Effective Management of Endodontic Retreatment Using Rogin Rotary Files: A Case Report of  Instrument Retrieval in a Lower Molar

Abstract:

Endodontic retreatment can be challenging, especially in cases where previous instrumentation has left behind separated files. This article presents a detailed account of the successful management of a lower molar retreatment case using the Rogin endodontic retreatment rotary file system. The case involved the retrieval of a separated instrument and subsequent cleaning and shaping of the root canal system. The performance of the Rogin system in this complex scenario highlights its efficiency and reliability, offering a promising solution for similar cases.

Introduction:

Endodontic retreatment is often required when the initial root canal treatment fails due to persistent infection, missed anatomy, or iatrogenic errors. The removal of separated instruments from the root canal system is one of the most technically demanding aspects of retreatment, as it requires precision and careful management to avoid further complications.

In this case report, we discuss the use of the Rogin endodontic retreatment rotary file system in a complex lower molar case. The file system’s design and functionality were crucial in both retrieving the separated instrument and achieving thorough debridement of the root canal system. The successful outcome emphasizes the importance of using reliable and effective tools in endodontic retreatment procedures.

Case Report of Patient History and Clinical Examination:

A 45-year-old female patient presented with persistent pain in the lower right first molar (tooth #46), despite having undergone root canal treatment two years earlier. The patient reported intermittent discomfort over the past few months, which had recently escalated to continuous pain. Clinical examination revealed multiple coronal fillings and tenderness on percussion and palpation. Radiographic evaluation showed inadequate obturation, a periapical radiolucency, and a separated file in the mesial root canal.

Diagnosis and Treatment Planning:

The diagnosis of symptomatic apical periodontitis secondary to failed root canal treatment was made. The treatment plan involved nonsurgical endodontic retreatment, focusing on the removal of the separated instrument and thorough disinfection of the root canal system using the Rogin endodontic retreatment rotary file system.

Procedure:

1. Access and Canal Identification: The existing restoration was removed, and the access cavity was refined to enhance visualization and access to the canal system. The previous obturation material was removed using the Rogin rotary file system at 600rpm, which efficiently cleared the canal space, exposing the separated instrument.
2. Instrument Retrieval: The separated file posed a significant challenge due to its location and the curvature of the mesial root canal. Using the Rogin file system, the coronal portion of the canal was flared, allowing for better access to the separated instrument. The file was carefully exposed further with ultrasonic tips and retrieved using after using EDTA and Ultrasonic power from the inner curve.
3. Canal Cleaning and Shaping: Following the retrieval, the Retreatment file and Rshaper from Rogin were employed to clean and shape the canal system. The files demonstrated excellent flexibility and resistance to cyclic fatigue, enabling efficient removal of residual obturation material and effective shaping of the canal system. Copious irrigation with sodium hypochlorite and EDTA was used throughout the procedure to ensure thorough disinfection.
4. Obturation: After achieving a dry and clean canal, obturation was performed using the warm vertical condensation technique with gutta-percha and AH Plus sealer. The final radiograph confirmed complete obturation of the canal system.

Discussion:

The successful management of this complex retreatment case underscores the importance of using reliable instruments capable of handling challenging scenarios. The Rogin endodontic retreatment rotary file system proved to be highly effective in this case, particularly in the retrieval of the previous gutta-percha, the separated instrument and the subsequent cleaning and shaping of the canal system.

Several key features of the Rogin system contributed to the positive outcome:

• Flexibility and Taper: The system’s files maintained excellent flexibility even in the curved mesial canal, minimizing the risk of canal transportation or ledging. On the other hand Retreatment file is stiff enough the access even a stiff gutta-percha.
• Cutting Efficiency: The files efficiently removed residual obturation material and dentin, streamlining the retreatment process.
• Resistance to Fracture: The files demonstrated remarkable resistance to cyclic fatigue, essential for navigating the canal’s complex anatomy.

Conclusion:

The Rogin endodontic retreatment rotary file system has proven to be a valuable tool in managing complex endodontic retreatment cases, particularly those involving separated instruments. Its design and functionality enable efficient and safe retreatment, contributing to positive clinical outcomes. This case report supports its use in endodontic practice and encourages further exploration of its potential in other challenging cases.

