Dr. Firas Haj Obeid, a skilled endodontist based in Poland, shares another impressive clinical case demonstrating excellent management of a complex retreatment.
Case Overview
Tooth: 26 (Upper Left First Molar)
Difficulty: Intermediate (4-Canal Retreatment)
Diagnosis: Previously initiated treatment with Symptomatic Apical Periodontitis (SAP)
Main Challenges: Moderate curvatures in MB1 and MB2 canals, along with residual obturation material.
This case highlights the importance of proper retreatment endodontics when addressing persistent infection and incomplete previous root canal therapy.
Clinical Workflow
- Access and Canal Location
Re-entry was performed under a dental operating microscope to successfully locate all four canals: MB1, MB2, DB, and Palatal. - Instrumentation
R-Shaper (Rogin) files were used in a crown-down sequence, shaping all four canals to 30/.04. The heat-treated NiTi system provided excellent flexibility to navigate moderate curvatures without transportation. - Irrigation Protocol
- 5.25% NaOCl delivered using Irriflex needles
- Passive Ultrasonic Irrigation (PUI) with Ultra-X
- Final rinse with 17% EDTA followed by distilled water This combination ensured thorough cleaning, especially in the apical third of the curved canals.
4.Obturation
Continuous wave compaction technique using AH Plus sealer (Dentsply).
Clinical Tips from Dr. Firas Haj Obeid
✔️ A dental operating microscope is essential for locating MB2 canals during retreatments.
✔️ Heat-treated NiTi files like R-Shaper offer superior flexibility and safety in curved canals.
✔️ Combining Irriflex needles with Passive Ultrasonic Irrigation (PUI) significantly improves irrigant penetration in challenging anatomies.
This well-executed retreatment showcases how modern endodontic techniques and proper tools can lead to predictable success even in intermediate-difficulty cases.
