title: Management of longstanding furcation perforation using a novel approach.
abstract: BACKGROUND
  Iatrogenic 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.
  
  
  METHODS
  A 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.
  
  
  CONCLUSIONS
  Longstanding 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.
authors: Department of Endodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: aazim@uthsc.edu.
authors: Adham A
authors: AA
authors: Azim
authors: Department of Endodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee.
authors: Adam
authors: A
authors: Lloyd
authors: Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee.
authors: George T-J
authors: GT
authors: Huang
mesh_terms: D017607:Aluminum Compounds / Q000627:therapeutic use; D016301:Alveolar Bone Loss / Q000209:etiology / Q000601:surgery / Q000628:therapy; D001861:Bone Regeneration / Q000502:physiology; D018786:Bone Substitutes / Q000627:therapeutic use; D017610:Calcium Compounds / Q000627:therapeutic use; D003188:Composite Resins / Q000737:chemistry; D003746:Dental Enamel Proteins / Q000627:therapeutic use; D003786:Dental Pulp Cavity / Q000293:injuries*; D003793:Dental Restoration, Permanent / Q000379:methods; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D017823:Furcation Defects / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D005899:Glass Ionomer Cements / Q000737:chemistry; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods; D006801:Humans; D008567:Membranes, Artificial; D008875:Middle Aged; D008903:Minerals / Q000627:therapeutic use; D008963:Molar / Q000293:injuries*; D010087:Oxides / Q000627:therapeutic use; D010347:Patient Care Planning; D019233:Retreatment; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D018915:Root Canal Preparation / Q000009:adverse effects* / Q000379:methods; D017640:Silicates / Q000627:therapeutic use; D015607:Stents; D013524:Surgical Flaps / Q000601:surgery
chemical_list: D017607:Aluminum Compounds; C077540:Bio-Oss; D018786:Bone Substitutes; D017610:Calcium Compounds; D003188:Composite Resins; D003746:Dental Enamel Proteins; D004338:Drug Combinations; C444701:Filtek Z250; D005899:Glass Ionomer Cements; D008567:Membranes, Artificial; D008903:Minerals; D010087:Oxides; D012387:Root Canal Filling Materials; D017640:Silicates; C109069:enamel matrix proteins; C086631:mineral trioxide aggregate
keywords: Emdogain; furcation; guided bone regeneration; mineral trioxide aggregate; perforation; reverse submarginal flap