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Root Canals

Instrument left behind, cement through root

10/11/2006

Question:

I just had a root canal performed this morning, due to a crack in my tooth. After it was over, the endodontist showed me the recent X ray and said two things that I am wondering about: 1 - he showed me on the Xray a piece of the instrument left behind. I have seen prior postings on this which suggest this happens in 3-5% of the time. Since this is such a small percentage, is it really advisable "not to worry"? I am having a tough time getting my head around that. 2 - I asked what was one other marking I saw in the Xray and he said "that`s cement which went through the root ...that`s a good thing because it shows we got to the bottom of the root"

I`m sure you understand my concern, esp after reading some of the other posts. What I want to know is: is extra cement in my jaw and a piece of an instrument left in the root really something not to be worried about??

Answer:

The separated instrument should not be a problem if it is in the tooth and the root canal was cleaned out prior to the separation. Once the root is cleaned out, healing should take place as long as the top part of the tooth is sealed with root canal material, a filling and crown.  Separation of an instrument in a tooth is certainly an unexpected and unwanted event, but does not always lead to a bad result.
 
Root canal sealer getting pushed out the end of a root is a bit controversial. Some schools of thought feel that the extrusion of the sealer indicates that the entire root canal has been cleaned and filled. In general, root canal sealer will be resorbed by your immune defense cells and within 6 months or so, no trace of the material will be evident on an x-ray. Other philosophies feel that the extrusion of sealer leads to unwanted irritation of the tissues around the root and should be avoided.
 
In your case, I would not be concerned at present. If problems were to develop, there are ways to remedy them without loss of the tooth. The bigger concern may be that the tooth was fractured and to what extent the fracture extended. Fractures that extend down the root are almost impossible to repair. If your symptoms have resolved since the root canal treatment, though, then you are probably in good shape.

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Response by:

John M Nusstein, DDS John M Nusstein, DDS
Associate Professor of Endodontics
College of Dentistry
The Ohio State University