A case report on Nonsurgical Retreatment and Iatrogenic Perforation Repair Using Mineral Trioxide Aggregate

Introduction: Most root canals fail mainly due to micro leakage and bacterial infection. The presence of new or persistent periapical radiolucency adjacent to a root filled tooth is often used as a criterion for endodontic treatment failure. Most common causes of endodontic failure are incomplete obturation, inadequate coronal seal, missed canals, iatrogenic events like instrument separation, and lateral perforations. Perforations during endodontic procedures are cited as the second greatest cause of treatment failures. These perforations can be managed surgically or non- surgically depending on various factors such as accessibility and visibility, duration and size of perforation, periodontal status, and the quality of root canal treatment, the strategic importance of the tooth, the patient’s oral hygiene, and the operator’s experience.

Case Presentation: A 32 year old female patient reported to the department, with a chief complaint of discolored front tooth associated with mild pain on chewing/biting. The patient gave a history of trauma 5 years back and had undergone root canal treatment 3 years back. Standard isolation procedure with rubber dam was followed. Coronal access opening was refined and cleaned.

Aims: The purpose of this case report is to describe an endodontic retreatment and nonsurgical management of large periapical radiolucency in a maxillary central incisor with coronal third perforation managed successfully with MTA-Angelus without matrix. Esthetic was restored using all ceramic crowns in anterior teeth.

Conclusion: Six months, one and 2 year follow-up appointments showed no signs of infection and tooth remained asymptomatic. Radiograph showed evidence of osseous repair with resolution of periapical radiolucency, reparation of periradicular tissues, and deposition of cementum over MTA at the perforation site. Despite a perceived poor prognosis, present case report showed good clinical results, and therefore the technique appears promising.