Case #4 separated file

Pre op xray separated in file in place

File was separated during cleaning of the canal.  Evidently it could not be removed or practitioner did not have the instruments to remove it.

Final post op completed RCT

Please note slight curve at the end of the root with a lateral canal going toward the distal.

Magnified view of post op apex

Comment:
Separated instruments in the upper third of the root system can generally be removed with ultrasonics. Separated files further down the system, especially around curves, are just about impossible to remove.  It is not the file that causes post operative problems,but rather, a canal system that was not cleaned properly and blocked by the file.

Case #3 retreatment #19 on 11 year old patient

Pre op: tooth #19 with a failing root canal

Please note the (underwhelming) root canal filling.  Patient, 11 years old, was quite symptomatic.

A young tooth is difficult to clean and obturate well because of the size of the canal system. 

Post op: completed retreatment

An alloy was placed in the access to ensure against any bacterial products.

3 year post operative x-ray

Periapical lesion has healed and tooth is  asymptomatic.

I recommend full coverage at 18 years of age to allow for structural changes in her dentition. Prior to 18 it is probably best that a posterior tooth have some sort of temporary crown.  I always recommend this to the patient and parents.

Case #2 Tooth #30 showing multiple silver points

Recommendation: Before a new crown is fabricated for a tooth that has had a root canal, making sure that the root canal is asymptomatic, no periapical lesions, and the root canal itself is of good quality. Additionally, all silver cone root canals should be retreated before new crowns are made.

This is an example of what I found in a lower first molar.

Pre Op - with Silver Points

Photo of ten silver points removed from tooth #30

Please note how corroded each point is.

Post Op - Root canal completed with gutta percha

(I can only speculate as to what the distal overhang is on the crown.)