Surgical Removal of Fractured Endodontic Instrument in Periapex of the Mandibular First Molar: A Case Report

The purpose of this paper is to present combined endodontic and surgical treatment in complicated endodontic cases, related to fracture of endodontic instrument and existence of periapical lesion. Case report Presentation of a case of a patient at the age of 23 years with periapical endodontic lesion of tooth 46 and fractured canal instrument in the lower 1/3 of the medial root. Retreatment of tooth 46 was done preoperatively, during which, the removal of the separated canal instrument could not be done due to the anatomic characteristics of the root of the tooth and the fracturing of the instrument at a distance of 2 mm outside the apex. The endodontic lesion was reached intraoperatively and the latter was extirpated, the apices of tooth 46 were resected, the fractured canal instrument was removed and retrograde obturation with MTA was done. Results After follow-up observation of the process of recovery high level of success rate was found after the performed combined endodontic and surgical treatment. A complete bone regeneration of the defect is observed after follow-up of the treatment in 6 months and 1 year. Conclusions The well performed endodontic and surgical treatment results in preservation of teeth with unfavorable prognosis. After sealing of the endodontic cavity coronally and apically, a complete bone regeneration is observed in the operative field. No enhancement of the mobility of the operated tooth is observed after apical surgery.