Endodontic Treatment Procedures Research Articles

Improving Antimicrobial Properties of GelMA Biocomposite Hydrogels for Regenerative Endodontic Treatment.

Regenerative endodontics is a developing field involving the restoration of tooth structure and re-vitality of necrotic pulp. One of the most critical clinical considerations for regenerative endodontic procedures is the disinfection of the root canal system, since infection interferes with regeneration, repair, and stem cell activity. In this study, we aimed to provide the synthesis of injectable biopolymeric tissue scaffolds that can be used in routine clinical and regenerative endodontic treatment procedures using Gelatin methacryloyl (GelMA), and to test the antimicrobial efficacy of Gelatin methacryloyl/Silver nanoparticles (GelMA/AgNP), Gelatin methacryloyl/Hyaluronic acid (GelMA/HYA), and Gelatin methacryloyl/hydroxyapatite (GelMA/HA) composite hydrogels against microorganisms that are often encountered in stubborn infections in endodontic microbiology. Injectable biocomposite hydrogels exhibiting effective antimicrobial activity and non-cytotoxic behavior were successfully synthesized. This is also promising for clinical applications of regenerative endodontic procedures with hydrogels, which are proposed based on the collected data. The GelMA hydrogel loaded with hyaluronic acid showed the highest efficacy against Enterococcus faecalis, one of the stubborn bacteria in the root canal. The GelMA hydrogel loaded with hydroxyapatite also showed a significant effect against Candida albicans, which is another bacteria responsible for stubborn infections in the root canal.

Harnessing antimicrobial peptides in endodontics.

Endodontic therapy includes various procedures such as vital pulp therapy, root canal treatment and retreatment, surgical endodontic treatment and regenerative endodontic procedures. Disinfection and tissue repair are crucial for the success of these therapies, necessitating the development of therapeutics that can effectively target microbiota, eliminate biofilms, modulate inflammation and promote tissue repair. However, no current endodontic agents can achieve these goals. Antimicrobial peptides (AMPs), which are sequences of amino acids, have gained attention due to their unique advantages, including reduced susceptibility to drug resistance, broad-spectrum antibacterial properties and the ability to modulate the immune response of the organism effectively. This review systematically discusses the structure, mechanisms of action, novel designs and limitations of AMPs. Additionally, it highlights the efforts made by researchers to overcome peptide shortcomings and emphasizes the potential applications of AMPs in endodontic treatments.

Morphological changes in root dentin after irradiation with diode laser 980 nm in two directions: an in-vitro study

Background/aim Laser technology is an essential aid tool for endodontic treatment procedures. The most common type of laser used in the endodontic field was diode laser 980 nm. The present work aimed to assess the morphological variations and chemical changes in root canal dentin treated with diode laser 980 nm in two directions parallel and perpendicular by scanning electron microscope (SEM) and energy dispersive X-ray spectroscopy (EDS). Materials and methods Thirty extracted human single-rooted lower premolars teeth with mature apex were chosen from Dental Department of Research Institute of Ophthalmology, Egypt. Their crowns were resected at the cement-enamel junction (CEJ), and their roots were mechanically prepared. The roots were categorized into two groups (each = 15): according to the direction of laser application. In group A the laser was directed parallel to the root canal, while in the group B it was directed perpendicular to the root canal. All groups were analyzed by SEM and EDS examination. Statistical analysis was done by Kolmogorov-Smirnov and Shapiro-Wilk tests and comparison between two groups was performed by independent t-analysis, while in qualitative data Chi-square test was used. Results The results of group A where the laser was directed parallel to the root canal exhibited score 1 (86.7%) in the coronal section, score 3 (80%) in the middle section, and score 4 (80%) in the apical section. The results of group B where the laser was directed perpendicular to the root canal represented score 1 (86.7%) in the coronal section, score 1 (73.3%) in the middle section, and score 3 (73.3%) in the apical section. Conclusion Diode laser 980 nm in a perpendicular direction to root canal dentin surface produced more morphological changes than when used in a parallel direction, however regarding the chemical changes, there were no chemical changes detected between the two directions.

Management of a flare up case after endodontic treatment procedure

A flare-up is defined as a pain and/or swelling of the soft tissues that occurs within a few hours or a few days following the root canal treatment. In some cases, the flare-ups can appear after the finishing of the root canal treatment, due to the penetration or development of the microorganisms into the root canal. The pain felt by the patient depends on the extent of the periradicular tissue injury, its severity and intensity of the inflammatory immune response. The article discusses the microbial irritation of apical periodontal tissue caused by insufficient instrumentation and filling of the root canals, factors that lead to failure of the outcome of root canals treatment.

