Iatrogenic dental perforations are the second most common cause of endodontic failure, creating communication between the endodontic space and the periodontium. They are highly diverse in terms of etiology, shape and size, and can occur anywhere along the endodontic path.The management of iatrogenic perforations calls for a number of therapeutic alternatives, the indications for which depend on certain criteria. Orthograde endodontic treatment is the preferred option.The aim of this paper is to guide the practitioner towards the necessary therapeutic approach to iatrogenic dental perforation, while emphasizing the importance of prevention. It also sheds light on the appropriate repair biomaterials that can improve the prognosis of such an accident.