Non-surgical endodontic treatment of bifurcation perforating: A case report

Objectives: To report a clinical case of successful conservative therapy of the first mandibular molar with perforation in the bifurcation area and previous canal filling. Case Report: A 24-year-old female was referred for endodontic retreatment of the right mandibular first molar. She was asymptomatic, with no sensitivity to percussion or palpation. A retroalveolar radiograph revealed undetectable mesial canals and two gutta-percha cones in the bifurcation and distal canal. The previous root canal filling in the distal canal was removed using Gates–Glidden burs and a reciprocating file system. Gutta-percha cones were removed from the bifurcation area with hand K-files. After controlling bleeding with 0.5% sodium-hypochlorite, a mesial canals was detected around 0.5 mm mesial to the perforation. Mesial canals were instrumented with TruNatomy rotary file system (Dentsply, Sirona) and irrigated with saline solution.Perforation diameters in the bifurcation area were assessed with gutta-percha cones (55.02 and 40.02) and verified radiographically. The perforations were sealed with mineral trioxide aggregate (MTA+, Cerkamed, Poland) and condensed by a hand instrument. In the next visit, three root canals were instrumented, and medicated with calcium hydroxide. The canals were obturated with a gutta-percha cones and epoxy resin-based sealer (AH Plus, Dentsply, Sirona) and a radiograph was taken to assess canal filling quality. After two years, clinical and radiographic examination showed satisfactory healing of lesion in bifurcation area. Conclusion: This case highlights the critical importance of knowledge of tooth morphology and careful preparation of the access cavity for long-term success in endodontic treatments.