PERAWATAN SALURAN AKAR VITAL PADA GIGI INCISIVUS LATERAL MAXILLA PULPITIS IRREVERSIBLE (Laporan Kasus)

Irreversible pulpitis is a persistent inflammatory condition of the pulp, which can be symptomatic or asymptomatic caused by a nerve stimulus. Tooth with pulp inflammation need root canal treatment to remove irritants of bacteria and clean the infected root canal from necrotic tissue. Root canal treatment aims to keep the teeth functioning properly. Irreversible pulpitis symptomps include persistent spontaneous pain of an external cause. The stages of root canal treatment include: root canal instrumentation which includes cleaning and shaping (biomechanical), disinfection, and obturation. A 16-year-old woman came to RSGM Soelastri, University of Muhammadiyah Surakarta with a complaint of a damaged restoration on her anterior teeth. Intra-oral examination revealed that tooth 12 appeared to be a damaged restoration. sondation (+), percussion (-), palpation (-), vitality test (+), EPT: 34, and Oral Hygiene 1,2 (moderate). The diagnosis for this case irreversible pulpitis with multivisit vital root canal treatment. The purpose of this case report irreversible pulpitis, root canal treatment, vitalis to describe of an endodontic treatment procedure that can maintain tooth 12. The control was carried out 1 week after treatment and patient did not feel any complaints. Intraoral examination were. sondation (-), percussion (-), palpation (-), vitality test (-) treatment was successfully carried out and proceed with final restoration of a porcelain fused to metal jacket crown with fiber post.Keywords:

Endodontic management in geriatric patient with medical compromised

Endodontic treatment in geriatric patient with medical compromise is not a contraindication, but needs special treats, those are medical history, medical problems, psychological, age-related changes, changes in tooth structure, and tissue response. This ar-ticle is aimed to describe the role of management endodontic treatment in geriatric patient. A 62 years old male was diagnosed of tooth 16 as asymptomatic apical periodontitis. Radiographic examination shows widening of the periodontal ligament and periapical radiolucency. The patient has a history of hypertension and takes medication regularly. The endodontictreatment pro-cedure is preceded by IEC to the patient regarding the multivisit endodontic treatment by fulfilling the endodontic triad princi-ples. The treatment was conducted in the morning with short duration. Rubber dam was used in this treatment before rewalling and other procedures. Root canal preparation using rotary Protaper Next files on mesiobuccal up to X2 file (#25/06) and X3 file (#30/07) on mesiodistal and palatal canals. The root canals were irrigated using5.25% NaOCl and aquades. The root canal fil-ling technique was performed using a single cone technique, an epoxy resin sealer and gutta-percha materials. Theresult showed endodontic treatment multivisit in geriatric patient with compromise medis is succesfull. It was concluded that appropriate en-dodontic management in geriatric patient with medical compromise will support the success of the treatment.

Comparison of Local and Systemic Ibuprofen for Relief of Postoperative Pain in Symptomatic Teeth with Apical Periodontitis.

BackgroundOne of the aims of endodontic treatment is to control preoperative and postoperative pain. The present study evaluated the effects of local and systemic ibuprofen on postoperative pain. It aimed to determine the most effective method for relieving postoperative pain due to chemomechanical preparation.Material/MethodsNinety patients with symptomatic apical periodontitis were randomly assigned to local ibuprofen, systemic ibuprofen, and control groups (n=30 each). Chemomechanical preparations were performed using a ProTaper Universal Ni-Ti rotary file under 2.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid irrigation. After the root canals were dried with sterile paper points, while Odontocide paste was applied into the root canals of the patients in the local ibuprofen group, calcium hydroxide paste was applied into the root canals of the patients in the systemic ibuprofen and control groups. Following completion of the endodontic treatment procedure, 200 mg ibuprofen was prescribed to patients in the systemic ibuprofen group. Friedman and Wilcoxon tests were used for statistical analysis.ResultsPosttreatment pain scores were recorded at 6, 12, 24, and 48 h using a visual analogue scale. Although there were no significant differences between the local ibuprofen group (Odontocide) and the control group (Ultracal) (P>0.05), pain scores in the systemic group (Ultracal+200 mg ibuprofen) were significantly lower than those in the other 2 groups (P<0.05).ConclusionsThese results indicate that systemic administration of ibuprofen is effective for postoperative pain relief.

