Cervical perforation
In the upper region (at the neck of the tooth or the pulp chamber floor in molars). The most common site. Usually straightforward to treat — direct access under the microscope.
07 — Perforation repair
Root
perforation in Kiel.
An injury to the root wall is not a death sentence for the tooth. With a dental operating microscope and bioceramic materials, perforations can be sealed in 80–90% of cases — durably and for the long term.
What is it?
A hole
in the root.
A root perforation is a pathological connection between the inside of the root canal and the surrounding tissue — bone, periodontium or gum. It usually arises as a complication of root canal treatment, or through advanced resorption or caries.
Left untreated, a perforation leads to chronic inflammation, bone loss and ultimately loss of the tooth. The good news: With modern bioceramic materials, perforations can be sealed under the microscope — the tooth can usually be preserved.
What matters most for the prognosis is the location, size and, above all, the time until treatment. The sooner, the better.
Where do they occur?
Three typical
sites.
The location determines both treatment and prognosis. We distinguish three clinically relevant regions:
Mid-root perforation
In the middle third of the root. Access is more demanding — usually orthograde under the microscope. MTA is the material of choice.
Apical perforation
At the root apex. Hard to reach with an orthograde approach — sometimes an apicoectomy is the better solution.
How do they occur?
Common
causes.
Perforations are rare — but when they do occur, it is usually during an earlier treatment or as a result of advanced disease.
Iatrogenic: post preparation
Preparing the canal for a root post can lead to a perforation of the root wall — usually in the middle third of the root.
Iatrogenic: access cavity
When the pulp chamber of a molar is opened, the floor can be perforated — particularly where the canal orifices are calcified.
Iatrogenic: file path
If a curved canal is prepared too straight, a file can breach the root wall — known as a ‘strip perforation’.
Advanced resorption
When internal or external resorption penetrates the root wall completely, a spontaneous perforation results.
Deep caries
Advanced caries at the neck of the tooth can extend right through the root wall — especially with defects lying deep below the gumline.
Trauma
Very rare — direct mechanical force on the root wall breaching the tooth structure.
Process
Treatment
in 7 steps.
01
CBCT diagnostics
Location and size of the perforation in 3D — the basis for every treatment decision.
02
Treatment plan
Orthograde, surgical or combined? We discuss the options and the prospects of success openly.
03
Anaesthesia & rubber dam
A pain-free, dry working field — the prerequisite for precise handling of MTA.
04
Access under the microscope
Direct visual contact with the perforation at 25× magnification. Gentle cleaning of the defect.
05
Bleeding control
A prerequisite for a reliable MTA seal — we wait until the tissue is free of bleeding.
06
MTA / bioceramic seal
Applied and condensed in layers under the microscope. The material sets in a moist environment and bonds biocompatibly with the surrounding tissue.
07
Definitive restoration
Root filling and a stable coronal restoration — usually a crown, depending on where the perforation lies.
80–90%
Success rate
Perforations treated under the microscope with MTA / bioceramics.
Early
= better
The sooner treatment is carried out, the better the chances of keeping the tooth.
MTA
Gold standard
Mineral Trioxide Aggregate — biocompatible, tight-sealing, stable in the long term.
Costs
What does
the repair cost?
Sealing a perforation is a specialised treatment involving work under the microscope and high-quality bioceramic materials — usually a private-fee service. Where a perforation arose during earlier treatment, it can be sensible to clarify cost coverage with the referring practice.
Guide prices
- Cervical perforation (orthograde): approx. €500–800
- Mid-root perforation: approx. €700–1,000
- Apical perforation (surgical): approx. €900–1,500
- If combined with retreatment: plus the cost of the retreatment
Before any treatment we provide a transparent written cost estimate.
Common questions
Answers
on perforation.
The questions we are asked most often about perforation treatment.
What is a root perforation?
A pathological connection between the inside of the root canal and the surrounding tissue (bone, gum, periodontium). It usually arises iatrogenically during an earlier treatment, or through advanced resorption or caries.
Left untreated, it leads to chronic inflammation and loss of the tooth.
Can the tooth be preserved after a perforation?
Yes, in most cases. What matters is the location and size of the perforation and the time until treatment. With a microscope and MTA, success rates of 80–90 % are achieved — particularly with early treatment.
How is a perforation diagnosed?
On 2D X-rays, perforations are often hard to detect. For a reliable diagnosis, a CBCT scan is usually required — it shows the location, size and any accompanying damage precisely.
Is the treatment painful?
Pain-free under local anaesthetic. Mild pressure sensitivity can occur afterwards, but it settles quickly.
Which material is used?
MTA (Mineral Trioxide Aggregate) or modern bioceramic materials. They are biocompatible, seal tightly and set in a moist environment. The surrounding tissue tolerates them very well — tissue regeneration at the margin of the defect is often seen.
What does the treatment cost?
Costs are usually between 500 and 1,200 euros, depending on location and complexity. If combined with retreatment or an apicoectomy, the overall cost can be higher. We provide a written cost estimate before treatment begins.
Do I need a referral?
No — you can book an appointment directly. Please bring recent X-rays or a CBCT scan with you; that speeds up the diagnosis.
More treatments
Related
treatments.
Perforation treatment is often part of a larger course of treatment.
Diagnostics
CBCT — 3D imaging
Essential for every perforation — precise localisation.
Find out more RetreatmentEndodontic retreatment
Usually combined with sealing the perforation.
Find out more Surgeryapicoectomy
Often the better solution for apical perforations.
Find out more SpecialResorption
A common cause of spontaneous perforations.
Find out moreBook
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