A 13-Year Follow-Up on an Iatrogenic Perforation Case

A case that reminds us why protocol and sound judgment are indispensable — a patient followed 13 years after treatment, showing how proper diagnosis and retreatment can turn a compromised situation into a long-term success. The patient was referred for surgical root canal treatment on tooth #26 just eight months after the original procedure. With only a 2D image available (pre-CBCT), Dr. Nudera noticed a radiopaque line across the coronal third of the root and a periapical radiolucency. The patient reported a "bump on the gums" — but this wasn't a sinus tract; it was gutta-percha protruding through the gingiva. The access had been misdirected buccally, leading to a perforation that went unaddressed before the original canal was completed, after which the patient was told surgery was the only option. Iatrogenic errors can happen to anyone, but they often reveal where diagnostic or procedural steps were skipped — here, the absence of mid-treatment radiographs, working length verification, or cone-fit images likely masked the error early. After reviewing the options, the choice was nonsurgical retreatment: accessing the tooth, retrieving the gutta-percha, repairing the perforation, and re-treating the canal; four weeks later, soft-tissue healing was complete and the second visit concluded with obturation and a bonded composite. At two years, complete healing. At eight years, stable. At 13 years, radiographic and CBCT imaging confirmed no apical pathology, with normal function and healthy soft tissue — proof that established protocols, applied under the right conditions, can carry even iatrogenic-complication cases to excellent outcomes.