Management Of Perforation And Separated Instrument Retrieval In The #36

In this case report, we repaired a perforation in the bottom of the left mandibular first permanent molar under a microscope, followed by the removal of a separated endodontic instrument with ultrasound assistance. Microscopic root canal treatment was performed, and after treatment, a onlay restoration was performed to restore occlusion. A 32-year-old female patient presented with a gingival sinus tract associated with the left mandibular posterior dentition. Clinical evaluation revealed: Extensive coronal restoration with gray tooth discoloration,Asymptomatic to percussion and probing, CBCT showed a large area of low-density shadow around the root apex, and high-density root filling images were observed in the root canal. The separation of instruments within the root canal can affect the subsequent shaping, cleaning, and filling of the root canal system, ultimately affecting the effectiveness of root canal treatment. If the separation instrument can be completely removed and the root canal access can be regained in a comfortable, effective, and minimally invasive manner, it would be most ideal. The methods for removing separation instruments include sleeve method, ultrasound method, electrochemical dissolution, etc. The use of dental microscopes significantly improves the success rate of treatment Repairing the perforation of the pulp floor can eliminate inflammation at the perforation site, and removing the separated endodontic instrument helps with the subsequent shaping, cleaning, and filling of the root canal system, ultimately achieving good results in root canal treatment.