Reparative procedures for endodontic perforations: towards a standardised approach

Endodontic success is based on the eradication of root canal infections and prevention of recontamination. The presence of any form of communication between the endodontium and surrounding tissue, in particular the oral cavity, provokes prompt infection relapse. Most of these communications are represented by iatrogenic perforation caused during endodontic procedures. The use of CBCT has significantly improved diagnosis and treatment planning when facing such clinical situations. The introduction of the surgical operating microscope has been another major improvement, allowing precise application of the repair material. Finally, the introduction of biocompatible and even bioactive hydraulic cements, including mineral trioxide aggregate, has been a significant development in improving the outcome of perforation repair, allowing a predictable and perduring seal that prevents further bacterial contamination. Some confusion persists regarding the clinical steps required to treat the different presentations. The present article illustrates the main techniques for repairing perforations based on their position. Suborifice perforation repair requires use of an appropriate sandwich technique.