PreOp Assessment:
Frequently, the pre-operative radiograph can tell a tooth’s ‘story’ before even having a discussion with the patient. In the above film, the palatal root is of interest because you can notice a 3 mm piece of metal in the mid-root area and an embedded file extending from that metal area to the occlusal surface. This patient originally had a post that fractured at the level of the palatal canal orifice. The file is actually a central metal core to a fiber post that was placed on top of the metal post by a second dentist who was unable to remove the remaining metal post fragment. Fortunately, with the use of an operating microscope and ultrasonic instrumentation, both posts were able to be removed. The actual cause of the apical radiolucency was a missed MB2, but evaluating the pre-operative image carefully tells you just what you’re going to be getting into when attempting root canal therapy.