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Iatrogenic perforations represent one of the most biologically challenging complications encountered in endodontic practice, particularly when they occur at the pulpal floor of molar teeth. These defects compromise the structural and biological integrity of the root canal system, establishing a direct pathway for microbial ingress into the periodontal tissues and significantly influencing prognosis if not managed appropriately.
Contemporary endodontics has evolved from traditional, often aggressive approaches to a more conservative, biologically driven philosophy that emphasises preservation of tooth structure and optimisation of healing. Within this context, minimally invasive repair strategies—supported by advanced biomaterials and enhanced visualisation—have redefined the management of such complications.
This chapter presents a detailed clinical narrative of a referred mandibular first molar (tooth 36) exhibiting a pulpal floor perforation, managed using mineral trioxide aggregate (MTA) delivered with precision through the appropriate system. Emphasis is placed on the role of magnification, controlled material placement, and adherence to the principles of corrective root canal therapy. The clinical workflow, biological rationale, and key procedural considerations are explored in depth, supported by current evidence and contemporary clinical insights.

In the world of endodontics, the line between a routine procedure and a clinical "detour" can be incredibly thin. Whether it’s a stubborn calcified canal or an unexpected instrument fracture, mishaps are less a sign of incompetence and more a reflection of the biological and anatomical complexities we face daily.

The major challenge associated with endodontic treatment of teeth with open apices is achieving a three-dimensional fluid-tight seal of the root canal system. In the absence of a natural apical […]

External inflammatory resorption (EIR) is present on the external surface of the root of majority of the teeth diagnosed with chronic apical periodontitis. EIR also affects teeth that suffer severe […]

Retreatment are always a challenge. One of the most difficult things is to manage ledge or/and perforation into a canal. When we have to work inside the canal the use […]

This article showing the Management of Dens Invagenatus of upper lateral incisor with large periapical lesion.

MTA is a bioactive cement that has gained immense popularity in endodontic treatments. It is composed of tricalcium silicate, dicalcium silicate, and bismuth oxide.  MTA possesses unique characteristics that make […]

Root resorption is a pathological process that may occur after surgical mechanical, chemical or thermal insult. Generally, it can be classified as internal and external root resorption. Depending on the […]

The purpose of this article is to explain all the phases to do in a correct way an apical plug. Today on the market there was a lot of material […]

Perforation is an iatrogenic communication that is formed between the tooth and supporting tissues.
It is important to manage perforations as soon as they are diagnosed.
An ideal peforation repair material is Mineral Trioxide Aggregate.

Perforation repair with MTA

The size of pulp exposure and the presence of spontaneous pain were significant criteria for treatment decisions in traditional direct pulp capping procedures. Direct pulp capping was considered viable when the pulp exposure size was 1 mm or less, and the patient did not experience spontaneous pain. Root canal treatment was routinely treatment choice in cases that did not meet these criteria. However, in light of contemporary insights from the literature, a new classification of pulp conditions has emerged. Consequently, this has led to a shift in our range of indications, predominantly favoring vital pulp treatments.