Iranian Endodontic Journal

Abstract

Strip perforation is a severe procedural complication during root canal therapy, often associated with poor prognosis, especially when combined with overextended gutta-percha. While surgical or nonsurgical retreatment is commonly indicated, patient-centered decision-making and long-term follow-up may influence the management strategy. This case report describes the conservative follow-up and eventual successful treatment of a mandibular second molar with an extensive midroot strip perforation and extruded gutta-percha, ultimately managed with intentional replantation and root-end filling using calcium-enriched mixture (CEM) cement. In 2015, a 40-year-old female patient presented for routine examination. A previously treated mandibular second molar (#37), which had a severe strip perforation in the mesial root and overextended gutta-percha one year prior, remained asymptomatic and functional. The patient declined retreatment and opted for annual monitoring. Over five years, the tooth remained functional and symptom-free, and the extruded gutta-percha showed gradual radiographic resorption. In 2023, the patient returned with a symptomatic apical periodontitis and a large periapical lesion associated with the same tooth. Intentional replantation was performed with midroot resection of the mesial root, root-end filling using CEM cement, and immediate replantation. At the 1-year follow-up, the tooth remained functional, asymptomatic, and radiographically healed. The case highlights the long-term clinical risks of untreated strip perforations, the unpredictable resorption of overextended materials, and the efficacy of minimally invasive surgical interventions in preserving tooth function.