This article describes the case of a vital molar tooth with a vast furcal iatrogenic root perforation and biologic width violation, which was successfully managed by a multidisciplinary approach aimed at preserving pulp vitality. The root perforation was cleaned and then sealed with mineral trioxide aggregate, which was positioned onto the pulp at the canal orifices. After one month, the patient was not reporting symptoms, and the tooth was positively responding to the thermal test. The tooth was orthodontically extruded, subjected to minimally invasive crown lengthening, and prepared to receive a full-crown restoration. Radiotransparent composite resin was chosen as a permanent restorative material to better monitor possible endodontic complications at the coronal level. The patient's tooth was followed up for eight years uneventfully. The present case is an example of the possibility to subject a root-repaired tooth with fully formed apices to conservative yet complex multidisciplinary treatment while maintaining pulp vitality.
