MTA Repair of a Supracrestal Perforation: A Case Report Renato Menezes, DDS, MS, Ulisses Xavier da Silva Neto, DDS, MS, Everdan Carneiro, DDS, MS, Ariadne Letra, DDS, MS, Clo ´vis Monteiro Bramante, DDS, MS, PhD, and Norberti Bernadinelli, DDS, MS, PhD Abstract Root perforations are undesired complications of end- odontic treatment. In the recent literature, MTA has been regarded as an ideal material for perforation repair. This article describes a case report where an iatrogenic supracrestal perforation was repaired suc- cessfully with mineral trioxide aggregate (MTA). From the Department of Endodontics and Biological Sci- ences, Bauru Dental School, University of Sa ˜ o Paulo, Brazil. Address request for reprints to Renato Menezes, Depart- ment of Endodontics, Faculdade de Odontologia de Bauru, USP, Alameda Dr. Octa ´ vio Pinheiro Brisolla, 9-75, Aeroporto, Bauru, SP, 17012-901; E-mail address: menezesr@ uol.com.br. Copyright © 2005 by the American Association of Endodontists R oot perforations are significant complications of endodontic treatment. However, when teeth are of strategic value, perforation repair is clearly indicated. The poor prognosis of root perforations is probably a result of bacterial leakage or lack of biocompatibility of repair materials. Repairing root perforations in a timely manner is vital to successful treatment. Mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair, retrograde filling, pulp capping, and apexification since its intro- duction in 1993. Various studies have demonstrated its excellent sealing ability and biocompatibility (1–3). Microscopic examinations of periodontal tissues after perfo- rations in the furcal area and subsequent sealing with MTA demonstrated repair of the periodontium, and new cementum formation over the material (2). On the basis of the physical and biological property studies of the mineral trioxide aggregate, this material may be suitable for closing the communication between the pulp chamber and the underlying periodontal tissues. This case report supports this hypothesis. Case Report A healthy 32-yr-old man was referred to the Endodontic Department of this insti- tution 17 days after an appointment for root canal treatment of the lower left second molar. He related that the dentist was unable to find the root canals because of a hemorrhage inside the root canal and poor visibility of the area. The patient complained of episodes of pain and persistent edema in the left mandibular region. Upon clinical examination, we observed that the tooth had taken a mesial direc- tion, probably because of the loss of the first molar, and responded slightly tender to percussion and exhibited normal mobility. Radiographs showed an intracanal ra- diopaque material on the distal area of the root, covering a supracrestal root perfora- tion (Fig. 1). An apical radiolucency was also observed, suggesting pulp necrosis. The case was diagnosed as a failed attempt to repair a supracrestal root perfora- tion. Treatment options were discussed with the patient. The patient expressed the desire to keep the tooth, and treatment planning of perforation repair with ProRoot MTA (Dentsply) was suggested. After administration of local anesthesia and with a rubber dam in place, the temporary restorative material was removed and a new access opening was made. At this moment with an endodontic file (Flexofile, Maillefer, USA) only one large root canal was detected in the center of the root. The perforation had been previously sealed with a white cement, probably zinc-oxide-eugenol, which was removed with burs and curets allowing us to see a large lateral supracrestal perforation on the distal area of the root, as well as intense hemorrhage. Hemorrhage was controlled with copious irrigation with 1% sodium hypochlorite. A cotton pellet embedded with sterile saline was then placed in the canal and the perforation sealed with mineral trioxide aggregate-sterile saline paste mixed in a 3:1 proportion. After 2 days, local anesthesia was administered and with a rubber dam in place, the root length was determined with Root ZX (J. Morita Corp., USA). The canal was cleaned and shaped using Profile .04 files (Dentsply-Maillefer, USA) in a step-back flaring technique and constant irrigation with 5.25% sodium hypochlorite and then obturated with gutta-percha points and Sealer 26 (Dentsply, Petro ´ polis, Brazil) using lateral condensation with subsequent use of McSpadden condensers (Dentsply-Maillefer, USA). At the first recall visit, a month later, the patient related the tooth to be asymptom- atic, with both edema and sensitivity to percussion having stopped. At the 6-month recall, tooth remained asymptomatic. No periodontal pockets were observed, and tooth Case Report/Clinical Techniques 212 Menezes et al. JOE — Volume 31, Number 3, March 2005