When I was at Penn someone said that you have not been doing enough root canals if you haven't perforated a tooth. I am not sure if that is an accurate statement. At least not when you are working with a microscope.
This is a case of a lower right first molar that was left open for drainage by a previous dentist and a perforation occurred at the furcation during cavity access. The patient failed to return for further treatment and the tooth was left opened for more than two years. Hence, the large radiolucency on both roots and furcal area. A discharging sinus was present at lingual sulcus. I dont agree with the practice of leaving the tooth open for drainage and sending the patient home because it will cause more damage than good with all the contamination.
RCT was initiated and the furcal perforation was repaired with MTA. CaOH was left in the canals for three months. When there
was evidence of healing/ bony repair, canals were obturated. The six month review radiograph showed complete periapical healing and the radiolucency around the furcal area reduced in size. Although the lingual sinus has completely closed, I expect to see more healing at the furcation when I review this case in six months.
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