middle-aged patient reported to our clinic with complaints of persistent pain in the upper right back tooth region along with headache. The patient had undergone a root canal treatment (RCT) attempt in a previous clinic but continued to experience discomfort.
Clinical History and Examination
Tooth involved: 16 (Upper Right First Molar)
Chief complaints: Pain while chewing and headache
History: Previously attempted RCT with a file separated in the distobuccal canal
Clinical Findings: Temporary restoration present, tenderness on percussion, no swelling
Radiographic Findings: Separated file visible in the distobuccal canal, inadequate obturation in other canals
Treatment Plan
- Removal of previous gutta-percha (GP) material
- Attempted bypass of the separated file
- Intracanal medicament placement
- Re-evaluation and completion of obturation
- Final composite restoration
- Regular follow-up for pain evaluation
Step-by-Step Treatment Performed
- Rubber Dam Isolation The tooth was isolated under a rubber dam to maintain a clean and dry working field.
- Access Opening & Gutta-Percha Removal Using endodontic retreatment files and solvent, all previously placed gutta-percha was carefully removed from all three canals.
- Separated File Management
- Intracanal Medication
- Symptom Resolution At the follow-up visit, the patient reported complete relief of pain and headache. There was no tenderness on percussion, and chewing efficiency had improved.
- Obturation & Restoration
Outcome
- The patient is now asymptomatic and able to chew comfortably.
- She is placed on regular follow-up to monitor any post-operative changes, especially concerning the separated file in the distobuccal canal.
- Radiographs show satisfactory obturation and no periapical pathology.
Conclusion
This case highlights the importance of a meticulous retreatment protocol, even in the presence of complications like separated files. While bypass or retrieval was not successful in this case, thorough disinfection and proper sealing helped resolve the patient’s symptoms and restore function.
Follow-Up Advice
- The patient is advised to return for routine check-ups.
- Any signs of discomfort, swelling, or persistent pain will be evaluated promptly, and further intervention (like surgical endodontics or CBCT analysis) may be considered if needed.