An endodontic re-treatment case with multiple challenges

Tony Druttman BChD, MSc, presents an intriguing referred case.

A general dental practitioner refers a 35-year-old female patient with no relevant medical history for endodontic re-treatment of the lower right first molar tooth. She complained of pain on eating, but did not require any analgesics.


On clinical examination the tooth was tender to percussion and had a leaking restoration on the mesial aspect. The pre-operative radiograph (Figure 1) indicated the presence of a fractured instrument in the middle third of one of the mesial canals, an over-extended root filling in the distal canal and peripical radiolucencies associated with both the mesial and distal roots.

[caption id="attachment_351821" align="alignnone" width="2000"]Endodontic re-treatment, showing a fractured instrument in the mesial root. Figure 1: Pre-operative radiograph showing a fractured instrument in the mesial root, extruded gutta percha in the distal canal and apical radiolucencies associated with both roots[/caption]

I gave a diagnosis of chronic apical periodontitis and discussed the options for treatment with the patient. She elected to have endodontic re-treatment.


We carried out treatment under local anaesthesia and isolated the tooth with rubber dam. We then removed the exiting root fillings using two different techniques. The root filling in the distal canal was removed by introducing two size 30 Hedstrom files on either side of the existing gutta percha, braiding them and withdrawing the cone in one piece. (Figure 2)

[caption id="attachment_351824" align="alignnone" width="1416"]Figure 2: : Removal of the gutta percha cone by braiding two Hedstrom filesroots Figure 2: : Removal of the gutta percha cone by braiding two Hedstrom filesroots[/caption]

The gutta percha in the mesial canals was removed with a size 25 Profile (Dentsply) rotary instrument at 1200rpm and the fractured instrument was identified in the...

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