Retreatment and surgical repair of the apical third perforation and osseous defect using mineral trioxide aggregate

One of the causes of non-healing periapical pathosis in endodontically treated tooth is root perforation. This can occur pathologically by resorption and caries, iatrogenically during endodontic therapy (zip, strip, furcal perforations). Root perforation results in bacterial contamination, periradicular tissue injury, inflammation, and bone resorption. The purpose of this case report is to describe endodontic retreatment and surgical management of a longstanding periapical lesion on maxillary lateral incisor, associated with perforation and osseous defects using mineral trioxide aggregate (MTA). Although the majority of bone support and root dentin was damaged, an attempt was made to repair the defect and restore the tooth. After the surgical intervention and root canal treatment, the perforation was subsequently sealed with MTA. Later, the root was reinforced with composites and the tooth was restored with direct veneer. Conclusion: Four-and-a-half year (54 months) recall examination showed no evidence of periodontal breakdown, no symptoms of further deterioration, and complete healing of periradicular lesions when examined by radiography. This case report presents a treatment strategy that could improve the healing process and beneficial outcomes for patients with perforation and osseous defect.