This study illustrates a conservative approach to nonsurgical management of apical root perforation in maxillary first molars. A patient was referred for retreatment of a maxillary left first molar. Her chief complaint was dull pain while biting in her maxillary left first molar. Periapical radiography showed radiolucency related to the mesiobuccal root and overextended gutta‐percha through a perforation in the apical part of the distobuccal root. A CBCT scan was acquired and revealed the location and size of the apical perforation. The clinical examination showed that the tooth has been endodontically treated and the canals were filled, tender to percussion and palpation. Thus, the nonsurgical root canal retreatment was done and the perforation site was repaired by using mineral trioxide aggregate (MTA). At the one‐year follow‐up, after the management of apical root perforation, we observed periapical tissue healing and no pain due to percussion and palpation, without any clinical/radiological signs or symptoms. The prognosis of this case has a higher success rate with the development of new materials such as MTA. The MTA not only can seal the site of the perforation but also has the ability to induce calcification. Many factors can contribute to the success rate of perforated cases, including time, size, and location of the perforation. With the use of this material and good tools like a microscope, there are those with having higher chances of repair and eventually higher success rates.

Utilizing a novel approach that concomitantly assessed cyclic fatigue and torsional overloading, we aimed to establish the maximum number of artificial canals that can be prepared by Hyflex EDM and NeoNiTi A1 operated at two different speeds until their separation. Forty-eight files were equally divided into four groups: (A) Hyflex EDM operated at 300 rotations per minute (RPM) and (B) at 500 RPM, and (C) NeoNiTi A1 at 300 RPM and (D) at 500 RPM. Files were used to completely shape 10 sequential artificial canals unless file separation occurred. Maximum number of canals prepared was noted and averaged. Fractography was conducted to determine the mechanism of file separation. Hyflex EDM prepared significantly more canals compared to NeoNiTi A1 (p = 0.008). When operated at 300 RPM, Hyflex EDM prepared significantly more canals compared to NeoNiTi A1 (p = 0.028), whereas no significant difference was observed when they were operated at 500 RPM (p = 0.116). One NeoNiTi file broke due to cyclic fatigue while another one separated due to torsional overloading. Hyflex EDM files showed signs of both mechanisms. Within the limitations of this study, one file safely prepared four to five canals before its fracture. There was a trend towards fewer prepared canals as the RPM increased.