A patient came in with pain on tooth No. 19. It had a crown with a previous root canal and a separated file at the apex in the mesial root (Figure 1). The tooth appeared to be beyond repair. The patient considered an extraction and implant.
If you look at the bone breakdown in the furcation area as well as the “J-shaped” lesion, which could be a periodontal issue or root fracture, this is definitely understandable (Figure 2). However, I’ve seen several cases like this before in almost 20 years of practice. I decided to retreat the tooth.
I could not remove the separated file at the apex, so I was able to bypass it with a file. Calcium hydroxide was placed for 2 weeks (Figure 3). There was no crack. The patient returned and the case was obturated with warm vertical condensation with the file left in place. He returned back in 6 months showing remarkable healing (Figure 4).
 |
 |
| Figure 1. The pre-operative radiograph shows a previous root canal. There is furcation bone breakdown, a “J-shaped” lesion, and a separated instrument in the mesial lingual canal at the apex. | Figure 2. This radiograph shows the tooth dissassembled, cleaned, and shaped, with calcium hydroxide (Ultracal) placed. The separated instrument could not be removed safely. |
 |
 |
| Figure 3. The case was completed using warm vertical condensation and Kerr EWT sealer. The separated instrument was left behind. | Figure 4. The 6-month recall showed areas of healing on the mesial root, the furcation, and the distal root. |
It turns out that he made a great decision. He saved time, money, and his tooth! #RelaxDontExtract
What would you have done? Email me at dr.short@yahoo.com, or visit our related posts on Facebook at facebook.com/DentistryToday/ or facebook.com/rootcanaldoc.
Rico D. Short, DMD, attended the Medical College of Georgia (MCG) School of Dentistry to attain a Doctor of Dental Medicine degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and 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 and assistant clinical professor at the Dental College of Georgia in Augusta. Dr. Short also has published articles in several magazines and peer-reviewed journals including Dentistry Today, Inside Dentistry, Rolling Out Magazine, Upscale Magazine, and the Journal of Endodontics. He has lectured throughout the United States and the Carribean. Dr. Short is endorsed by the American Association of Endodontists speakers bureau, and his private practice, Apex Endodontics PC, is located in Smryna, Ga. Dr. Short also has authored a book, Getting to the Root of Your Problem: 365 Days of Inspirational Thinking.
Related Articles
A Short Case Study: Is It Periapical Cemental Dysplasia?
How to Convince Your Patients That Flossing Is Important
Adherence to Guidelines After Dental Trauma Ensures Positive Outcomes
