The patient B.A. came to our clinic, after about a week since the last visit of the attending doctor, complaining of intense pain and a feeling of swelling in the posterior region of the 4th quadrant. After the clinical investigation and the radiological examination, we came to the conclusion that we have to do with a totally wrong endodontic treatment, with a distal perforation, with the invasion of the bone space with gutta-percha filling substance and an overhang of approximately 5 mm on the distal root and with undetected medial roots. In the first stage, we tried to remove the filling material from the distal root and from inside the bone tissue, acting directly through the perforation. After asserting the bone tissue, we proceeded to close the perforation, using three materials. I managed to make a bed for the future MTA cement, with the help of Gelaspone sponges, and slowing down the bleeding. I applied MTA cement, and then applied glass ionomer cement to the level of natural dentin. MTA was used as a support, to be able to rebuild the destroyed wall. Then, I sterilized the root canals by irrigating with NaCl solution and hypochlorite 5.25% and proceeded to obturation of the distal canal in the apical area, also with MTA cement (apical opening over 90). After that I obturate the three canals with liquid gutta-percha (3D technique)

After a week, I was able to restore the coronary part with the help of a fiberglass pivot. After six months, without symptoms, the patient could benefit from a prosthetic treatment on this tooth. I’m looking forward to the follow-up X-ray, two years after the intervention.