Vol. 11, Issue 4, Part G (2025)

Strip perforations represent a critical endodontic mishap that compromises both tooth structure and periodontal integrity. They typically occur in roots with thin dentinal walls, especially in the mesial canals of mandibular molars, as a result of over-instrumentation or aggressive coronal flaring. Unlike apical or furcal perforations, strip perforations are elongated and irregular, making them difficult to seal and more prone to bacterial leakage. Their prognosis depends heavily on the immediate use of repair materials that provide a hermetic seal with dentin (marginal adaptation) and simultaneously reinforce the remaining root to resist functional stresses (fracture resistance). Mineral trioxide aggregate (MTA) has historically been the benchmark material for perforation repair due to its excellent sealing ability and bioactivity. However, its disadvantages, including prolonged setting time, challenging handling, and potential discoloration, have driven the search for alternatives. Biodentine, a calcium silicate-based cement with dentin-like elasticity and enhanced bioactivity, has demonstrated superior marginal adaptation and significantly greater reinforcement of structurally weakened teeth compared to MTA. More recent advancements, such as premixed bioceramic putties and sealers, show promise in combining ease of application with bioactive sealing, although their clinical evidence remains limited. Overall, available literature suggests that calcium silicate-based bioceramics, particularly Biodentine, provide the most favorable balance between sealing ability and reinforcement in strip perforation repair. Nevertheless, most supporting data originates from laboratory-based studies. Future research should focus on standardized methodologies and long-term clinical trials to establish evidence-based protocols and validate the superior outcomes suggested in vitro.