engleski

Removal of broken instruments and endodontic treatment of chronic periapical parodontitis: a case report

Introduction: Chronic periapical changes caused by pulp tissue decomposition during infection or because of inadequate endodontic treatment can be present in the bone without any subjective symptoms and only detected accidentally on x-ray during routine examination. Case report: 26 year old female patient came to the office for a regular check up. Because the presence of orthodontic anomaly, (primary compression in both jaws) orthodontic treatment was suggested. Furthermore, X-ray examination revealed large periapical lesion in the area of lower central incisors. Inside the root canal of left lower central incisor fragment of a broken endodontic instrument was observed. Vitality test performed on right lower central incisor was negative. After rubber dam placement endodontic treatment was performed. Four broken fragments (3 lentulo spirals and Höedstrem file) were removed from the root canal of the left lower central incisor. Working length was determined using apex locator. Both central incisors were cleaned and shaped using step-back method and filled with cold lateral condensation technique. After completing the endodontic treatment, composite fillings were made using Tetric EvoCeram composite material (Ivoclar Vivadent, Schaan, Liechenstein). Discussion: When performing endodontic treatment there is always a risk of endodontic instruments breaking inside the canal. This mistake intensifies if fragments of instruments are left inside the root canal causing inadequate obturation and development of periapical lesions. Endodontic treatment enables restitutio ad integrum of bone as well as periapex. X-ray taken immediately after the treatment confirmed the root canal obturation followed by first one month control, which revealed no significant change. However, the X-ray taken after 3 month revealed healing as well as new bone formation. Another control X-ray will be taken after 6 months as well. Conclusion: Success of endodontic treatment depends on successful obturation of cleaned and shaped root canal to enable organism immune response to infection and periapical healing. If there is a breakage of endodontic instrument during treatment before obturation is achieved the fragment should be removed. Endodontic treatment is considered completed when the tooth is restored with filling or prosthetic crown to stop coronal leakage and reinfection.

endodontic instruments; broken instruments; revision of rooth canal filling

nije evidentirano