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When you see a root perforation, you may not even be thinking about how to treat that perforated root canal. That’s because some dentists have been taught that root canal perforations aren’t restorable. Today, I want to walk you through my thought process on this subject, and why you might be able to save more teeth than you originally thought.
Remember, the variables that affect a root perforation are time, size, and location.
- The longer the perforation has been there, the worse the prognosis.
- The bigger the perforation, the worse the prognosis.
- And the more coronal the perforation, the worse the prognosis.
But if I followed all the rules in life, I would get nowhere. Endodontics is truly regenerative, and it’s incredible what we can heal for our patients, given patience and proper treatment.
That’s why I want to share this tooth story that supports why you shouldn’t give up!
A Case of Root Canal Perforation
Trust me, the temptation was there to write this tooth off as nonviable. It was previously treated and had a furcal lesion. It was rough.
Some people may jump to the conclusion that this tooth is cracked, but what else could it be? A perforation from that post? Leakage from the open margins? Hell, in some cases it’s both.
I want to train you to start thinking differently and beyond the easy diagnosis. Just because it’s simple doesn’t mean it’s correct.
There was the root perforation, right into the furcation. This root canal was about 10 years old, so this perforation was at least the same age, if not more.
Remember our rules up above? Ten years is a long time! Going by what we were taught in dental school, extraction at this point would have been the only option.
Here’s the postoperative radiograph.
How to Treat a Perforated Root Canal
The secret for how to treat a perforated root canal is to simply #GiveTeethAChance. Even when it’s been a long time, even when the perforation is big, even when the perforation is coronal.
Obviously, endodontics can’t save every tooth with a perforated root canal on the planet. But you also miss 100% of the shots you don’t take.
Let me show you the one-year recall radiograph from this case, so you can see the healing.
She has her bone back! I’m so proud of this result!
But let’s go even farther out. Take a look at the 4-year recall.
Boom! It’s still there! Nice and healthy.
We need to give teeth a chance. They want to be better. Our bodies are naturally good at healing, and root canals give immune systems a chance to fight back against the bacteria and infection.
And look, I don’t expect all dentists to feel comfortable with taking on a tooth like this. Please do your own risk assessment and know your limits. It really sucks to start a tooth and not be able to finish it.
But my goal is to make you aware that a tooth with a root canal perforation doesn’t necessarily need to go straight to the oral surgeon for extraction. If you don’t feel confident proceeding with treatment, send it to someone who can save it.
My job is just to teach you that anything is possible. Your job is to believe.
The best way to learn the extent of the healing potential of endodontics is through E-School, my online CE course for dentists. Enroll today, and empower yourself to up-level your game as a tooth healer.