Retreatment of an upper first molar due to an instrument fracture
Dr. Purificación Varela show us a retreatment clinic case of an upper first molar due to an instrument fracture using RetreatAll® and BlueShaper® files.
One of the causes of endodontic treatment failure is the persistence of the infection due to the lack of cleaning of the root canals and consequently the inadequate filling of the canal system. This can be due to different causes, among them the fracture of an instrument within the canal that hinders the penetration of the cleaning materials and its subsequent obturation.
The separate instrument leads to incomplete root canal cleaning and often results in treatment failure.
To successfully complete the treatment, the separate instrument should preferably be removed and, if not possible, attempted bypassing.
Clinical case
Patient referred for re-endodontia on 16.
Image taken after 3D obturation.
Diagnosis
We performed X-rays and observed in the mesial root of 16 a fractured file in the mesiobuccal canal with apical periodontitis. (Fig. 1)
Figure 1. Preoperative X-ray. File fragment at 16 .
Treatment
The canals are unclogged with RetreatAll® files 1 and 2 (ZARC4endo), Zr1 (30.04 of 21 mm) and Zr2 (25.04 of 25 mm), (Fig 2), which are very effective in removing gutta-percha without the need for solvents that produce a paste that is difficult to remove from the duct wall. The separated fragment is removed using the Star X® 3 ultrasonic tip from Dentsply Sirona and the ET25® from Satelec.
After re-waterproofing and correcting the working length, we finished shaping the canals with BlueShaper® files (Zarc4Endo, Gijon-Spain). The pre-filling irrigation is performed with 5.25% Sodium hypochlorite and 17% EDTA, activating both irrigants with the Ultra X® ultrasonic activator and X Blue tip (flexible) (Fig 3). We closed the three canals with Thermafil® (Fig. 4) and sent for reconstruction of the crown.
Review 3 months later (Fig 5).
Figure 2. RetreatAll® 1 & 2
Figure 3. Activador Ultrasónico Ultra X® y punta X-Blue (soft)
Figure 4. Root filling
Figure 5. Three months later
Dr. Purificación Varela
PhD in Medicine and Surgery by University of Santiago de Compostela. Endodontics Master’s director in Medicine and Dentistry College of University of Santiago de Compostela. Member of Spanish Society of Conservative Dentistry. President of EFAM. Endodontics speaker and autor of several communications over the world. Exclusive practice of endodontics in Bahillo Policlínica Dental.
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