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Separated instruments

Despite the use of brand new instruments and your dentist exercising great care and attention, small files sometimes break in fine canals (Figure 5). The broken file is no danger in itself but it prevents the canal system beyond it being cleaned. Our Endodontists are adept in the use of specialised instruments to remove these obstructions and clean the remainder of the canal system (Figure 6).

Figure 5 (left). A broken instrument.

 Figure 6 (right). The instrument has been removed
 and the canals have been cleaned and filled.

Apicectomy

In a small number of cases infection persists despite thorough cleaning of the root canal system (Figure 7). This is caused by infection in the very complex fine anatomy that can exist at the tip of the root. In this instance the tooth can still be saved by a procedure called an apicectomy. This involves removing the infected tip of the root, cleaning the exposed root canal and placing a special filling in the end of the root (Figure 8).

Figure 7 (left).  This tooth still has a persistent infection despite a good quality root canal treatment. A dark area can be seen in the bone at the end of the root.

Figure 8 (right). Root 18 months on, following apicectomy, showing healing of the bone.

Under normal circumstances apicectomies are only be carried out when a high quality root canal treatment has been unsuccessful in dealing with the infection. The exceptions are cases with well fitting crowns with excellent appearance and a post in the root but with a flawed root canal treatment that has resulted in an abscess. We can take the apicectomy one stage further and treat the whole canal up to the post from the tip of the root. This is a technically demanding treatment but is something that our highly trained Endodontists do routinely. It is called a ‘retrograde root canal treatment’ and an example is shown in Figures 9 & 10.

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