A patient came in with pain on tooth No. 19. It had a very large and deep decay with very long, skinny roots. I took a bitewing x-ray to see the bone and perio condition and to evaluate its restorability. The patient had perio issues but had enough space for a crown without invading the biological width (Figure 1). I performed endodontic treatment.
I did everything right—straight line access, glide path, irrigation, RC-Prep, etc. Then, the heat-treated NiTi file separated in the mesiolingual canal. All files can separate! I used ultrasonics, but I could not remove the entire piece without risking a perforation. I was then able to bypass the separated instrument with small handfiles and established the working length to the apex.
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| Figure 2: I bypassed the separated instrument with small handfiles. There were four separate portals of exits. |
I then cleaned and sealed the canals with heat-treated NiTi files and obturated them with bioceramic sealer and gutta-percha. There were four separate portals of exits (Figure 2). On this case, it was critical to get to length because the mesiobuccal and mesiolingual did not join. The patient will be fine with a buildup and crown and by getting those perio issues addressed.
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Dr. Short attended the Medical College of Georgia School of Dentistry to attain a DMD degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and then became a Diplomate of the American Board of Endodontics in 2009. Dr. Short is an expert consultant in endodontics to the Georgia Board of Dentistry, author, speaker, and assistant clinical professor at the Dental College of Georgia in Augusta. His private practice, Apex Endodontics PC, is located in Smryna, Ga. He can be reached at dr.short@yahoo.com.
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