Abstract
A 30-year-old female presented with gingival swelling around #46, which her previousdentist deemed difficult to preserve against the patient’s preference. Radiographic and clinicalexamination revealed a failed root canal treatment (RCT) with an associated chronic periapicallesion, a deep (7mm) localized periodontal pocket suggesting possible fracture or perforation,and extruded root filling material outside the mesial root canal, along with a well-fit crown andno radiolucency in the distal region. Initial management focused on non-surgical infected rootcanal treatment, during which two perforations were identified on the mesial root (buccolingualand inner surface). Following disinfection and sealing of the perforations, the primary technicalchallenge was the removal of the highly mobile extruded filling material and associated infectedtissue. This was successfully achieved using a TGR instrument with an arrowhead-shaped tip toengage and retrieve the material. Postoperative follow-up demonstrated favorable clinical andradiographic outcomes, including marked reduction of the periapical radiolucency, reformationof the lamina dura, and normalization of probing pocket depths. This case highlights that evencomplex endodontic failures involving multiple perforations and extruded, mobile material canachieve long-term resolution and successful periodontal healing. The outcome highlights thecrucial importance of meticulous disinfection, careful perforation management, and the use ofsuitable instruments, such as the TGR instrument, for the removal of extraradicular foreignbodies.
