10/06/2026
Retx #19 | Dx: PT/AAA
A 27-year-old patient in her third trimester of pregnancy presented with a dental emergency. I initiated treatment and placed calcium hydroxide in all canals, with plans to complete treatment after delivery. I perform incision and drainage due large apical swelling.
A previously separated instrument in the mesiolingual (ML) canal was visible and easily bypassed. I left it in place at the initial appointment to minimize chair time, as the patient had difficulty remaining reclined for extended periods.
She returned four months later, after delivering her baby, for completion of treatment. Radiographs showed encouraging healing: the distal radiolucency appeared to have resolved, and the mesial radiolucency had decreased in size. Soft tissue healing also looked excellent.
After reaccessing the canals, I used EDDY tips with sterile water to help remove the calcium hydroxide. Following removal of the intracanal medicament, I could no longer visualize the separated instrument. I suspect it may have shifted into the isthmus between the ML and mesiobuccal (MB) canals during irrigant activation, although its location could not be confirmed.
Patency was maintained in both mesial canals, and preparation to the intended master apical file size was achieved easily with rotary instrumentation. Obturation was completed that day.
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