Carboxymethyl cellulose hydroxyapatite hybrid hydrogel used to evaluate the osteogenic and odontogenic differentiation potential of dental pulp and periodontal ligament stem cells

In order to maintain optimal function, the aim of pulp treatment is to maintain the tooth structure intact. Retaining the vitality of teeth damaged due to caries or trauma is also one of the purpose of pulp treatment. In particular, the preservation of pulp vitality is essential for continuous root development and apical closure in the case of immature permanent teeth. In recent years, regenerative endodontic treatment procedures have been suggested in order to replace the damaged pulp tissue with viable tissue. The idea of regeneration of the dentin-pulp complex was introduced into endodontics to restore the vitality of young permanent teeth that have been non-vitalized due to trauma/dental caries. The concept of success in regenerative endodontic procedures is relied on three basic elements that are; stem cells, growth factors, and scaffolds. Each of these play their own important role in the regeneration of pulp-dentin complex. This invitro comparative study had intended to deal with the new experimental custom prepared semi-synthetic hybrid scaffold (CMC-HA), its acceptance for the cells (DPSCs and PDLSCs) seeded on it and osteogenic and odontogenic differentiation of both the dental pulp and periodontal ligament stem cells.

Accuracy of Dynamic Navigation for Non-Surgical Endodontic Treatment: A Systematic Review.

In recent years, the application of Guided Endodontics has gained interest for non-surgical endodontic treatment and retreatment. The newest research focuses on the accuracy of Dynamic Navigation (DN). This article systematically reviewed existing data on the accuracy of non-surgical endodontic treatment procedures that were completed using DN. Following the PRISMA criteria, an electronic database search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library. Studies comparing the accuracy of non-surgical endodontic treatment using DN and the conventional freehand technique were eligible. The literature search resulted in 176 preliminary records. After the selection process six studies were included. The risk of bias was evaluated using the modified Cochrane Collaboration Risk of Bias 2.0 tool. Five studies examined the aid of DN for planning and executing endodontic access cavities, and one for fiber post removal. In two studies, endodontic access cavities were performed in teeth with pulp canal obliteration. The main outcomes that were measured in the included studies were preparation time, global coronal entry point and apical endpoint deviations, angular deviation, tooth substance loss, qualitative precision, number of unsuccessful attempts or procedural mishaps. The risk of bias was rated from low to raising some concerns. Overall, DN showed increased accuracy compared to the freehanded technique and could be especially helpful in treating highly difficult endodontic cases. Clinical studies are needed to confirm the published in vitro data.

The Acceptance of Rubber Dam Isolation by Patients undergoing Endodontic Treatment and Its Feedback: A Questionnaire Based Survey

Objective: The study was done to evaluate the average time taken by the operators to apply the rubber dam, procedure time and the acceptability or rejection of placement of rubber dam by the patients during endodontic treatment procedures.&#x0D; Design: The study was carried out on 450 patients requiring endodontic treatment reported at department during the time interval of May, 2021 to August, 2021. Out of 450 patients, 180 patients were randomly selected for the study by lottery method. All the endodontic procedures were performed under rubber dam isolation and rubber dam application time and time for isolation was determined. Further, a questionnaire survey was performed to evaluate the patient’s acceptance or rejection of procedures rubber dam and various reasons for rejection.&#x0D; Results: The highest number of respondents belonged to 21-30 years of age group i.e. 26.6% followed by 31-40 years i.e. 26.11%. Average rubber dam application time and procedure time were estimated as 4.04 and 44.07 minutes respectively. More than 90 % of the participants were willing to accept the procedure under rubber dam isolation in future. However, on contrary, only 9.44 % of the participants rejected the procedure under rubber dam isolation and the most common reasons for rejection were uneasiness felt by the patient and difficulty in breathing.&#x0D; Conclusions: The acceptability of rubber dam isolation while performing endodontic procedures/ treatments was quite significant among the patients. Very few patients had allergy to the latex material of rubber dam sheets and respiratory disorders.

Post-Operative Endodontic Pain Management: An Overview of Systematic Reviews on Post-Operatively Administered Oral Medications and Integrated Evidence-Based Clinical Recommendations.

