What do you do when you see a root perforation?  Does that usually mean “non-restorable” to you?  We learned before that the variables that affect a root perforation are TIME, SIZE and LOCATION.

      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.

If I followed all the rules in life, I would get nowhere.  Here is a tooth story that proves that you just shouldn’t give up!  This tooth was previously treated and had a furcal lesion. Again, some people may jump to the conclusion that this tooth is cracked.  But, what else could it be?

What about a perforation from that post?

Could it be leakage from the open margins? Or both?

I want to train you to start thinking differently and beyond the easy diagnosis.

There was a draining sinus tract, so I was able to make the diagnosis, Previously Treated and Chronic Apical Abscess #19.

This case was done in my pre-CBCT days so I don’t have a CBCT to show you.  But, that’s actually some good news, because you don’t need a CBCT all the time and the traditional methods work just as well.  The only thing I knew how to do then was to disassemble the tooth and look with my microscope.  And once I removed the post, I could see the etiology with my own four eyes!

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! All I can say is that we need to give teeth a chance.  And if you feel like something like this is out of your wheelhouse, then 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!

-Sonia

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