Volume 10 • 2023 • Issue 1

Root perforations can and do occur for a variety of reasons and can lead to chronic infection, potentially resulting in tooth loss. Knowing how to recognize them and the best ways to treat them is the best strategy to anticipate and correct possible damage. How to Manage Root Perforations Mary Dabuleanu, DDS, MSc, FRCD(C), is a parttime clinical demonstrator at the University of Toronto for undergraduate dental students and graduate endodontic residents. Dr. Dabuleanu is a practising endodontist in North York, Ontario. Root perforations are stressful and occur regularly during or following endodontic treatment.1 Management of the perforations will largely depend on their nature and location. The increase in complex endodontic treatments makes it logical to envisage an increased frequency of perforations. While about half (53%) of iatrogenic perforations occur during post insertion, the remaining instances occur during routine endodontics treatment.2 Perforations can be pathological, resulting from caries or resorptive defects. But in the majority of cases, they occur during root canal treatment and can account for almost 10% of all cases of endodontic failure. Therefore, trying to avoid them altogether remains the best option. Dr. Mary Dabuleanu, clinical demonstrator at the University of Toronto for endodontic residents, advises taking time at the initial stages. “The access preparation requires a lot of focus and requires time,” she says. Often the result of attempts to locate andopen canals, perforations in the coronal and furcation third regions can be generated by pulp chamber and orifice calcifications, misidentification of canals, large crown-root angulation and excessive coronal dentine shrinkage. Perforations in the middle third can occur with overzealous instrumentation in this area, after an aggressive approach to crown descent with large instruments used in narrow canals. They can also occur if files are too large or if the filing technique is too aggressive in shaping the canals away from the root centre during root preparation. Traditionally, curved 29 Issue 1 | 2023 |