Fig. 1

A 60 years old male patient was referred from a general Practitioner to my clinic for management of furcal perforation and root canal treatment.

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

Tooth 36 presents an iatrogenic furcal perforation , obliterated pulp canal, asymptomatic apical periodontitis and physiological probing. 

We explain the situation to the patient and decide on a non-surgical approach under surgical microscope.

Fig. 2

Initial situation: We remove temporary cement and cotton using a Ultrasonic Tip

Fig. 3

Once the temporary filling was removed, poor furcal perforation sealing was found (possibly MTA). We decided to clean and seal it again under a surgical microscope.

Fig. 4

A tapered ultrasonic tip was used to remove the old MTA. In this image we can see the perforation located between the mesial canals.

Fig. 5

After cleaning the perforation, we temporarily sealed it with sterile Teflon and proceeded to the location and instrumentation of the root canals. In this image we can see how the confluence is cleaned by a continuous flow of irrigant (5.25% sodium hypochlorite). 

The following protocol was used in root canal treatment:

Glide Path ; #08 C+, #10 C+

Preflaring ; Proglider File

Instrumentation ; Protaper Next X1, X2 

Irrigation; Sodium hypochlorite 5,25% + Saline Solution+ Edta 17%  PUI + sodium hypochlorite 5,25% PUI

Obturation; Continuous Wave   + Conform Fit #25 *+ AH

Fig. 6

This image shows the situation before root canal filling.

Fig. 7

Downpack x-ray

Fig. 8

Root canal filling with continuous wave of condensation of gutta percha.

Fig. 9

Collagen matrix was placed in the perforation to prevent mta extrusion.

Fig. 10

To seal the perforation, MTA was used. It was placed with the MAP System (Produits Dentaires SA, Vevey, Switzerland), which allows us a simple and predictable use of bioceramic cement.

Fig. 11

Image of repaired furcal perforation and root canal treatment performed

Fig. 12

Final Orthoradial xRay

Fig. 13

Final Mesioradial xRay .

Full case video


We can conclude that the non surgical approach is predictable, conservative and with su cess rates above 70%.

In view of the relatively high rate of clinical success, nonsurgical repair may be considered as the preferred treatment to handle this complication that arises during root canal therapy. We consider that the use of the magnification and the MAP System Kit are of great help in handling these cases.


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Sinkar RC, Patil SS, Jogad NP, Gade VJ. Comparison of sealing ability of ProRoot MTA, RetroMTA, and Biodentine as furcation repair materials: An ultraviolet spectrophotometric analysis. J Conserv Dent. ; 2015;18(6):445–8. 

Parirokh M, Torabinejad M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: An updated overview - part I: Vital pulp therapy. Int Endod J. 2017;1–34.