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Endodontic Case Presentation. PRESENTED BY AHMAD S. ALQAHTANI [SSC-Dent(Endo)], R3 27 jan 2010. FIRST CASE. Patient personal data. Age: 29 year-old Sex: male Nationality :- Saudi Date started: 10 /Nov/2009 Date finished: 17 /Nov/2009. Chief complaint.

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endodontic case presentation

Endodontic Case Presentation



[SSC-Dent(Endo)], R3

27 jan 2010

patient personal data
Patient personal data
  • Age: 29 year-old
  • Sex: male Nationality :- Saudi
  • Date started: 10/Nov/2009
  • Date finished: 17/Nov/2009
chief complaint
Chief complaint
  • “I want to complete the treatment of my tooth and to replace the lost restoration ”.
  • Medical History
  • Past :- NAD
  • Current :- NAD

Extra-Oral Examination




Pulpal :- Pulpless tooth

Periapical :- Asymptomatic Periradicular Periodontitis

Periodontal:- Healthy periodontal attachment



Treatment plan

1-.Non surgical root canal treatment.

2- post and core build –up.

3-Full coverage restoration.

4- Follow-up.


- Do procedural errors cause endodontic treatment failure?

LOUIS M. LIN et al,2005

- There are three possible outcomes that may be encountered when treating these cases: (I) Retrieval, (ii) Bypass and sealing the fragment within the root canal space, (iii) True blockage.

- Success of retrieval depends on the canal anatomy, type of instrument, the location in the canal, the plane in which the canal curves, the length of the separated fragment, and the diameter of the canal itself.

Steven J. Cohen et al,2005


- Fors UGH et al, Endodontic treatment of root canals obstructed by foreign objects. Int Endod J 1968, recommended a strategy to be followed:

- in coronal 1/3: attempt retrieval.

- in middle 1/3: retrieve or bypass.

- in apical third: leave and observe.

- Complications Associated with Fractured File Removal Using an Ultrasonic Technique, N. Souter& H. Messer,2005

*Removal of a fractured file fragment from the apical third of canals should not be routinely attempted, and if attempted, the chances of success should be balanced against potential complications.

*the root strength decreased by 40% if a fragment located in the apical third is attempted for retrieval.


Studies reporting the effect of a retained fracturedinstrument on the outcome of endodontic treatmentmodified from Spili et al,2005 and Peter Parashos,2006


- The overall frequency of fractured endodontic instruments left in the root canal after treatment was found to be 3.3% of treated teeth and comprised 78.1% rotary NiTi files, 15.9% SS hand files, 4.0% paste fillers, and 2.0% lateral spreaders. The frequency of rotary NiTi instrument breakage was comparable to that previously reported for hand files.

-endodontic instrument fracture had no adverse influence on the outcome of nonsurgical root canal treatment and retreatment when the instrument remained in the root canal. The presence of a preoperative periapical radiolucency, rather than the fractured instrument per se, was a more clinically significant prognostic indicator.

Spili et al,2005


- If a separated instrument can be bypassed and incorporated into the root canal filling, the prognosis for endodontic therapy is favorable.

Forset al,1968

- Bypassing and sealing the fragment into place can be very successful, if the canal is thoroughly cleaned around the obstacle, andthe apical terminus is sealed.

Steven J. Cohen et al,2005

- effect of a separated instrument on bacterial penetration of obturated root canals.( saunders et al, 2004):

The separated instrument itself does not play a large role in the sealing ability of the obturation material, more important is the coronal seal and absence of any residual irritant beyond the level of the separated instrument.

  • (Lee et al. 2006), found that the root canal curvature is greatest in the apical third compared with the other thirds of the root.
  • The fact that roots are curved was initially appreciated by simply stating the angle of the curve and then categorizing roots as straight (5° and less), moderately (10 to 20°) or severely (>20°) curved.

Schneider SW,1971


- the radius of the curve has to be viewed together with its angle because “two canals measured at the same angle in degrees by the Schneider method could have very different radii or abruptness of curvatures, thus having a very different impact on the difficulty of canal instrumentation.”

Pruett JP et al,1997

  • Schäfer et al. (2002), found by taking radiographs in both clinical and proximal view, that 84% of all root canals in all teeth in the jaw (third molars excluded) showed a curvature of at least 10 degrees and 17.5% of all root canals also showed a secondary curvature, so called S-shaped root canals.
patient personal data23
Patient personal data
  • Age: 27 years
  • Sex: male Nationality :- Saudi
  • Date started: 5/May/2009
  • Date finished: 5/May/2009
chief complaint24
Chief complaint
  • “my dentist told me that I need a root canal treatment of my tooth prior to restore it permanently”
  • Hx of C.C.

-initial Tx of the tooth in question was done 6 weeks ago.

- the tooth is asymptomatic since that time except for mild discomfort due to partial loss of filling and subsequent food impaction since last week prior to this visit.

- no hx of swelling, severe or spontaneous pain.

  • Medical History
  • Past :- NAD
  • Current :- NAD

Extra-Oral Examination




Pulpal :- pulpless.

Periapical :- asymptomatic Periradicular Periodontitis

Periodontal:- Healthy periodontal attachment



Treatment plan

1- Non surgical root canal treatment.

2- cast post and core.

3- full coverage restoration.

  • Evaluating the maxillary premolar with three canals for endodontic therapy

Ralph B e l l i z z i ,1981

* categories of three-rooted maxillary premolars:

Category 1:fusion of all three roots or only the two buccal ones, and a semifused or free palatal root.

Category 2: normal separation of the buccal roots at the midroot or apical-third level, with either a semifused or free palatal root.

Category 3: normal separation of the buccal roots up to the cervical level, with a free palatal root and the classic tripod appearance.

endodontic tx31
Endodontic Tx

The three-canalled maxillary premolar requires an access cavity modification into a "T“ shape, mesial-distally extending the buccal aspect of the usual outline form. This modification allows good access to each of the two buccal canals.Sieraski,1989