Dr. Alfred Khallouf illustrates the #12 post perforation repair with MTA on mesial aspect subcrestally. Please visit AlfredKhallouf.com to learn more.

2. #12 Pre-op on 14 Oct 2004
First Visible
Pulp Space
Approx 5mm
From cusp after
Removal of
provisional
crown

3. #12 Post-perforation Repair with
MTA on Mesial aspect Subcrestally
■ 14 October 2004 after MTA placed
MTA
Track Progress with:
1) Check X-Ray
2) Perio Probe
Measurement
3) Staff Guidance

4. Signs I Ignored
■ Early Out Signal with the Root ZX
■ No Good Apical Stop
■ The File Handle was exiting at a different Angle
■ I Could see the side of the Pulp Chamber BUT I
did not recognize it
■ In fact, I continued to try and discover the WL for
about another 15 minutes
■ I overlooked the fact the tooth continued to bleed
and tried to stop it with paper points

5. Working Length
■ 04 Nov 2004 04 Nov 2004
Cavit was
placed to seal
the perforation.
The MTA had
Been lost for
An unknown
reasons
Cavit

6. How was my pt Doing?
■ Pt was Asymptomatic since last appt
■ Probing measurements had NOT Increased
■ CAVIT
■ Perf must always be sealed
■ Do NOT push into Cavit because it has not
completely set, it is still somewhat soft
■ File will easily go through the cavit
■ BE CAREFUL AND AVOID PROBING THE CAVIT

7. MAF Radiograph
■ 04 Nov 2004 04 Nov 2004

8. Final Obturation with MTA in area of
defect and entire pulp chamber
■ 04 Nov 2004- Final
MTA placed
correctly and
properly

9. Keys to Perforation repair
■ Same Day Perf Repair
■ Treat Only With a Pulpotomy
■ Perf must be sealed
■ Timing of perf Repair
■ Size of Perf Repair
■ Location of Perf Repair

10. Principals of MTA use
■ Careful use of Sodium Hypochlorite
■ Consider Peridex
■ Advise pt. to avoid occluding on that tooth
for at least 4 hours
■ 3-Month Recall is important
■ Assess if Symptomatic
■ Probing depths, have they changes?
■ Any pathological changes on Radiographs