Diagnóstico tardio e manejo clínico de perfuração radicular iatrogênica em dente anterior: relato de caso

Abstract

Root perforation consists of communication between the root canal system and the supporting periodontal tissues (ALSHEHRI et al., 2024). This occurrence can have a pathological etiology, resulting from extensive carious lesions or root resorptions due to osteoclastic action, or an iatrogenic etiology (ESTRELA et al., 2023). The latter constitutes a surgical accident, resulting from the professional's action, moving away from a purely physiopathological phenomenon of the patient's organism (DE-DEUS et al., 2024). In clinical practice, iatrogenic perforation can occur in different root thirds. In the cervical third, it is frequently associated with deviations during coronal access, as well as partial obturation and gutta-percha lowering procedures. In the middle third, it can result from aggressive instrumentation, especially in atretic canals. In the apical third, it is generally related to the deviation of the long axis of the root canal. (VERSANI et al., 2022). Historically, teeth affected by iatrogenic perforations had an unfavorable prognosis, mainly due to the intense inflammatory response of the periodontium to bacterial contamination (MACEDO et al., 2025). The proper management of these lesions requires early sealing of the perforation, using materials that have favorable biological and physicochemical properties (TORABINEJAD et al., 2020). In this context, the development of dentin substitutes capable of combining biocompatibility, bacteriostatic action, dimensional stability and biomineralization potential was sought. Mineral Trioxide Aggregate (MTA) stood out in this scenario and has consolidated itself, over time, as a reference material in the literature (PRATI & GANDOLFI, 2021). More recently, advances in the dental industry have enabled the emergence of new bioceramic materials, based on purified calcium silicate, such as Biodentine, ready-to-use putty cements, such as TotalFill BC Putty and Bio-C Repair, as well as highly plastic injectable repair materials, such as MTA Repair HP (ALSHEHRI et al., 2024). These new systems have expanded clinical possibilities, offering better manipulation, lower risk of tooth color alteration, and maintenance of the ability to induce bone neoformation (MACEDO et al., 2025). Once the integrity of the root walls is restored through immediate sealing of the perforation using appropriate repair materials, it becomes safe and feasible to proceed with endodontic retreatment (SIQUEIRA JR. et al., 2021). Thus, the appropriate selection of the auxiliary chemical substance (ACS) and intracanal medication (ICM) plays a crucial role in the therapeutic protocol (GOMES et al., 2024). This set of mechanical-chemical procedures aims to eliminate remaining and persistent microorganisms, reduce peripheral tissue inflammation and control exudates, promoting an environment favorable to complete healing of the canal system (ZANZE et al., 2023). Associated with all stages of clinical management, radiographic examination acts as an indispensable ally before, during and after surgical procedures (DEVINE, 2025). Imaging follow-up is mandatory not only for the accurate diagnosis of the injury location, but also to monitor periodontal repercussions and, crucially, to guide long-term follow-up, validating lesion regression and bone neoformation (SILVA et al., 2026). Given the above, this work aims, through a narrative literature review associated with a clinical case report, to analyze the main implications of root perforations during endodontic treatment. In addition, it seeks to discuss the most suitable sealing materials and highlight the importance of accurate diagnosis, careful performance of intermediate radiographic examinations, and adequate follow-up for therapeutic success and preservation of the patient's health.