Endodontic treatment comprises the overall management of pre-, intra- and post-operative symptoms, including post-operative endodontic pain, considered as a complication susceptible of chronicization. Post-operative pain is very common and highly unpreventable and has a multi-factorial etiology and a potential pathogenic link to the acute inflammation of the periapical area, secondary to localized chemical, mechanical, host and/or microbial damage occurring during endodontic treatment. Considering the multitude of heterogeneous technical and pharmacological approaches proposed to control post-operative endodontic pain, the present study primarily comprised an overview of systematic reviews of systematic reviews of randomized clinical trials, summarizing findings on post-operatively administered oral medications for post-operative endodontic pain control, in order to note the most effective type and dosage of such drugs. Secondarily, a narrative review of the current evidence on technical solutions to be observed during endodontic treatment procedures, to control post-operative pain, was conducted to provide integrated evidence-based clinical recommendations for optimal post-operative endodontic pain management.

Levels of Anxiety and Fear Related to Non-Surgical Root Canal Treatment Performed by Endodontic Residents and Endodontists

ObjectivesDespite advances in endodontic treatment procedures, root canal treatment is still associated with anxiety and fear. This may cause care avoidance and subsequent oral complications due to untreated endodontic infections. Anxiety and fear levels in response to non-surgical root canal treatment performed by endodontic residents and endodontists were analyzed.MethodsA descriptive, cross-sectional survey was conducted among patients visiting the endodontic clinics at the University Dental Hospital. The questions addressed the participant's demographics, previous root canal treatment visits, clinician's level of training, and post-treatment experience.ResultsDemographics play a role in anxiety and dental fear in root canal treatment. Men scored significantly lower in the high-anxiety category than women, and patients treated by endodontic residents expressed lower levels of anxiety. Post-treatment experience of an endodontist or endodontic resident was a significant factor in reducing dental fear and anxiety.ConclusionThe level of anxiety and fear related to root canal experience of endodontists or endodontic residents is very low. Most of the patients expressed willingness to undergo further root canal treatment to save a tooth.

Expert Lecture and Live Demo: The Latest Endodontic Treatment and Restoration with Dental Fiber Posts

Endodontic treatment of anterior trauma and caries followed by post and crown restoration is not included in the minimum standard of oral care in primary health facilities. Endodontic treatment, which requires a relatively long time and the number of visits compared to mere tooth extraction, often makes it impossible to carry out in a health facility with many patients per day. This community service was aimed to provide technical understanding and knowledge of endodontic treatment procedures for anterior teeth that are simple, up-to-date, with a minimum number of visits, and provide an understanding of the selection of dental fibre post materials that meet reasonable material requirements at a more affordable price. Methods for implementing the activities consisted of: (1) Formulation and preparation; (2) Pre-test; (3) Expert lecture; (4) Live demo; and (5) Post-test. This community service increased the knowledge and ability in endodontic treatments for anterior teeth and their restoration with dental fibre posts from the prospective dentists and dentists who were participants in this community service. This activity can also lead to the making of the latest manual and standards for endodontic treatment for anterior teeth and their restoration with dental fibre posts.

YouTube™ as an information source for regenerative endodontic treatment procedures: Quality and content analysis

BackgroundRegenerative endodontic procedures (REPs) are one of the most important developments in dental practice, and in the era of Covid 19 pandemic, audio-visual contents of YouTube™ could be an information source for dental students, practitioners and patients. The aim of this study was to evaluate the quality, content and the demographics of YouTube™ videos about REPs. MethodsA search on YouTube™ was performed for REPs using “endodontic regeneration”, “pulp regeneration”, “regenerative endodontics”, “regenerative endodontic procedures”, “revascularization” and “revitalization” keywords. Totally 531 videos were found and 60 videos met the inclusion criteria. Following the assessment of the demographic features of the videos and the viewing rate of the videos were calculated. The content of the videos was evaluated based on the selected headings. The quality of the videos was assessed using the video information, quality index (VIQI), Global Quality Score (GQS) and DISCERN. The statistical analysis was performed using Spearman Correlation and linear regression analysis. ResultsMajority of the videos about REPs were created by dental professionals (91.7%). The most commonly covered topic was “clinical application” (76.7%). Total content score showed a positive correlation with total VIQI (r = 0.795; p < 0.001) and GQS (r = 0.952; p < 0.001). There were significant relationships between total content score, duration, GQS, total VIQI score and DISCERN. ConclusionThe findings revealed that YouTube™ videos about REPs provide predominantly clinical information about patient chairside practice of REPs and they could be considered as a supplementary information source for dental students and practitioners.

