Background: The first permanent molar (FPM) is the most caries prone tooth in the permanent dentition. Sometimes early extraction of badly decayed first permanent molars must be considered because of their poor long-term prognosis. This is a complex problem, and there is no consensus in the literature for the treatment management of these children. That is why the pediatric dentist and the orthodontist must work as a team and consider many factors before determining the appropriate treatment method. Case Report: The aim of this clinical report is to present a complex interdisciplinary treatment approach for an 11-year-old girl with history of early childhood caries and multiple restorations on her permanent upper front teeth and 4 non-restorable first permanent molars. Conclusion:The compromised teeth were extracted and new stable positions of the second permanent molars were achieved. The future eruption of the third molars will allow this patient to have fully functional dentition with 28 teeth. Clinical significance: This case illustrates that extraction of all 4 FPM and a careful planed orthodontic treatment can be beneficial to the oral health of young patients if it is done well. Extraction of first permanent molars at a young age is a difficult decision. Therefore, it is recommended that a team of pediatric dentist and an orthodontist plan the treatment together as soon as possible after detection of a compromised FPM.

Background: One of the reasons for endodontic treatment failure is iatrogenic perforation. That is why it is important to provide adequate endodontic education for graduating young practitioners. Aim: The aim of this study is to determine the most common locations of the iatrogenic perforations made by last year students in the Dental Faculty in Sofia, Bulgaria, to note the association of particular errors with particular teeth and to determine how this information can improve their education. Methods: All patient records of last-year students for 2015 and 2016 were examined. Perforations were diagnosed by radiography, and also confirmed clinically. Results: From all 778 teeth 30 incidents of root perforations were found: 10 in 2015 and 20 in 2016. More perforations were found in upper posterior teeth- 80% of all the perforations made in 2015, and 45% of all registered perforations in 2016. For the entire period of the research perforation frequency in upper molars, and in upper anterior teeth were found to be significantly higher than in other group of teeth. In academic 2015 year, 8 of the perforations (80%) were furcal. In 2016 year, 11 (55%) of all perforations were apical. Conclusions: More in-depth knowledge of endodontic anatomy , and also more strict supervision on students’ tasks are needed, especially regarding standard root canal treatment on molar teeth.

The aim of this study was to evaluate the technical procedural iatrogenic errors, especially to determine the frequency of dental perforation made by undergraduate students in Sofia, Faculty of Dentistry, Bulgaria, in the school years of 2014/2015 and 2015/2016. The assessment was by examination of periapical radiographs of completed endodontically treated teeth, performed by last year dental students. A total of 748 teeth were evaluated and 30 perforations were found. From 285 treated in 2015, 10 perforations were found. From 493 teeth treated in 2016, 20 perforations were found. The overall frequency of perforations was 3.9% for 2015 and 4.1% for 2016. The frequency of perforations made by postgraduate Bulgarian students established by us is low and it is similar to that made by general practitioners and found by other Bulgarian researches. Perforation frequency found in this study is due to the large number of retreatments (36% of all cases) and the prevailing number of elderly patients with calcified canals that come to be treated in our facility. And yet it is not significantly different from other published data.