Between Clinical Reasoning and Patient Autonomy : Decision-Making in Endodontics

A patient, a final-year dental student , presented to my office with spontaneous pain, pain on biting and tenderness on percussion in a mandibular first molar, for which endodontic treatment had already been performed. Clinical examination and radiographic evaluation revealed the presence of three separated instruments: Two in the mesio-buccal canal , one short hand file and the other a long rotary file. And a third, beyond the apex. After analyzing the case using a CBCT , I proposed an approach based on the principle of minimally invasive treatment: Surgically remove the extruded file beyond the apex, and proceed only with retreatment of the mesio-lingual canal , since the mesio-buccal canal joins it in the apical third to form a…