01/10/2026
🇬🇧 X marks the spot… (🇫🇷 version française sur la slide suivante)
A 62-year-old female patient was referred for persistent pain on tooth n•25 following recent crown placement and root canal treatment.
No significant apical lesion was visible, but the endodontic treatment was incomplete. A fractured instrument, approximately 3 mm long, was located in the middle third of the palatal canal, leaving the apical portion untreated.
The CBCT revealed the key to understanding the case, particularly on the sagittal view: the canal space communicates through an isthmus in the middle third before separating into two distinct apical pathways with independent foramina, creating an almost X-shaped anatomy.
The fragment was located precisely at the entrance of the palatal division. Bypassing it was unsuccessful and, since the palatal pathway did not rejoin the buccal one apically, removal was necessary to gain access to the untreated apical third.
The fragment was removed using ultrasonic inserts under magnification. Both apical pathways could then be cleaned, shaped and obturated using warm vertical compaction. The ability of the Blue Shaper Pro to be pre curved made it much easier to prepare separetly the 2 apical thirds.
Once retrieved, the diameter of the fractured instrument appeared strikingly large compared with the initial canal anatomy — even the final preparation did not reach a comparable enlargement.
In this case, understanding the anatomy determined the strategy: leaving the fragment meant leaving an entire apical pathway untreated.
Sometimes, the only way out is up. 😉
Zarc4Endo Endoboutik
dentalmicroscope
🇫🇷 Derrière le fragment, il restait encore du chemin…
Patiente de 62 ans adressée pour des douleurs persistantes sur 25 depuis la pose récente d’une couronne et la réalisation du traitement endodontique.
Il n’existe pas d’image apicale significative, mais le traitement endodontique est incomplet. Un fragment instrumental d’environ 3 mm est présent dans le tiers moyen du canal palatin, laissant sa portion apicale non traitée.
Le CBCT permet de comprendre toute la dif