Combined surgical and nonsurgical endodontic therapy for the retreatment of a root canal with a broken round bur in the apical third: A case report with a 4-year follow-up

Abstract

Management of endodontic lesions in previously treated teeth might be challenging due to the presence of procedural mishaps such as metallic objects that have been broken accidently by the previous treating dentist. A 36-year-old female complaining of pain with biting was referred for endodontic retreatment of her maxillary left central incisor. The involved tooth was sensitive to percussion, and the periapical radiographic examination revealed the presence of an apical radiolucency, a lateral radiolucency, and a separated round bur in the apical third. Cone-beam computed tomographic imaging was performed to provide a detailed assessment of the tooth and the surrounding structures. The tooth was diagnosed as previously treated with symptomatic apical periodontitis. Root canal retreatment was completed using a combined surgical and nonsurgical approach under an operating microscope. At 1-year follow-up, the patient was asymptomatic, and the two-dimensional radiographic examination revealed complete healing and remained so for the 4 years of follow-up. The presence of a broken bur in a previously filled root canal is unusual. Endodontic management of such cases requires careful evaluation and good clinical management.