Non-Surgical Management of Iatrogenic Perforation in Mandibular Molar Using Mineral Trioxide Aggregate Followed by Composite Onlay: A Case Report

Abstract

One of the most common iatrogenic during endodontic is a perforation, especially furcation perforation on the molar. Perforation creates an artificial communication between a root canal and periodontal tissue, which could lead to pulpal inflammation extends to the periodontium. Management of perforation is a challenging task for clinicians’ inconsideration of poor accessibility and visibility. This case report aims to present a case of furcal perforation treatment by a non-surgical approach. A 24-year-old patient was referred to the Conservative Dental Clinic Prof. Soedomo Dental Hospital to continue root canal treatment on a mandibular first molar (36). The patient had been treated by two dentists before. Clinical examination showed a black area on the floor of the pulp chamber. The radiographic examination showed a little radiolucent area in the furcal region of tooth 36. The palpation test did not reveal any tenderness with no mobility but had percussion pain. An artificial wall was built on the distal wall. Root canal treatment was done by a rotary file with the crown down technique on three canals. Furcation perforation was treated under endodontic microscopic. Mineral trioxide aggregate (MTA) was placed on the perforation by using the MTA carrier. After MTA has set, bulk-fill and fiber-reinforced composite were placed on building up the cavity. Final restoration made by direct-indirect technique with onlay composite, Conclusion, non-surgical approach of perforation treatment could be done by using MTA under good magnification to achieve proper material placement on the perforation. MTA has a good sealability to repair perforation, and this case could be done successfully.