Fig. 1

 Periapical radiograph inadequate root canal treatment in 15. 

Periapical radiolucency associated with the root of 15 can also be seen. 


Treatment plan:

Re-root canal treatment with the following options:

  1. Re-rct through the present all ceramic crown
  2. Re-rct after emoval of the all ceramic crown

Patient chose option 1. 

However, it was made clear Incase All ceramic crown decemented during the retreatment procedure then a new all ceramic crown will have to be fabricated. Patient agreed and we started the re-rct through the present crown. 

Step wise procedures in the first visit: 

  1. Buccal infiltration anesthesia was administered, the tooth was isolated with rubber dam isolation and the tooth was seen under the microscope preoperatively.
Fig. 2

Tooth 15 under isolation with all ceramic crown before starting with the retreatment procedure.

Fig. 3

Endodontic access was prepared through the ceramic crown and older gutta perchas located.

The coronal part of the gutta perchas in the pulp chamber were removed with ultrasonic scaler.

Fig. 4

Gutta percha inside the root canal was removed with the help a dedicated file used at 2500rpm.

Fig. 5

Previous gutta percha was removed  and intracanal medicament placed. The patient was recalled for second visit.

Fig. 6

While placing the clamp the all-ceramic crown popped out and the patient was informed. Irrigation was done to remove the Intracanal medicament from the canals. 08K and 10K endodontic files were pre curved and used in an attempt to open the calcified canals. C+ files were also used in order to open up the apically calcified part of the root canals. These files were used with passive motion in presence of the irrigants. Once the calcified part was negotiated, working length was determined with Electronic apex locator and verified with a periapical radiograph.

In the initial phase of cleaning and shaping, a rotary file was used with copious irrigation.

Cleaning and shaping under irrigation

Fig. 7

Both the canals were finally prepared up to 25/04

Fig. 8

Master cone verified for the cone fit. The master cones were verified on the periapical radiograph.

AH plus sealer was used and applied inside the canals. The master cones were coated with the sealer and placed inside the canals. Warm vertical condensation technique was used to obturate the canals.

Fig. 9

Both the canals were obturated and the pulp chamber cleaned of any gutta percha or sealer. 

Fig. 10

Immediate postoperative radiograph was taken to verify the final obturation.

Fig. 11

New All ceramic crown was fabricated and cemented. 6- month recall of the case showed adequate healing and patient remained asymptomatic.


In order to achieve success in endodontic treatment, root canal system needs to be thoroughly cleaned, shaped, disinfected and obturated during the treatment. 

Inability to negotiate the whole length of the canal will lead to inadequate cleaning and shaping leaving residual microorganisms behind which might cause failure of the root canal treatment as seen in this case.

Therefore, the root canals should be, coronally & apically sealed, properly up to the full working length in order to achieve success in endodontic treatment. 


  1. Retreatment of endodontic fillings: Gunnar Bergenholtz Ulf Lekholm, Ralph Milthon, Gunnar Heden , Björn Ödesjö , Bure Engström;
  1. The Outcome of Endodontic Retreatment: A 2-yr Follow-up: Fabio G.M.Gorni, Massimo M.Gagliani;
  1. Nonsurgical Retreatment: Clifford J.Ruddle;
  1. Determination of the Minimum Instrumentation Size for Penetration of Irrigants to the Apical Third of Root Canal Systems: AbbasaliKhademi, MohammadYazdizadeh, MahboobeFeizianfard;