Southbank Endodontics

11/09/2026

I got an interesting case which I am super excited about. I ‘inherited’ this patient for the continuation of endodontic retreatment because of an unexpected separation of a rotary endodontic instrument in the apical space. As the separated instrument was beyond reach, the initial plan was to continue endodontic retreatment and encourage periapical healing. Later, the separated instrument appears to move closer to the root end after six months of medication, and this was also confirmed with a CBCT. Therefore, a decision was made to attempt its removal.

Following endodontic access, the preparation phase involved careful removal of the apical granulation tissues and traction of the head of the separated instrument towards the apical foramen with Terauchi GPR and Micro Excavator (Seto Japan). The constant use of a micro suction to evacuate the bleeding assisted with visibility. Once the head of the separated instrument was visualised, the Terauchi GPR successfully elevated the instrument away from the interstitial soft tissue and into the canal space, completing the instrument removal process.

The tooth was medicated and another appointment was scheduled for its obturation. The plan is to use MTA for the obturation of the whole root canal space. The finished result will probably be aesthetically challenged. Please do not criticise me for the case selection as I did not start the case. The root also appears to have undergone further apical root resorption and it is now quite short. The outcome may still be worthy of the original decision to retreat it, as the tooth is no longer painful, there is minimal tooth mobility and there is good healing of the apical space compared to the pre-operative radiograph.

19/06/2026

An easy Broken Instrument removal for the week.

Whilst removing the last remnants of the old root canal filling with the FKG XP-Shaper, 4.5mm of the rotary files fractured in the apical third of the distal canal.

The canal was flared a little with Profile 60/04 to the head of the BF (broken instrument). As the root was relatively short at 17.5mm, visibility to the head of the BF was good. Additional space was created around the head of the broken instrument with Acteon ultrasonic file tip for about 10 seconds and the BF just jumped out of the canal.

Root canal was then continued with no further complication. More to come.

14/05/2026

This patient was referred for the removal of the broken instrument (BF) and completion of the RCT. As the patient lives 1500km away, we arranged for the treatment to be completed over two hour-long back to back appointments.

The broken instrument was found to be firmly wedged into the root dentine, completely obstructing apical access. First, the canal was opened with 70/02 rotary for visibility. Terauchi TFRK S-tip was then used to trephine around the BF. Additionally, Zumax BIRK 0.8mm trephine bur was used to expose the head of the BF in preparation for a Loop device. However, removal of the BF with the Loop device was not successful because of how firmly the BF (Reciproc Blue R25) was driven into the dentine. The head of the BF then underwent a secondary fracture when subjected to ultrasonic energy.

Thus, TFRK S-tip was brought out again to trephine around the apical fragment in combination with EDTAC, and the BF suddenly jumped out of the canal. The rest of the RCT was completed uneventfully in one sitting.

18/07/2025

ASE(WA) Half-Day Lunch & Lecture by Dr. Poh Hun Loh

Friday 8th August 12pm
at Kailis Bros Leederville WA 101 Oxford St Leederville WA

Free Parking Available at the restaurant carpark - Carpark entry from the Leederville Pde.

Please find more information and register online: https://www.asewa.org.au/event-6066590

We look forward to seeing you all there.

11/06/2025

Endodontic retreatment of tooth 46 with two broken files and apical blockages.

This patient was referred for endodontic retreatment of the 46 because of evidence of periapical pathology. Access was prepared through the existing crown and the RCF was removed with Chloroform until the broken files in the mesial canals were cleared of root filling.
For the MB, the coronal ⅓ was flared using MicroMega One Flare or***ce opener and until Dentsply ProFile 60/04 could reach the head of the broken file. The 3mm BF was then ejected with TFRK-S ultrasonic.
For the ML, the coronal ⅓ was flared using Ultrasonic file at 50% ultrasonic power before using TFRK-S (at 20%) for the removal of the 5mm broken file. Amazingly the file was ejected from the canal.
Apical root canal transportation/blockage was encountered for all canal. Luckily, the apical blockage of the MB and ML canal could be cleared, after persistence with Mani D-Finders and K-Files. The distal canal remains completely obstructed.
RC obturation was via bioceramic cement/sealer with modified hydraulic obturation technique. The endo access cavity was then restored with EverX and Tokuyama Estelite Sigma Quick composite.

04/06/2025

Endodontic retreatment of the 46 with periapical lesion and a 6mm rotary file in the MB canal.

The lower right first molar (46) was referred for endodontic retreatment because of a prominent mesial root periapical lesion. A broken instrument was found to have lodged in the MB canal, which impeded root canal cleaning. The existing RC filling was removed with the aid of chloroform, GGB2, Micro Mega One Remover, FKG XP-Shaper and Hedstrom #20, used in each thirds of the root canal. The broken file was removed after loosening with TFRK-S ultrasonic and removed with a loop device. Root canal preparation was completed with Micro Mega One Curve for the MB, and EndoWave 40/04 (for ML) and ProFile 45/04 (For D). The root canal system was subsequently obturated with Bioceramic and GP once there is good evidence of periapical healing.

15/05/2025

13/05/2025

Made a new friend at ADC Perth 2025. Jenise Low

13/05/2025

So excited to have received this set of anterior and posterior retro-prep ultrasonic tips courtesy of . The 3, 6 and 9mm tips for anterior and posterior teeth will be really useful for complex endo surgical cases as per the Microsurgical Endodontic course ran by Prof Adham A. Azim at the Arthur A. Dugoni School of Dentistry at the University of the Pacific.

08/05/2025

The patient was referred for a second opinion after being told the tooth 46 is fractured and cannot be saved. Interestingly, no fracture line was found when examining the pulp chamber cavity walls and floor. The Broken File (BF) in the MB canal was found to obstruct apical access, thus removal of BF was initiated.

MicroMega OneFlare, Reciproc R25 and ProFile 60/04 were used to approximate the head of the BF which was not initially visible from the access cavity. Additionally, ultrasonic (US) file tip on the Satelec at 50% power was used to remove columns of dentine that may impede the exit of the BF.

Then a pre-curved TFRK-S was used in a withdrawal motion around the inside curve (ML and D of the MB canal) taking care not to cause strip perforation distally. This was done at 20% US power with intermittent activation, mostly under wet condition (mostly NaOCl and some EDTA). The intermittent activation of the US and the wet/damp root canal condition kept the TFRK-S and BF cool, and mitigate secondary fracture. TFRK-S was used until the BF started to move.

A Loop device was then carefully tightened around the head of the BF using a winding action until a ‘pop’ sound was heard. I thought the loop wire broke under tension, but it must have been the BF popping out of the canal under the ever-tightening grasp of the loop wire. The BF was then removed from the root canal.
The measurements from the CBCT, BF is ~5-6mm at ~23˚ (B/L)and 30˚(M/D) angles were consistent with the actual length of the BF. Generally, if the BF can be seen, it can be removed. Btw, the 45 is knackered.