Management of separated instruments with periapical healing

The patient was referred by a colleague for the orthograde retreatment of teeth 15 and 16. The patient was asymptomatic at the time of examination. The pre-operative radiograph of tooth 15 revealed a periapical lesion associated with previous root canal treatment and the presence of a fractured instrument inside the canal. A second instrument fracture occurred during a previous attempt to bypass the fragment. Orthograde retreatment was therefore indicated. The initial treatment strategy consisted of retrieving both fractured instruments followed by orthograde retreatment of teeth 15 and 16 in order to allow proper disinfection and healing of the periapical tissues. Pre Operative Radiography During the retreatment of tooth 15, one of the fractured instruments was successfully removed in the palatin…