Dr Kwa Zheng Kang

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A non-visible ±3mm H-file separated beyond the curvature of the mandibular DL canal during retreatment attempts by the r...
09/09/2025

A non-visible ±3mm H-file separated beyond the curvature of the mandibular DL canal during retreatment attempts by the referring dentist.

Options discussed:
1. leave it in situ, surgical removal in future if necessary.
2. bypass
3. attempts for non-surgical removal

Patient keen for removal, understanding the pros and cons.

Minimum preparation with Katana tip from the inner wall of the separated file, loosen with CM files using T-mode.




0.5 of 2025
03/07/2025

0.5 of 2025




A case of Non-surgical ReRCT follow-up. 50+ female dental nurse was recommended by her doctor for a second opinion on he...
23/01/2025

A case of Non-surgical ReRCT follow-up.

50+ female dental nurse was recommended by her doctor for a second opinion on her #36.
Preoperative cbct shows deficient root canal treatment on distal root, with the present of +-10x6mm pa lesion.

Selective non-surgical retreatment initiated, old root canal fillings removed, only DB canal patency achieved.
Mechanical instrumentation on severely ledged and obliterated DL canal were only achievable up to 5mm short from WL.

Irrigation activated and assisted with R-SWEEPS, Fotona Laser.
All canals were obturated with OrthoMTA.
Post-op cbct shows patency on DL canal achieved after laser activation.


From Köln 🇩🇪 to Jakarta 🇮🇩 We are missing some good 🍺 🍺
20/11/2024

From Köln 🇩🇪 to Jakarta 🇮🇩
We are missing some good 🍺 🍺



1.7mm k-file was separated at the apical third during retreatment attempt by referring colleague. The 20mm long journey ...
13/08/2024

1.7mm k-file was separated at the apical third during retreatment attempt by referring colleague. The 20mm long journey into the canal can reduce the tactile sensation on the ultrasonic tip to catch the space between the BF and dentine wall.

Canal was prepared with #50.03 up to achievable WL, U88 Katana tip was used, and BF was removed with the aid of 17% EDTA solution.

Due to its cavity access design through the palatal wall, it's quite unlikely for me to have a direct vision onto the separated instruments without sacrificing more tooth structure. In this case, the BF was rather seen with tactile sensation.


I always pay extra attention during the glidepath negotiation of the disto-lingual canal on mandibular first molar. How ...
13/03/2024

I always pay extra attention during the glidepath negotiation of the disto-lingual canal on mandibular first molar.

How common is the present of disto-lingual root?
11% from local study and up to 25% worldwide, yet they are frequently present in mild to severe curved bucco-lingually, which is not easy to be seen in IOPA X-ray.

1.8mm hand file separated at the one third apical, beyond the steep curve, barely visible under microscope.
Ultrasonic tip TFRK-H was used to engage at the inner wall of the separated file, with the aid of 17% EDTA, the file popped out in minutes.


Rule of thumb in separated instruments removal: Clearly Visible.. In this case, I first wanted to bypass. Later, the bro...
30/01/2024

Rule of thumb in separated instruments removal: Clearly Visible..

In this case, I first wanted to bypass.
Later, the broken file was seen with my fingers, tactile sensation.

Placement of removal instrument at the inner wall of curvature confirmed with IOPA. BF is removed with TFRK katana E87 ultrasonic tip.




Twisting a H-file in root canal is dangerous, especially in a small & engaging tight canal. The torsional strength of a ...
14/09/2023

Twisting a H-file in root canal is dangerous, especially in a small & engaging tight canal. The torsional strength of a milled H-file is much lower compared to K-file, and is designed to be used in filing motion (up&down).

I personally don't use H-file in canal negotiation unless to pick up gp residues during retreatment.






A case of 22mm periapical radiolucent lesion on tooth #12 &11 presented on CBCT, after 6 months post-op NS-ReRCT. Patie...
07/09/2023

A case of 22mm periapical radiolucent lesion on tooth #12 &11 presented on CBCT, after 6 months post-op NS-ReRCT. Patient agreed to proceed with surgical removal of the infectious tissue, buying a chance before placing the titanium screw.

*Clinical colourful photos will be uploaded in the comments section.







Tip of a tiny rotary file is always fragile to sudden engagement into the canal.. Tactile sensation in initial hand file...
08/06/2023

Tip of a tiny rotary file is always fragile to sudden engagement into the canal.. Tactile sensation in initial hand file negotiations is important to reduce the risk of file separation.. of course, a small fov pre-op cbct can prepare our mind better..








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