Fig. 1

A 32-year-old patient was referred to our dental office for endodontic re-treatment. Previously initiated treatment. History of a few endodontic interventions. 4.6 with old chipped MOD composite filling. Presence of the sinus tract on the buccal aspect. Diagnostic radiograph showed radiolucent lesion in periapical and furcal area (perforation suspected) of 4.6. Percussion painless, periodontal probing within normal limits. The Endodontic plan was to perform non-surgical root canal re-treatment with repair of the perforation with the use of MTA cement.

Initial appearance: Panoramic radiograph

Referred patient, V., 32 yo, female

4.6 Chronic Apical Abscess

Furcal Perforation
Sinus Tract

Fig. 2

Objective appearance

Diagnostic Periodical Radiographs

Fig. 3

1st appointment

Local Anesthesia, Isolation, Initial access, Desobturation, Gaining patency. Chemo-mechanical root canal preparation, MB/BL confluent, MAF 30.04, D - oval shape, MAF - 80.02. Pulpal floor perforation revealed next to MB orifice. Multiple irrigation with 5.25% sodium hypochlorite solution with ultrasonic agitation, finished with calcium hydroxide dressing for 10 days.

Fig. 4

2nd appointment

Asymptomatic. Sinus tract healing. Local Anesthesia, Isolation, Access, Copious Irrigation with 5.25% Sodium Hypochlorite, 17% EDTA + US agitation. Filling of root canals: MB/BL - continuous wave compaction, D - MTA plug. Perforation: periapical matrix (gelatin sponge), MTA plug. 

Fig. 5

2nd appointment

Root canal filling: MB/L - Continuous wave compaction

Radiographic control

Fig. 6

2nd appointment

Perforation repair: Placement of periapical matrix (gelatin sponge)

Fig. 7

2nd appointment

Perforation repair: Placement of MTA plug over perforation site
Distal canal: MTA plug

Radiographic control 

Fig. 8

1,5 y recall: Complete healing of the periapical lesion and bone defect in perforation area 

Fig. 9

About the author:

Stanislav Heranin

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”


Hydraulic Calcium Silicate Cements (MTA / Bioceramics) used as an apical barrier and perforation repair material are the primary materials of choice at present due to high biocompatibility and high sealing properties.


  1. Torabinejad M, Corr R, Handysides R, Shabahang S. Outcomes of nonsurgical retreatment and endodontic surgery: a systematic review. J Endod 2009;35:930–7 
  2. Gorni FG, Gagliani MM. The outcome of endodontic retreatment: a 2-yr follow-up. J Endod. 2004 Jan;30(1):1-4. doi: 10.1097/00004770-200401000-00001. PMID: 14760899.
  3. Torabinejad M, Parirokh M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications. Int Endod J. 2018 Mar;51(3):284-317. doi: 10.1111/iej.12843. Epub 2017 Oct 11. PMID: 28846134.
  4. Castellucci A. The use of mineral trioxide aggregate in clinical and surgical endodontics. Dent Today. 2003 Mar;22(3):74-81. PMID: 12705015.
  5. Nazeer A, Nazir A, Manzoor SA, Khan MA, Shaukat Z, Saleem M, Sajid M, Kashif M. Efficacy of Mineral Trioxide Aggregate (MTA) as a Reparative Material in Iatrogenic Furcal Perforations in Mandibular Molars. Cureus. 2024 Jan 29;16(1):e53206. doi: 10.7759/cureus.53206. PMID: 38425600; PMCID: PMC10902626.Bains R, Bains VK, Loomba K, Verma K, Nasir A. Management of pulpal floor perforation and grade II Furcation involvement using mineral trioxide aggregate and platelet rich fibrin: A clinical report. Contemp Clin Dent. 2012 Sep;3(Suppl 2):S223-7. doi: 10.4103/0976-237X.101100. PMID: 23230369; PMCID: PMC3514927.
  6. Nagmode P, Janbandhu P, Jagtap A, Basatwar H, Godge S, Shinde S. A scanning electron microscopic study evaluating the sealing ability of MTA, BiodentineTM, and new light-cure MTA used for furcal perforation repair. J Clin Exp Dent. 2023 Jan 1;15(1):e32-e37. doi: 10.4317/jced.59755. PMID: 36755683; PMCID: PMC9899359.