Management of a case with multiple perforations

Perforation: The prognosis of a tooth with a perforation of the pulp chamber depends on its relationship to the gingival margin, its size, its sterility, the time elapsed before its restoration, the material used, and the sealing quality of the restoration (Lamprianidis, Iatrogenic Injuries).

A woman with diabetes presented for re-treatment of tooth #16. During the removal of the temporary filling material, a large perforation was discovered in the sub-pulpal area, along with two perforations in the lateral walls of the pulp chamber. The root canals were located and treated, calcium hydroxide was placed, and for the perforations, a combination of calcium hydroxide and Cavit was used to facilitate the second session.

In the second session, the root canals were filled, and then, using ultrasound, the temporary material was removed from the perforations. The entire pulp chamber was filled with Biodentine.

The coronal restoration was performed immediately by a colleague, using a standard restoration and covering the access openings.

Eighteen months later, no signs or symptoms were observed. Radiographically, the periapical tissues appear normal, and periodontal probing revealed no pockets.