Which materials are recommended for sealing perforations in endodontic procedures?

• A. MTA or Biodentine
• B. Gutta-percha alone
• C. Zinc phosphate cement
• D. Glass ionomer cement

Answer: (A)

When sealing a perforation, you want a material that is biocompatible, seals well in a moist environment, and supports healing by promoting hard tissue formation. Mineral trioxide aggregate (MTA) and Biodentine are calcium silicate–based materials that meet these needs. They set in the presence of moisture, provide a durable seal against microleakage, are well tolerated by periapical tissues, and can encourage dentin bridge formation to repair the perforation. They also offer good radiopacity for evaluation and resist washout in the clinical field.

Gutta-percha alone cannot provide an adequate seal for a perforation because it lacks adhesion and durable sealing properties in a moist defect. Zinc phosphate cement is acidic and irritating to tissues and does not offer a reliable, long-lasting seal or bioactivity for healing. Glass ionomer cement has some adhesive qualities but does not perform as reliably as MTA or Biodentine in perforation repair, especially in a moist environment where healing is essential. For these reasons, MTA or Biodentine are the preferred choices for sealing perforations.