Management of Endodontic Failure

Abstract

There are several reasons for a root canal therapy to be unsuccessful. One of the causes for endodontic failure is instrument separation. As a consequence of fracture, access to the apical portion of the root canal is obstructed, leading to improper disinfection. The retrieval of separated instrument followed by obturation to the working length is the treatment option. Many factors can make retrieval difficult. In such cases, management can be done even by bypassing the separated instrument. Another factor for endodontic failure is underobturation. It may be due to block or ledge in the apical third of the canal. Proper instrumentation with frequent confirmation of apical patency during instrumentation can prevent formation of ledge. The inability to treat all the canals is the other cause leading to endodontic failure. Bacteria residing in these canals lead to the persistence of symptoms. Proper evaluation of the radiograph with proper deroofing can prevent chances for missed canals. Combination of all these factors can make retreatment difficult. This case report discusses two endodontic failure cases. In the first case, a premolar tooth with separated instrument and incomplete obturation was treated by retrieval of separated instrument and the obturation of both canals to working length was done. The second one was a molar tooth which had a missed canal, a separated instrument, and an incomplete obturation. Missed canal was negotiated and the fractured instrument was bypassed and root canal was obturated.