What do you do when you see a root perforation?

Does that usually mean “non-restorable” to you? It’s important to remember the variables that affect a root perforation are #1 TIME, #2 SIZE, and #3 LOCATION!! So…

  • The longer the perforation has been there, the worse the prognosis.
  • The bigger the perforation, the worse the prognosis.
  • And the more coronal the perforation, the worse the prognosis.

But here’s the thing…if I followed all the rules in life, I would get nowhere. That’s why I want to share this tooth story that supports why you shouldn’t give up! And trust me, the temptation was there. This tooth was previously treated and had a furcal lesion. It was rough.

Some people may jump to the conclusion that this tooth is cracked, but what else could it be? A perforation from that post? Leakage from the open margins? Hell, in some cases it’s both.

I want to train you to start thinking differently and beyond the easy diagnosis. Just because it’s simple doesn’t mean it’s correct.


There was the root perforation, right into the furcation. This root canal was about 10 years old, so this perforation was at least the same age, if not more. Going by the normal rules, extraction at this point would have been the only option. But, I’m the rule breaker! So I disinfected the tooth (because that is always step one) and I repaired the perforation with MTA, obturated, and waited for the followup.

There was the root perforation, right into the furcation.  This root canal was about 10 years old, so this perforation was at least that old.  If I followed the rules, then extraction would have been the only option.  But, I’m the rule breaker!  So I disinfected the tooth (because that is always step one) and I repaired the perforation with MTA, obturated and waited for the followup.

And one year later…

She has her bone back!

What about 4 years later?

It’s still there! Nice and healthy.

We need to give teeth a chance. They want to be better. 

If you feel like something like this is out of your wheelhouse, that’s okay. Do what is right and send it to someone who can save it. My job is just to teach you that anything is possible.

Now go save some teeth!

Empower Yourself,

Sonia

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