In evaluating teeth for re-treatment, I usually look at the bitewing first to evaluate the remaining peri-cervical dentin (PCD). Then I adjust my gaze apically to see what’s going on. In evaluating this tooth, it really hadn’t been violated too bad with axial reduction as it had a gold crown, the access didn’t look particularly gauged, and the root canal shaping hadn’t been excessive. So, this tooth has another life. Honestly, I didn’t notice the separated instrument in-bedded in the root. I was able to bypass the instrument in the missed canal and medicate beyond it. We discussed the need for possibility of surgery in the future. We also discussed the risks and benefits of trying to remove the instrument rather than bypass. Lots of times, in an effort to remove an instrument the dentin cost is pretty high. So, we opted to to be content with the bypass. At the 1 year mark, it looks like we’ve got full regeneration apically. One of the clinical applications for CBCT is to evaluate healing at different time intervals.
-Trudeau