Endodontic Re-treatment of Maxillary molar with broken instrument and missed fourth canal
37 year old male patient named Konstantin was referred by our Prosthodontist collegue for endodontic opinion and management of tooth no. 16 having unsatisfactory previous endodontic treatment and periapical pathology.
On examination Tooth no.16 was previously endodonticaly treated having inadequately obturated canals, separated/broken instrument in mesial canal system and missed 4th canal (2nd mesial) and periapical pathology as confirmed on CBCT.
Chronic apical periodontitis of tooth no. 16
Treatment done in 2 visits due to challenging anatomy and broken instrument requiring meticulous management.
Visit 1: Under local Anaesthesia rubber dam application was done followed by access opening through old restoration under magnification (Microscope). Previoulsy filled canals were exposed and located. Old root canal fillings were removed with mechanical instrumentation and solvents one by one. After removing old filling from mesial canal the broken instrument was encountered obstructing the path to remaining canal. The instrument was then slowly bypassed with small instruments to reach the full length. Old fillings were then removed from distobuccal and palatal canals. Missed 4th canal (2nd mesio buccal) was now located using ultrasonics and explorer. All canals were then shaped, cleaned and intracanal medication was placed.
Broken instrument bypassed:
Locating, negotiating and preparing missed MB-2 Canal:
Visit 2: Under local anaesthesia rubber dam application was done followed by cleaning of canals. After which the canals were dried and obturated (filled) using warm vertical compcation (Thermoplastic obturation). Patient was the referred back to our prosthodontist for further restorative treatment.