MTA: Internal Repair of Iatrogenic Perforation

1. Perforation can happen in furca (Fig.1: >) between mesial (M) and distal (D) roots
2. To repair the perforation, use a rubber dam, debride the root canal system using intra-canal instruments (files), and irrigatge with NaOCl (bleach)
3. Dry the canal system with paper points and isolate the perforation (Fig.2: >)
4. Obturate all the canal space, apical to the perforation
5. Prepare the ProRoot MTA root repair material according to the mixing instructions provided
6. Using the carrier (plastic sleeve over carrier), dispense the cement into the perforation site.  Condense the ProRoot MTA root repair material into the perforation site with a small plugger (with a stopper, adjust the length), cotton pellet or paper points.  Create a three-to-five-millimeter apical barrier of ProRoot MTA root repair material
7. Confirm placement of the ProRoot MTA root repair material with a radiograph (Fig.3: M).  If an adequate barrier has not been created, rinse the ProRoot MTA root repair material out of the canal and repeat the procedure
8. Take a wet cotton pellet, remove excess moisture from the pellet and place in the canal.  Seal the access preparation with a temporary restoration for a minumum of four hours
9. After four hours, or at a later appointment, use a rubber dam and examine the ProRoot MTA root repair material.  This material should be hard.  If not, rinse and repeat the application
10. When the ProRoot MTA root repair material is hardened, obuturate the remaining canal space.  The ProRoot MTA root repair material remains as a permanent part of the root canal filling
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Xin Wei, DDS, PhD, MS 1st edition 07/12/2011, last revision 07/13/2011