A Short Case Study: Separated Instruments? Perforation? Relax!

Rico D. Short, DMD


A dentist referred a patient to me after the patient had seen the dentist, a periodontist, and two other dentists. The patient said no one was able to help her. Her general dentist had attempted a root canal on tooth No. 30. There were complications, including three separated instruments and canal transportation.

The general dentist first sent her to an endodontist, who attempted retreatment but could not remove the instruments and recommended an extraction and implant. The patient then went to another endodontist, who did not feel comfortable trying to treat it after the first endodontist had tried to already. Next, the patient saw the periodontist, who recommended an extraction and an implant.

Figure 2: Thanks to ultrasonics and bypassing, I was able to remove all three separated instruments. Figure 3: Six months later, the patient presented with nice healing on the distal root.

However, the patient also had heard about me from a friend and a recent Short Case Study that I had posted on social media. She came in for a consult, and I told her that we could try to retreat, but I offered no guarantees.

The diagnosis was a previous root canal attempt, separated instruments, and chronic apical periodontitis. I performed the retreatment in one visit. I found the three separated instruments in the tooth. I was able to remove one with ultrasonics and bypassed the other two. I also repaired a perforation in the mesial root with Brasseler USA’s Bioceramics (Figure 2).

The patient returned in six months asymptomatic with nice healing on the distal root, and the mesial root perforation repair is working well. You can see her video testimonial here.



Dr. Short attended the Medical College of Georgia School of Dentistry to attain a DMD degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and then became a Diplomate of the American Board of Endodontics in 2009. Dr. Short is an expert consultant in endodontics to the Georgia Board of Dentistry, author, speaker, and assistant clinical professor at the Dental College of Georgia in Augusta. His private practice, Apex Endodontics PC, is located in Smryna, Ga. He can be reached at dr.short@yahoo.com.

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