Procedural Misadventures

Objectives and Goals

  • should be familiar with the factors that affect the prognosis of perforations.
  • should be familiar with the various techniques and materials available for repair of perforations.
  • should be experts in the prevention of perforations.
  • should be familiar with the signs, symptoms, and treatment of sodium hypochlorite incidents.
  • be familiar with the prevention and treatment of subcutaneous emphysema
  • be familiar with the sequelae of separated instruments.
  • be familiar with the various techniques for dealing with separated instruments.
  • be experts in the prevention of separated instruments.

Lantz B, Persson P. Periodontal tissue reactions after root  perforations in dogs’ teeth: a histologic study.  Odont Tids 1967;75:209-220

Jew RCK, Weine FS, Keene JJ, Smulson MH. A histologic evaluation of periodontal tissue adjacent to root perforations filled with cavit. Oral Surg 1982;54(1):124 - 135.

ElDeeb ME, ElDeeb M, Tabibi A, Jensen JR. An evaluation of the use of amalgam, cavit, and calcium hydroxide in the repair of furcation perforations. J Endodon 1982;8(10):458 - 465.

Beavers RA, Bergenholtz G, Cox CF. Periodontal wound healing following intentional root perforations in permanent teeth of Macaca mulatta. Int Endod J 1986;1(19):36-44.

Fuss Z, Trope M.  Root perforatons:  clasification and treatment choices based on prognostic factors. 1996 Endod Dent Traumatol 12:255-64

Nakata T, Bae K, Baumgartner J.  Perforation repair comparing mineral trioxide aggregate and amalgam using an anaerobic bacterial leakage model.  J Endodon 1998 24(3):184-186

Rafter M, Baker M, Alves M, Daniel J, Remeikis N.  Evaluation of healing with use of an internal matrix to repair furcation perforations.  Int Endod J 2002 35:775-783

Weldon J, Pashley D, Loushine R, Weller N, Kimbrough F.  Sealing ability of mineral trioxide aggregate and super-EBA when used as furcation repair materials:  a longitudinal study.  J Endodon 2002;28(6):467-470

Main C, Mirzayan N, Shabahang S, Torabinejad M.  Repair of root perforations using mineral trioxide aggregate: a long-term study.  J Endodon 2004;30(2):80-83

Pathways of the Pulp. 9th edition, 2006. pp 9960-1001              


Prinz, H.  The removal of broken instruments from root canals. Brit Dent J.  1922 43:467

Strindberg, LA.  Dependence of the results of pulp therapy on certain factors. Acta Odont Scand 1956 14:78

Grossman LI. Fate of endodontically treated teeth with fractured root canal     instruments. Brit Endod Soc 1968;2:35.

Crump MC, Natkin E. Relationship of broken root canal instruments to endodontic case prognosis:  a clinical investigation. JADA 1970;80:1341 - 1347.

Fox J. Filling root canal with files radiographic evaluation of 304 cases. NYS Dent J 1972;38(3):154-157.

Suter B.  A new method for retrieving silver points and separated instruments from root canals.  1998 J Endodon 24(6):446448

Ward J, Parashos P, Messer H.  Evaluation of an ultrasonic technique to remove fractured rotary nickel-titanium endodontic instruments from root canals: an experimental study.  J Endodon 2003;29(11):756-763

Saunders J, Eleazer P, Zhang P, Michalek S.  Effect of a separated instrument on bacterial penetration of obturated root canals.  J Endodon 2004;30(3):177-179

Shen Y, Peng B, Cheung G.  Factors associated with the removal of fractured NiTi instruments from root canal systems.  OOO 2004:98(5):605-610

Iqbal M, Rafailov H, Kratchman S, Karabucek.  A comparison of three methods for preparing centered latforms around separated instruments in curved canals.  J Endodon 2006;32(1):48-51

Pathways of the Pulp.  9th edition, 2006.  pp 982-992


Hermann JW, Heicht R.  Complications in therapeutic use of sodium hypochlorite.  J Endodon 1979;5(5):160

Sabala C, Powell S.  Sodium hypochlorite injection into periapical tissues. JEndodon 1989;15(10):490-492

Battrum DE, Gutmann JL.  Implications, prevention and management of subcutaneous emphysema during endodontic treatment.  Endod Dent Traumatol 1995;11:109-114.

Eleazer P, Eleazer K.  Air pressures developed beyond the apex from drying root canals with pressurized air.  J Endodon 1998; 24(12):833-836

Lindgren P, Eriksonn K, Rngberg A.  Severe facial ischemia after endodontic treatment.  J Oral Maxiillofac Surg 2002;60:576-79



Auslander WP, Weinberg G.  Anatomic repair of internal perforations with indium foil and silver amalgam: outline of a method.  NY J Dent 1969;39:454-457

Lantz B, Persson P. Periodontal tissue reactions after surgical treatment of root perforations in dogs' teeth: a histologic study. Odont Revy 1970;21:51-60.

Seltzer S. Periodontal effects of root perforations before and during endodontic procedures. J Dent Res 1970;49:332-339.

Riggans JW. The case history of a root perforation and a method for its prevention. Dental Digest 1971;(May).

Bhaskar SN, Rappaport HM. Histologic evaluation of endodontic procedures in dogs. Oral Surg 1971;31(4):526 - 534.

Weisman JW. Unique sealing of an internal resorptive of the bifurcation. Georgia Dent J 1971;(April)

Stromberg T. Endodontic treatment of traumatic root perforations in man. Swed Dent J 1972;65:457-466.

Frank A. Resorption, perforations, and fractures. Dent Clin North Am 1974;18:465.

