Root Canal revision procedure on a maxillary molar which implied a plastic carrier removal as well as the by-pass of a fractured instrument previously left in the root.
MicroEndodontic. Case Study Number 530346
Insertion of a rotating SX file into calcified canal led to instrument breakage because its brittle tip fitted too snuggly into the narrow funnel. Referring dentist wanted us to retrieve that broken instrument in distal root canal.
The use of ultrasonic tips could not dislodge the entire fragment after first attempt because apical fragment was too firmly engaged into calcified dentine. Instead ultrasonic vibrations caused it to break once more, leaving a piece of the instrument much deeper into the canal. Thus, we had to work our way around the remaining fragment taking great care not to excessively flare up the coronal part of root canal in order to retrieve the remaining half. Buck 1A and Titanium CPR 8 FROM SPARTAN were most helpful for that purpose.
Being able to magnify the “head” of the separated instrument in distal root canal was of a big help in that retrieval procedure.
Study Case Number 491047
We have been presented with this previously treated tooth. The canal system has been filled with Sargenti’s paste and a separated past filler still remains in mesial canal. Second image displays a mesial root close up with the broken paste filler reaching it’s apical third.
Patient is informed about these facts and is made aware of the tooth poor prognosis if separated instrument cannot be removed and if Sargenti’s paste cannot be completely removed from canal system. Extraction and implant therapy is considered but patient wants to keep her own tooth. Informed consent is given by the patient.
Pulp chamber is accessed trough amalgam obturation, filling material is then removed with ultrasonic tips and two canal entries (out of three) are localised. Sargenti’s paste is broken into smaller pieces until a softer aspect of the material is found, coronal part of paste filler is exposed and the separated instrument is retrieved and an Xray dental film is taken (Third image). First instrument, a number 06 ISO K file is reaching the apex in fourth X ray image. Fift image is a” calcium hydroxide paste insertion” post operative X ray dental film. Last image (bottom to the right) is a final obturation with Pulp Canal Sealer and gutta percha (lateral and vertical condensation).
Case Study Number 410712
Teeth 12, 13 and 17 are existing 17XXX13,12 bridge abutments. Previous bridge done by a prosthodontist lasted 12 years. Lack of bone structure precluded implants surgery in number 16,15 and 14 and patient did not want any sinus lift surgery. Tooth number 12 became a key abutment to save without shortening its root lenght. Root canal performed 12 years ago on tooth number 12, a casted post has to be removed, broken Hedstrom file number 45 ISO also has to be removed in apical third of root canal. Tooth decay surrounded the file fragment and apical root canal size diameter had to be enlarged to 80 ISO diameter file. After re-endo, casted posts on teeth number 12,13 and a new 17XXX13,12 bridge are planned. Last Xray is a post operative X ray with cemented post and abutment 12 of 17XXX13,12 bridge.
Case Study Number 318
Endodontic retreatment on lower right first premolar (Vertucci’s Type V canal configuration) Pre operative X ray film shows:
1- First separated instrument in lingual canal
2-Second separated instrument in vestibular canal
Second X ray film (post operative from first session) shows the other fragment yet to be removed with the help of a surgical operative microscope. Provisional material obturation left in canal is called Clip from Voco. Not very radio opaque but still is an excellent provisional material easy to insert and remove. Second appointment post operative showing second fragment removal and Ca (OH)2 with barium sulfate dressing in canals. Acrylic crown with radicular retention has been cemented with Temp Bond. Fourth X ray shows final root canal filling with casted post for try in at third appointment. Last X Ray shows a 7 years post operative outcome. Sealer extrusion into the periapex vanished, tooth is asymptomatic and has been a partial denture keytooth since then.