Endodontic and Surgical Management of Root Perforation Caused by Intermaxillary Fixation (IMF) Screw Placement: A Case Report

The use of fixation screws is a valuable tool in the clinical practice of oral and maxillofacial surgeries. One potential complication of screw placement for fracture fixation is root damage during surgery. In some cases, this damage can further lead to irreversible pulp damage, which requires endodontic and/or surgical intervention. The present report describes a case of iatrogenic root perforation during intermaxillary fixation (IMF) screw placement, leading to pulp necrosis. Despite the complication, the root damage was effectively managed through non-surgical root canal treatment using calcium silicate root filling material, followed by surgical apicectomy and retrograde fill. The patient was asymptomatic at a nine-month follow-up, and radiographic examinations showed signs of initial bone healing at the surgical site. After the successful management of the root perforation, the patient was referred to the prosthodontics department for the placement of the final restoration. It is important to understand the potential damage that may occur with screw-root contact and how it can be avoided or minimized. This report highlights the challenges and considerations in managing such cases and emphasizes the importance of using IMF screws with caution and the need for regular follow-ups in instances where tooth root damage has been confirmed.