If a perforation is encountered during access preparation, which immediate management steps are appropriate?

• A. Control hemorrhage if present, seal the perforation with a biocompatible material (e.g., MTA or biodentine) and plan reinforcement restoration.
• B. Remove the tooth and delay treatment
• C. Fill with gutta-percha immediately
• D. Ignore and continue with canal instrumentation

Answer: (A)

When a perforation happens during access, the main goal is to prevent contamination and stabilize the tooth so healing can occur. Start by controlling any bleeding and keeping the space clean, then seal the perforation with a biocompatible material that can set in a moist environment and bond well to dentin and canal walls—MTA or Biodentine are ideal choices because they create a durable seal and support tissue healing. Once the perforation is sealed, plan a reinforcement restoration to protect the repair and restore coronal structure, reducing the risk of reinjury or breakdown. Filling with gutta-percha right away isn’t appropriate for sealing a perforation, and continuing instrumentation without addressing the perforation would worsen the prognosis.