PMC5299576_01
Initial radiographic aspect. (A) Radiolucent area indicating retreatment. (B) Radiolucent area caused by an iatrogenic radicular perforation.
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Periodontal probing was considered normal and radiographic examination revealed a small radiolucent area at the periapical region of the tooth (Fig. 1A). During post removal, iatrogenic perforation of the mesial face of the distal root occurred (Fig. 1B).
Detection of perforation. (A) Localization of perforation. (B) Application hemostatic.
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F2
Rubber dam isolation of the tooth was performed and the root perforation was assessed (Fig. 2A) and treated under high magnification microscope (Carl Zeiss , Oberkochen, Germany). Bleeding was controlled with copious irrigation with 1% sodium hypochlorite and application of hemostatic agent (ViscoStat , Ultradent, Utah, USA) for 2 minutes (Fig. 2B).
Endodontic retreatment (A) Root canal length measurements radiograph and MTA at perforation (B) Oclusal view (C) Final radiograph.
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Morita , Kyoto, Japan) and confirmed by periapical radiography root canal length measurements that also showed MTA in the drilling region (Fig. 3A). The canals were dried with sterile paper points and obturated with gutta-percha points and AH 26  (Dentsply, DeTrey Konstanz, Germany) sealer using the lateral condensation technique (Fig. 3B and C).
Radiographic follow-up. Periapical radiographies after (A) three, (B) seven and (C) ten years, evidencing the healing of regions.
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Periapical radiographies revealed absence of radiolucent area at the region of perforation and the periapices during follow-up appointments (Fig. 4A, B and C).
Cone beam computed tomography (CBCT) scans. Sagittal slices indicating absence of radiolucency at the region of perforation and periapices (A) and axial slices indicating the repair of the area of the radicular perforation (B).
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Through the examination of Cone Beam Computed Tomography (CBCT) scans, absence of radiolucency at the region of perforation and periapices was confirmed (Fig. 5A and B).