Endodontics is a branch of dentistry with the primary goal of preventing tooth loss. Despite the efforts of dentists to maintain the vitality of the teeth, it is sometimes necessary to initiate endodontic treatment, during which errors can occur. One of the errors is traumatic tooth perforation, also known as the fausse route or via falsa. Perforation implies any pathological communication between the root canal and the surrounding periodontium that can lead to a failure of endodontic therapy. Root canal perforations can be classified according to etiology, localization, and factors influencing treatment outcome. They can be a result of internal or external root resorption, invasive dental caries, or errors that occur during root canal instrumentation and post-endodontic tooth restoration. Factors, such as time between perforation occurrence and its detection, size and shape of the perforation, localization, and repair material selection, affect the potential for infection control at the perforation site. Diagnosis is based on subjective and objective symptoms and signs, aided by radiographs, CBCT scans, and electronic apex locators. The primary goal of the treatment is to close the resulting perforation and thus separate the endodontic anatomical unit from the periodontal one by a procedure that can be performed non-surgically or surgically, or a combination of both.