#6 Post perforation on a long span (7 unit) bridge. Pt is insistant that she does not want to lose this tooth or bridge at this time. Lateral radiolucent lesion is present adjacent to the perforation.
CBCT taken to evaluate the position and extent of perforation, bone loss and possible surgical intervention. Given the treatment options, the patient wishes to try and maintain the tooth with surgical repair of post perforation. Pt understands that post repair will not improve coronal margins, but does not wish to replace bridge at this time.
Surgical flap reflected, post perforation located, 2-3mm post resected, lateral root preparation created.
Geristore used to repair root.
Lateral root restoration contoured to adjacent root.
Post Op radiograph showing perforation repair.
6 month recall showing initial healing. Pt is asymptomatic and fully functional.
At 18 month recall, bone has healed completely, tooth #6 is asymptomatic and fully functional. Tooth #4 is now testing necrotic w/ asymptomatic apical periodontitis. RCT has been recommended.
This case demonstrates how a skilled endodontist's surgical abilities can save what would seem like non-restorable, iatrogenic damage.