Question

Following endodontic therapy, a post was placed in the mandibular premolar. A lateral root perforation occurred during post preparation. The post was cemented. The radiograph was taken one week after placement of the post. The patient is asymptomatic. Appropriate management of this patient is to

A. attempt to remove the post and seal the perforation with amalgam, then re-cement the post.
B. attempt to remove the post and seal the perforation with amalgam, prepare the post space again in the canal and place a new post.
C. remove the post, place Ca(OH)2 in the post preparation, temporize the coronal portion and re-evaluate periodically.
D. perform a surgical procedure in which a full flap is reflected and an amalgam repair is placed over the perforation site.
E. do nothing with the perforation at this time, place a temporary crown, and recall the patient periodically for radiographic and clinical evaluations.

Answer 1

The best approach for managing a lateral root perforation after endodontic therapy is conservatively removing the post, treating the site with Ca(OH)2, and re-assessing over time.

Step-by-step explanation:

The appropriate management of a patient who has had a lateral root perforation during post-placement in a mandibular premolar after endodontic therapy, and is asymptomatic, would involve careful evaluation and possible intervention. Given that the patient is asymptomatic but has had a procedural complication, the most conservative treatment should be considered while ensuring the long-term health of the tooth and surrounding tissues. A suitable approach might include the removal of the post, cleaning the area, and sealing the perforation with a biocompatible material, followed by reassessment over time.

Option C, which involves removing the post, placing Ca(OH)2 in the post preparation, temporizing the coronal portion, and re-evaluating periodically, generally aligns with a conservative and minimizing further damage or distress to the patient.