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.
Tooth discoloration commonly occurs after trauma to tooth, which leads to pulpal injury. Trauma to the pulpal blood vessel leads to hemorrhage and releases iron from hemoglobin. The iron which is released from hemoglobin combines with hydrogen sulfide to form iron sulfide, which gives the tooth its characteristic dark appearance. Tooth discoloration can be treated by nonvital tooth bleaching, if the tooth structure is intact. A combination of hydrogen peroxide and sodium perborate reduces the discoloration of the tooth by a process of oxidation. During root canal preparation procedures, the common mishap that occurs is instrument separation inside the root canal. The fractured fragment in the root canal can hinder proper preparation of root canal space. Continuous pain or discomfort may result if it is not removed or bypassed. It is more conservative to bypass the fractured instrument, particularly in cases where access to the fragment is restricted (apical one-third of canal or beyond the canal curvature) and its removal may lead to excessive removal of dentin with associated sequelae.
Trauma to the tooth mainly results in pulpal injury, and these injuries during formative stage can result in incomplete root formation. This can result in failure in closure of root apex, resulting in wide open apex. This causes problem for the conventional root canal therapy as there is no apical stop against which the obturation material can be condensed. The management of a nonvital tooth with open apex is aimed at creation of an apical barrier. The newly introduced bioactive dentin substitute commercially available as biodentin is a promising material. It is a cement for stimulating hard tissue formation, i.e., the formation of reactive or reparative (tertiary) dentin. This case report describes the management of a traumatized permanent maxillary central incisor with an open apex.
Tooth resorption is a condition associated with either a physiologic or a pathologic process resulting in a loss of dentin, cementum, and/or bone. Inflammatory process is initiated when the predentin or precemental layer of the tooth is damaged. Resorption can either be external or internal in form. In order to control the tooth resorption, it is necessary to treat the root canal by removing all the pulp tissue. Due to varied root canal morphology, root canal treatment poses a challenge for the clinician. In such cases a combination of conventional lateral compaction and thermoplasticized gutta percha can enable the three-dimensional obturation of the canal space. This case report describes a nonsurgical mode of management of a tooth having internal and external (surface) resorption.
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