The endodontist performing exploratory or endodontic surgery should inform the patient about the possibility of finding a vertical root fracture
(VRF) or other situation that will necessitate extraction. Although implant surgery is not easy, if the endo specialist has the required knowledge, training and skill, an immediate implant is an option that should be presented to the patient.
The first step is to finish the root canal treatment. In the root to be treated, leave the gutta-percha below the level of future cut, and obturate the remaining canal with a definitive restorative material, as for the pulp chamber and crown access (but root resection on vital pulp can also be done as an emergency during periodontal surgery, most often in maxillary molars).
The aim is to remove unbeatable root parts in otherwise retainable and restorable multirooted teeth. It is imperative to assess beforehand the impact the treatment will have on the periodontal and occlusal status, integrating these data into the necessary restorative procedures.
Iatrogenic perforations are the most frequent type, and several factors must be taken into consideration in their management.
Diagnosis is based in clinical and radiological assessments. Symptoms tend to be acute, with periodontal abscess
formation associated with pain, swelling, pus exudate, pocket formation
due to gingival epithelium down-growth to the perforation site, and tooth mobility
. However, a more chronic response may sometimes occur without pain, involving the sudden appearance of a pocket with bleeding on probing or shy pus exudation.
The cause of most endodontic failures is leakage. This leakage can be from the root canal system to the periodontium
through the apical foraminas or through lateral canals. A lateroradicular lesion may or may not communicate to the cervical periodontium, but with no relation to the periapical region.