Treatment of a root canal perforation using a calcium-silicate based sealer: A case report with a 4 year follow-up

Aim: This case report presents a root canal retreatment distinguished by a canal perforation successfully treated with a calcium-silicate based sealer (EndoSequence BC sealer, Brasseler USA, Savannah, GA, USA) with a 4 year follow-up. Summary: Root canal retreatment of a lower left second molar was performed in 80 years old patient because of a periapical chronic periodontitis with buccal fistula. The scouting of the mesio-lingual and distal canal was obtained with a k-file #10, while the mesio-buccal was not negotiable because of a perforation in the middle third of the root. Instrumentation of patent root canal was performed and the distal canal was filled with AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany) and Thermafil Obturator (Dentsply Maillefer, Ballaigues, Switzerland) whereas the mesial canals and the perforation were sealed using EndoSequence BC Sealer and dedicated EndoSequence BC Points in order to perform a successive apical surgery. The improvement of clinical conditions and, successively, the gradual bone healing, confirmed with analogical radiographs, led to avoid the complicated endodontic surgery on this lower second molar, having already an acceptable clinical success. Key Learning Points: This case report confirmed the favorable physical and biological properties of calcium-silicate based sealers and, most of all, the handling properties of the EndoSequence BC sealer. In selected cases these type of sealers might lead to resolve complex treatments without using specialistic equipments like microscope and help general clinicians to approach complicated endodontic cases in an easier way.