Fig. 1

A 30 years old male patient was referred from a general Practitioner to my clinic for management of furcal perforation and root canal retreatment.

After a clinical and radiographic examination, we observe the following : 

Tooth 46 presents double iatrogenic furcal perforation , poor endodontic treatment, asymptomatic apical periodontitis and physiological probing. 

We decide to perform a non-surgical approach under surgical microscope. The patient was informed of the pros and cons of the treatment and signed the informed consent.

1.1. Pre-operative X-ray 

1.2. Pre-operative CBCT

1.3. Pre-operative Image

Fig. 2

Acces Cavity was redefine and the chamber floor cleaned using ultrasonic tips. 

Fig. 3

The Root Canal System was prepared and disinfected with rotary files and iatrogenic perforations were located and disinfected. 

Fig. 4

Intracanal medication (calcium hydroxide) was placed for 15 days to improve the bacterial environment.


    4.1. Pre-operative X-ray

    4.2. Intracanal  X-ray

Fig. 5

Iatrogenic perforations were temporarily sealed with sterile Teflon (to avoid contamination by sealer and gutta-percha) and root canal retreatment was performed.

Fig. 6

The entrance of the canals was sealed with composite before to perforation management.

Fig. 7

6.1. The margins of the perforations were enlarged and cleaned with ultrasonic tips to remove contaminated tissue.

6.2. Collagen matrix was placed into the perforation to avoid extrusion of the bioceramic material.

Fig. 8

7.1. Iatrogenic perforations were sealed using Neo-Mta and the Maps system as carrier.

7.2. Glass ionomer was used to protect the bioceramic material.

Fig. 9

Final X-Ray

Fig. 10

1 Year recall showing good healing.


In conclusion, root perforations are serious complications that reduce the prognosis of endodontic procedures and can cause tooth loss. The operating microscope facilitates endodontic procedures and reduces the risk of unnecessarily weakening or perforating a tooth in complicated clinical situations. MTA is an excellent material for perforation repair.


1. Gorni FG, Andreano A, Ambrogi F, et al. Patient and clinical characteristics associated with primary healing of iatrogenic perforation after root canal treatment: results of a long-term Italian study. J Endod. 2016;42 (2):211-215.

2. Clauder T. Present status and future directions - Managing perforations. Int Endod J. 2022 Oct;55 Suppl 4:872-891.

3. American Association of Endodontists. Treatment Options for the Compromised Tooth: A Decision Guide .

4. Tsesis I, Fuss Z. Diagnosis and treatment of accidental root perforations. Endod Top 2006;13:95–107.