Outcome of an Extensive Mid-Root Perforation With Unintentional Bioceramic Extrusion: A Case Report With 2-Year Recall Using CBCT.

Background: Iatrogenic root perforation is a serious complication that can adversely influence the prognosis of endodontic treatment. Premixed bioceramic repair materials have emerged as promising alternatives to mineral trioxide aggregate because of their favorable handling characteristics, biocompatibility, and bioactivity. This case report describes the 2-year clinical and radiographic outcome of a large mid-root perforation repaired nonsurgically with a premixed bioceramic material despite significant unintended extrusion into the periradicular tissues. Case Report: A 34-year-old man developed an iatrogenic mid-root perforation in the middle third of the distal root of the mandibular left first molar during postspace preparation. The perforation was repaired immediately under magnification using a premixed tricalcium silicate-based material (Bio-C Repair). Postoperative imaging showed a well-condensed repair with extrusion of the material beyond the root surface. CBCT assessment demonstrated a perforation diameter of 3.5 mm and material extrusion of 3 mm into the periradicular area. At 24 months, the tooth was functional and asymptomatic, with no tenderness to percussion or palpation and normal periodontal probing depths. Periapical radiography and CBCT demonstrated complete healing of the previous periapical lesion and no evidence of furcal pathosis. Conclusion: Within the limitations of a single case report, nonsurgical repair of a large mid-root perforation with a premixed bioceramic material was associated with favorable clinical and radiographic healing, despite significant unintended material extrusion. This case supports the view that extrusion of bioceramic repair material does not necessarily preclude a favorable outcome.