Management of Longstanding Furcation Perforation Using a Novel Approach

IntroductionIatrogenic furcation perforation may occur during the access preparation of the endodontic treatment. This may lead to periodontal defects and subsequent tooth loss. In this case report, we presented a new approach that may help salvage cases with a longstanding furcation involvement and substantial bone loss resulting from perforation.MethodsA mandibular molar case that had a furcation perforation and longstanding furcation bone loss with a probing depth of 10 mm in the buccal furcation area. We applied a novel approach, which used both nonsurgical and surgical interventions. We first reaccessed the tooth to reseal the perforation site with MTA followed by a newly designed surgical approach including the use of a stent, a reverse submarginal flap, Emdogain (Straumann USA, Andover, MA), guided bone regeneration, and postoperative isolation of the surgical site. The post-treatment follow-ups with up to 19-month recall showed favorable results with significant bone regeneration at the furcation and the probing depth reduced to 4–5 mm.ConclusionsLongstanding furcation perforations with periodontal involvement may be savable and have a better prognosis. This may require a modified flap design to access the defect, guided bone and periodontal regeneration, and postoperative isolation of the surgical defect.