Perforation of a tooth during access used to have a poor prognosis, and often led to the extraction of the affected tooth. Fortunately, with modern materials and techniques teeth with perforations can now be predictably saved.
This case was started by a dentist, using the classic access design from the palatal toward the facial. An iatrogenic perforation was created through the facial aspect of the cervical third of the root while searching for the calcified canal. The sagittal view of the cone beam image demonstrates how this orientation for access will inherently lead to this type of perforation. The sagittal view also shows how the more appropriate straight line access is right through the incisal edge.
This tooth was treated in two visits. The perforation was repaired with white MTA, a glass ionomer orifice barrier was placed, and sodium perborate was sealed in the access as a walking bleach technique. An access through the incisal edge in the direction of the long access of the root was used to locate and treat the calcified canal on the second visit.