Clinical case: Lower anteriors, fractured instrument and missed anatomy

Endodontic retreatment considerations: Balancing biology, imaging, and patient needs in a lower anterior case

Overview

This video explores the assessment and management of endodontic retreatment in lower anterior teeth, considering both the biological objectives and practical patient factors.  This clinical cases illustrates diagnostic challenges, treatment planning decisions, and patient-centred approaches for achieving successful long-term outcomes.

Key topics covered

• Assessment of coronal features, restorability, and periapical status
• Use of 3D imaging (CBCT) to understand root canal anatomy and pathology
• Clinical case discussions:
  • Managing fractured instruments/sectional silver points
  • Addressing apical periodontitis and joining morphology
• Prioritisation of biologic outcomes
• Balancing the ‘need’ to treat vs. what is already acceptable

Clinical relevance

This video offers practical guidance for dentists faced with complex retreatment decisions in the lower anterior region. It demonstrates a systematic approach to assessing restorability, imaging findings, and treatment challenges, while also emphasising the importance of patient involvement and informed decision-making.

Learning outcomes

After watching this video, dentists will be able to:

• Evaluate restorability and assess the impact of coronal leakage
• Understand the limitations of 2D imaging and the benefits of CBCT
• Prioritise biological objectives and weigh the risks/benefits of various treatment options
• Apply a systematic approach to retreatment planning that considers both clinical and patient factors
• Communicate effectively with patients about complex treatment decisions and their potential implications