Challenges in Management of Compromised First Permanent Molar With Pathologic Perforation and Periapical Lesion in a 10-Year-Old Boy: A Case Report.

First permanent molars play a critical role in mastication, development of occlusion, dentoalveolar growth and maintenance of dentofacial and skeletal harmony. The first permanent molar is the most caries-prone tooth in the permanent dentition due to its early exposure to the oral environment. Additionally, it takes the longest time to develop from its intrauterine formation to eruption in the oral cavity making it particularly susceptible to hypoplastic changes during development. It has been frequently observed that the age of the child, stage of growth and development, incomplete root formation, limited working area in pediatric patients, behavioural changes, and delayed reporting to the dental clinic complicate the management and affect the long-term prognosis of the molar. Management of compromised first permanent molars (cFPM) in pediatric patients presents several challenges, including behavioural issues, limited cooperation, incomplete root formation, restricted working space, and delayed presentation to dental clinics. These factors, along with difficulties in achieving effective local anesthesia, poor saliva control, and the rapid progression of carious lesions, further complicate treatment and affect the long-term prognosis. The present paper describes the management of compromised first permanent molar in a 10-year-old boy with carious and pathologic furcation involvement and compromised periodontal prognosis using Triple antibiotic paste, Tricalcium silicate cement, intra-operative and post-operative challenges during its management. At follow-up, the tooth was evaluated clinically for the presence of pain, swelling, and difficulty in mastication. Radiographic assessment was performed over a specified time period to monitor the resolution of the periapical lesion and to confirm signs of bone healing and re-establishment of the lamina dura.