Assessment of Post-operative Pain after using EdgeFile X7 and Protaper Next Rotary Systems in Patients with Symptomatic Pulpitis in Mandibular Molars: A Randomized Controlled Clinical Trial

AIM: The aim of the study was to evaluate the incidence of post-operative pain and analgesics intake after single-visit endodontic treatment using Edge File X7 and ProTaper Next (PTN) rotary files in mandibular molars having symptomatic pulpitis. METHODS: The study included 60 patients complaining of symptomatic pulpitis in mandibular molar teeth. After confirming the diagnosis clinically and radiographically, patients were assigned into two equal groups; Group (I): Instrumentation was done with Edge File X7 (EF) rotary files and Group (II): Instrumentation was done with PTN rotary files. The patients underwent standardized single visit endodontic treatment procedures using 2.5% sodium hypochlorite for irrigation. Modified visual analogue scale was used to access pain preoperatively, and then postoperatively after 6, 12, 24, 48, and 72 h. An analgesic (ibuprofen 400 mg) was prescribed to the patient who suffered from persistent pain. The incidence and/or number of analgesic tablets intake were recorded. Data of pain score were compared using Mann–Whitney U test for intergroup comparisons and Freidman’s test followed by Dunn’s post hoc test for intragroup comparisons. RESULTS: No statistically significant difference was detected between EF and PTN groups regarding the incidence and intensity of pain at different time intervals (p &gt; 0.05). There was a significant reduction in the mean VAS score through the follow-up periods in both groups (p &lt; 0.001). The incidence of analgesic intake was not significant in both groups. CONCLUSION: The incidence of post-operative pain and the analgesic intake in terms of frequency and quantity were found to be similar with both rotary systems for all the post-operative time points.

Dentinal microcracks induced by endodontic procedures: A scientometric and bibliometric analysis.

Background:Due to the large number of publications relating the occurrence of dental microcracks to endodontic procedures, this bibliometric study evaluated the scientific pattern and trends in literature and provided an overview of scientific production in this context.Aim:To analyze, quantify, and characterize the scientific production and trends of published articles evaluating dentinal microcracks formation after endodontic treatment procedures between 2010 and 2020 using bibliometric indicators.Materials and Methods:Published articles were found by the search in the Medline (PubMed) and Scopus database using the combination of the following keywords: Dentinal crack OR Dentinal Microcrack OR Crack formation OR Dentin Defect AND Endodontic treatment OR Root canal preparation OR Canal Preparation OR Root canal treatment OR endodontic procedures. The search was also conducted in the Journal of Endodontics and International Endodontic Journal. After inclusion and exclusion criteria application, data from all studies included were collected.Results:Among the 556 results after the search, 45 studies were included and analyzed in this bibliometry. No trend was observed in terms of the increasing number of articles over time. Most of them used an in vitro design, compared the effect of different endodontic techniques/systems for root canal instrumentation on dentinal microcracks formation, and were conducted in Turkey, Brazil, and India. Journal of Endodontics and International Endodontic Journal were the main journals with a higher number of articles published. Interestingly, studies conducted with some funding did not lead to higher citation numbers. Moreover, a relevant proportion of studies did not consider the inclusion of control groups, baseline evaluation, or statistical analysis. Micro-CT was the main technique used to evaluate microcrack presence.Conclusion:Microcrack formation after the use of different endodontic techniques/systems has been constantly evaluated in the literature. There is a pattern of methodologies used, which may explain the concentration of these studies in specific journals and countries.

Coronavirus disease (COVID-19) transmission through aerosols in restorative and endodontic practice: Strategies for prevention.

Rapid spread of coronavirus disease 2019 (COVID-19) in several countries of the world has created a state of public health emergency. COVID-19 is principally a respiratory disease, and the virus is present in respiratory secretions. Oral health-care professionals are susceptible to being infected with the disease since they work in close proximity to patient's face and oral cavity for long period of time. Restorative dentists and endodontists play a significant role in delivering “urgent” or “emergency” dental care to patients. Occupational Safety and Health Administration has categorized dentists performing aerosol-generating treatment procedures at “very high exposure risk” whereas the dentists not performing aerosol-generating procedures at “high exposure risk.” Most of the restorative and endodontic treatment procedures involve generation of aerosols. Owing to the possibility of transmission of virus through aerosols, these procedures may transmit the disease to clinician or other patients. A comprehensive search of literature was conducted with the help of PubMed/MEDLINE and Scopus databases using a combination of terms, “COVID-19,” “severe acute respiratory syndrome coronavirus 2,” “aerosols,” “restorative dentistry,” and “endodontics.” Along with universal precautions, some additional precautions need to be taken to prevent such transmission and cross-infection. This article reviews the research evidence about the role of aerosols in the transmission of COVID-19 and various measures which should be implemented during restorative and endodontic practice for the prevention of such transmission.

