Fig. 1

Initial Appearance

Referred Patient, 32 yo, 1.4 Chronic Apical Abscess

Fig. 2

Pre-operative X-Ray

Presence of the sinus tract next to the maxillary tooth on the right. Previously treated a week ago with unsuccessful attempts to finish the root canal treatment. 

Diagnostic radiograph revealed the periapical radiolucent area. Tracing pointed the source of the sinus tract. 

Fig. 3

Pulpal floor examination 

3 suspected pulpal floor perforations   

Obliterated true orifices

Fig. 4

True Orifice opening with carbide long-neck bur

Fig. 5

Cleaning and Shaping of the root canal system

Revealing of the Perforations

Cleaning and Shaping of the root canal system

Final irrigation with 5.25% Sodium Hypochlorite and 17% EDTA

Final Appearance of the pulpal floor

Fig. 6

Root canal filling (X-Ray control)

True Buccal & Lingual Canals - Continuous Wave Compaction 

«Dead End» false Canal - Injection Molded Technique

Fig. 7

MTA plugs & Thermafil carriers 

Predictable placement of the MTA apical plug in long curved canals with plastic carriers

Fig. 8

MTA plugs & Thermafil carriers (Advanced Technique)

It is convenient to use special Endodontic file holder to facilitate the manipulations under the microscope 

MTA plugs & Thermafil carriers (Advanced Technique)

Easy controlled apical placement of the MTA plug

Fig. 9

Final appearance of the pulpal floor

Fig. 10

X-Ray control 

Fig. 11

10 m Follow-up

Fig. 12

1999: Graduated in Dentistry from the Ukrainian Medical Stomatological Academy - Faculty of Dentistry

1999-2001 - Postgraduate Education (UMSA)

2001-2012 - Professor Assistant - Department of Therapeutic Dentistry (UMSA)

2012-2019 - Professor Assistant - Department of Postgraduate Education of Dental Practitioners (UMSA)

2011: PhD in Dentistry (Ukrainian Medical Stomatological Academy)

2023 until now Associate Professor at The Department of Dentistry – School of Medicine - V.N.Karazin
              Kharkiv National University 

Private Dental Practice - Dental Centre “Machaon” (Poltava, Ukraine)

Founder of the Educational Centre EndoDiscovery

Past-President of the Ukrainian Academy of Esthetic Dentistry

Board Member of the Ukrainian Endodontic Association

Member of the Ukrainian Endodontic Society

Member of International Jury of Dental Restorative Contest ”Prisma-Championship”

Board member of the International Journal “Ukrainian Dental Journal”


Placement of the traditional MTA plug in a long curved root canals makes it quite challenging for the operator. 

Success or failure depend on the ability to access the perforation area and promote an appropriate sealing. 

Visual control of every single manipulation under the operational microscope gives the is the crucial factor in daily endodontics


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  2. 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:
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