It’s not usually a good thing when your dentist says “oops” during a procedure. I’m sure that the dentist who did this didn’t say “oops” out loud, but instead thought something much more profane when he saw what he had done.

The patient has been experiencing episodic symptoms for almost a year (since the implant was done). The periodontist who did the implants bounced the patient to an endodontist and an oral surgeon. Nobody really wanted to do anything. A CT scan was ordered by the oral surgeon and, although results were not conclusive, there were findings consistent with the fact that the implant was in contact with the root of the tooth. It was difficult to determine if the canal space had been perforated.

The patient was eventually referred to me for a second endodontic opinion. I recommended exploratory access and a retreatment start. The film above shows the story after I had accessed the crown, cleared gutta-percha from the canal, and then loaded the canal up with Calcium Hydroxide paste. The plan was to leave the tooth in this state for at least 4 weeks to see if symptoms improved.

During instrumentation of the canal, I found a solid, wide blockage in the apical 1/3 of the canal but fairly short of where the root should have ended. Electronic apex locator readings showed an apex at this blockage. These finding are consistent with the blockage being a metallic object that had perforated the root.

Over the past few weeks our patient has not noticed any significant relief from the current treatment. This means that completion of the retreatment will make no difference either. I’m not interested in doing apical surgery around an implant, so back he goes to his periodontist for further direction.