Harris WE. A simplified method of treatment for endodontic perforations. Journal of Endodontics 1976;2(5):126 - 134.

Sanai IH. Endodontic perforations: their prognosis and treatment I. JADA 1977;95:90-95.

Meister F Jr., Lommel TJ, Gerstein H, Davies EE. Endodontic perforations which resulted in alveolar bone loss. Oral Surg 1979;47(5):463-470.

Oswald RJ. Procedural accidents and their repair. Dent Clin North Am 1979;23(4):593 - 616.

Delivanis PD, Goerig AC. Repair of perforations. Quintessence Int 1981;12(9):985 - 992.

Martin LR, Gilbert B, Dickerson AWI. Management of endodontic perforations. Oral Surg 1982;54(6):668-677.

Abou-Rass M, Jann JM, Jobe D, Tsutsui F. Preparation of space for posting:  effect on thickness of canal walls and incidence of perforation in molars. JADA 1982;104(6):834-837.

Kessler JR, Peters DD, Lorton L. Comparison of the relative risk of molar root perforations using various endodontic instrumentation techniques. J Endodon 1983;9(10):439 - 447.

Himel V.  Evaluation of the repair of mechanical perforations of the pulp chamber floor using biodegradable tricalcium phosphate or calcium hydroxide. J Endodon1985;11(4):161-165.

Benenati FW, Roane JB, Biggs JT, Simon JH. Recall evaluation of iatrogenic root perforations repaired with amalgam and guttta percha. J Endodon 1986;12(4):161 - 166.

Aguirre R, ElDeeb ME, ElDeeb ME. Evaluation of the repair of mechanical furcation perforations using amalgam, gutta-percha, or indium foil. J Endodon 1986;12(6):249-256.

Bramante CM, Berbert A. Root perforations dressed with calcium hydroxide or zinc oxide and eugenol. J Endodon 1987;13(8):392 - 395.

Biggs JT, Benenati FW, Sabala CL. Treatment of iatrogenic root perforations with associated osseous lesions. J Endodon 1988;14(12):620-624.

Sanai IH. An evaluation of tricalcium phosphate as a treatment for endodontic perforations. J Endodon 1989;15:399-403.

Dazey S, Senia ES. An in vitro comparison of the sealing ability of materials paced in lateral root perforations. J Endodon 1990;16(1):19 - 23.

Balla R, LoMonaco CJ, Skribner J, Lin LM.  Histological study of furcation perforations treated with tricalcium phosphate, hydroxyapatite, amalgam, and life.  J Endodon 1991;17(5):234-238

Alhadainy HA. Root perforations: a review of literature. Oral Surg 1994;78(3):368-374.

Alhadainy HA, Himel VT. An in vitro evaluation of plaster of paris barriers used under amalgam and glass ionomer to repair furcation perforations. J Endodon 1994;20(9):449-452.

Himel V, Alhadainy H.  Effect of dentin preparation and acid etching on the sealing ability of glass ionomer and composite resin when used to repair furcation perforations over plaster of paris barriers. J Endodon 1995;21(3):142-145.

Arens DE, Torabinejad M.  Repair of furcal perforations with mineral trioxide aggregate.  Oral Surg 1996;82(1):84-88

Makkawy H, Kroka S, Lavin M, Ewoldsen N.  Cytotoxicity of root perforation repair materials.  J Endodon 1998 24(7):477-479

Holland R,Filho J, Souza V, Nery M, Bernfabe P,Dezan E.  Mineral trioxide aggregate repair of lateral root perforations.  J Endodon 2001;27(4):281-84

Separated Instruments

Grossman LI. Guidelines for the prevention of fracture of root canal instruments. Oral Surg 1969;28:746.

Feldman G, Soloman C, Notaro P, Moskowitz E. Retrieving broken endodontic instruments. JADA 1974;88:588.

Barry, Heyman, Fried. Sealing quality of instruments cemented in root canals with polycarboxylate cements. J Endodon 1975;1(3):112 - 115.

Chernick LB, Jacobs JJ, Lautenschlager EP, Heuer MA. Torsional failure of endodontic files. J Endodon 1976;2(4):94 - 97.

Lautenschlager EP, Jacobs JJ, Marshall GWJ, Heuer MA. Brittle and ductile torsional failures of endodontic instruments. J Endodon 1977;3(5):175-178.

Adams WR, Patterson SS, Swartz ML. The effect of the apical dentinal plug on broken endodontic intruments. J Endodon 1979;5(4):121.

Roig-Greene JL. The retrieval of foreign objects from root canals: a simple aid. J Endodon 1983;9(9):394 - 397.

Roane JB, Sabala C. Clockwise or counterclockwise. J Endodon 1984;10(8):349 - 353.

Sotokawa T. An analysis of clinical breakage of root canal instruments. J Endodon 1988;14(2):75 - 82.

Ahmad M. An analysis of breakage of ultrasonic files during root canal instrumentation. Endod Dent Traumatol 1989;5(2):78-82.

Sotokawa T. A systematic approach to preventing intracanal breakage of endodontic files. Endod Dent Traumatol 1990;6(2):60 - 62.

Seto BG, Nicholls JI, Harrington GW. Torsional properties of twisted and machined endodontic files. J Endodon 1990;16(8):355-360.

Luebke NH, Brantley WA. Physical dimensions and torsional properties of rotary endodontic instruments.  I. gates glidden drills. J Endodon 1990;16(9):438-441.

Haikel Y, Gasser P, Alleman C.  Dynamic fracture  of hybrid endodontic hand instruments compared with traditional files.  J Endodon 1991;17(5):217-220