CBCT Visualization of Furcation Perforation Repair Materials Using Different Voxel Sizes

Background: Three-dimensional cone-beam computed tomography is gaining popularity as an imaging modality aiding the performance of difficult endodontic treatment procedures. For this reason, we assessed the visualization of bioactive furcal perforation repair materials in an ex vivo study using CBCT with different voxel sizes and determined which voxel size yielding the best images with least artefacts. Visualization of endodontic restorative material is affected by the appearance of various artifacts. This study was conducted to evaluate the CBCT visualization of three perforation repair materials using five different voxel sizes.&#x0D; Methods: This study was performed with 84 mandibular molars that had been extracted for various reasons. All samples were measured with a digital caliper (Digimess, São Paulo, Brazil), marked at 3 mm above the cementoenamel junction, and decoronized at this line. The root segments were amputated at 3 mm below the furcation site using diamond discs under water cooling. Endodontic access cavities were then created, and the perforations were formed. Biodentine, MTA, and EndoSequence were mixed following the manufacturers’ instructions and applied to the perforation sites. Five image sets were obtained: 0.075 mm3; 0.1 mm3; 0.15 mm3; 0.2 mm3; and 0.4 mm3. Each scan was evaluated by 2 observers with 8 to 12 years of experience in CBCT imaging.&#x0D; Results: The best image quality for repair all materials was achieved with a voxel size of 0.1 mm3. Image clarity of repair materials was no statistically difference between voxel sizes of 0.075 mm3 and 0.15 mm3. Image quality was significantly reduced at voxel sizes of 0.2 mm3 and 0.4 mm3, and was the worst quality at 0.4 mm3 voxels in all groups.&#x0D; Conclusions: CBCT imaging can be used to examine endodontic repair materials with adjustment of the effective radiation dose rate and selection of the appropriate voxel size.

Effect of different coronal restorations on the fracture resistance of teeth with simulated regenerative endodontic treatment: An invitro study.

This study investigated the effect of different coronal restorations on the fracture resistance (FR) of immature teeth with simulated regenerative endodontic treatment. A total of 120 lower premolars were divided into eight groups. Except for negative control, the root canals were instrumented with rotary files and Peeso reamers. Fifteen instrumented teeth were acted as positive control (unrestorated). In the remaining 90 teeth, regenerative endodontic treatment procedures were performed. Ninety teeth were randomly divided into 6 groups according to coronal restoration type; Filtek Z550, Filtek Bulk fill Restorative (FBR), SDR+Filtek Z550, EverX+Filtek Z550, Ribbond+FBR and Ribbond+SDR+Filtek Z550. After thermal ageing, the restorated teeth were subjected to vertical loading force. FR values was obtained as follows: Negative control > Ribbond+FBR = Ribbond+SDR+Filtek Z550 > Filtek Z550 = FBR =SDR+Filtek Z550 = EverX+Filtek Z550 > Positive control, (P < 0.05). The use of Ribbond in combination with composite resin enhanced the FR of teeth.

A Novel Surgical Approach for the Successful Removal of Overextruded Separated Endodontic Instruments

Endodontic procedures can result in various complications. Separation of the endodontic instrument is a common complication of incorrect use or overuse of the instrument. However, a separated endodontic instrument may hinder cleaning and shaping during endodontic treatment procedures, which can potentially impact prognosis. Therefore, it is necessary to manage this complication by removal of the separated instruments from inside the root canal. Although several devices are used, nonsurgical removal for retreatment remains difficult. We report the case of a failed attempt to manage a separated endodontic instrument nonsurgically by a private dentist, which resulted in extrusion of the instrument beyond the root apex and its migration into the mandible. We describe a novel surgical approach involving intentional tooth replantation combined with alveolar osteotomy. There have been few reports on the management of separated endodontic instruments that were pushed out beyond the root apex. Our novel surgical approach suggests a technique for the potential removal of a separated endodontic instrument extruded beyond the root apex.