Management of longstanding furcation perforation using a novel approach.

INTRODUCTION: 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.