Successful Retreatment of an Upper Left First Molar with Short Root Filling and Missed MB2 Canal Using the Rogin Rotary File System: A Case Report

Abstract:

Endodontic retreatment presents numerous challenges, particularly when previous treatments have left short root fillings, ledges and/or missed critical canal anatomy. This case report discusses the successful retreatment of a maxillary first molar (tooth #26) with a previous short root filling and an untreated MB2 canal. The Rogin endodontic retreatment rotary file system played a pivotal role in the removal of the old filling material, locating and treating the missed MB2 canal, and ensuring thorough canal cleaning and shaping. The case underscores the importance of comprehensive canal exploration and the use of efficient instruments in retreatment cases.

Introduction:

The maxillary first molar is known for its complex root canal anatomy, particularly the mesiobuccal (MB) root, which often contains two canals (MB1 and MB2). The failure to locate and treat the MB2 canal is a common cause of endodontic failure. Short root fillings, which do not adequately fill the apical third of the canal, also contribute to treatment failure by allowing residual bacteria to persist.

This case report details the retreatment of a maxillary first molar with both a short root filling and a missed MB2 canal. The retreatment process involved the removal of the old filling material, identification, and treatment of the missed MB2 canal, and complete cleaning and shaping of the canal system using the Rogin endodontic retreatment rotary file system.

Case Report of Patient History and Clinical Examination:

A 52-year-old female patient presented with discomfort and occasional sensitivity in the upper left first molar (tooth #26). The patient had undergone root canal treatment on this tooth five years earlier. Clinical examination revealed a crown in good condition, but tenderness on percussion was noted. Radiographic examination showed a short root filling in all three canals, with a visible periapical radiolucency around the mesiobuccal root. Closer inspection of the radiograph suggested the presence of an untreated MB2 canal.

Diagnosis and Treatment Planning:

The diagnosis of chronic apical periodontitis due to inadequate root canal treatment was made. The treatment plan involved nonsurgical endodontic retreatment, focusing on the removal of the short root filling, location, and treatment of the MB2 canal, and thorough cleaning and shaping of all canals to the terminus using the Rogin endodontic retreatment D3 rotary file system.

Procedure:

1. Access and Canal Exploration: The existing crown was carefully accessed through the occlusal surface. The previous obturation material was removed using the Rogin retreatment D3 rotary file system, which efficiently cleared the canals of gutta-percha and sealer. The MB1, distobuccal (DB), and palatal canals were all found to be filled short of the apex. A thorough exploration of the mesiobuccal root using magnification (dental microscope) led to the identification of the MB2 canal which was very calcified. Even though the 10k file could not progress into the canal, the D3 retreatment file successfully done the work as an orifice opener, which had been missed in the original treatment.
2. Canal Cleaning and Shaping: All four canals (MB1, MB2, DB, and palatal) were cleaned and shaped using the Rogin system to the terminus. The Rogin files allowed for thorough debridement of the canals, effectively removing any residual debris and old filling material. Continuous irrigation with sodium hypochlorite and final rinse with EDTA was employed to ensure cleanliness.
3. Obturation: The canals were dried with paper points, and obturation was performed using the warm vertical condensation technique. Gutta-percha and AH Plus sealer were used to fill all four canals to their full working length, as confirmed by the final radiograph. The missed MB2 canal was successfully treated, and the previously short-filled canals were now completely obturated.
4. Final Restoration: The access cavity was sealed with a composite resin by the referral dentist. A follow-up appointment was scheduled to monitor the healing process.

Discussion:

This case highlights the importance of recognizing and treating the MB2 canal in maxillary first molars, which, when missed, is a common reason for endodontic failure. The Rogin endodontic retreatment rotary file system was crucial in achieving a successful outcome. The system’s features, including its flexibility, cutting efficiency, and resistance to cyclic fatigue, allowed for safe and effective retreatment of the tooth.

Several factors contributed to the success of this case:

• Identification of the MB2 Canal: The use of magnification and careful exploration of the root canal system was key to locating the previously missed MB2 canal.
• Efficient Removal of Old Filling Material: The Rogin files easily removed the old gutta-percha and sealer, allowing for full-length obturation.
• Effective Cleaning and Shaping: The files’ ability to negotiate and clean even the narrow and curved MB2 canal ensured the complete removal of infection.

Conclusion:

The successful retreatment of the upper left first molar in this case report demonstrates the importance of identifying and treating all root canals, particularly the MB2 canal in maxillary molars. The Rogin endodontic retreatment rotary file system proved to be an efficient and reliable tool in this complex procedure, allowing for thorough cleaning, shaping, and obturation of the canal system. This case highlights the system’s effectiveness in managing challenging retreatment cases and its role in achieving positive clinical outcomes.