with MTA: A 14-year Longitudinal Study DOI:https://doi.org/10.1016/j.joen.2022.06.005