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Résumé

Bien que le traitement endodontique ait un taux de succès élevé, les échecs demeurent fréquents. Le retraitement par voie orthograde, en tant que première option thérapeutique, peut s’avérer complexe en raison des accidents iatrogènes survenus au cours du traitement initial. Ce cas clinique rapporte la prise en charge d’une première molaire maxillaire, traitée endodontiquement, qui présente une parodontite péri-apicale, d’une patiente de 56 ans.
L’examen clinique et radiologique ont révélé la présence d’une perforation du plancher et d’un instrument fracturé. Le traitement consistait en la désobturation mécanique des canaux, le bypass du fragment suivi par la mise en forme, la désinfection et l’obturation du système canalaire, ainsi que la réparation de la perforation par un ciment à base de biocéramique.
L’utilisation de techniques modernes telles que le grossissement, les ultrasons et les nouveaux biomatériaux a permis de simplifier la gestion des accidents iatrogènes et d’améliorer le pronostic du retraitement endodontique.

Abstract
Non-surgical retreatment of a first maxillary molar with pulpal floor perforation and a separated instrument: a case report

Despite the high success rate of root canal treatment, post-treatment disease remains a common finding. Non-surgical root canal retreatment, as a first treatment option, can be challenging because of procedural errors. This case report illustrates the successful non-surgical retreatment of a first maxillary molar of 56-year-old women. Clinical and radiographic examination revealed pulpal floor perforation and a separated instrument.
The first step of the retreatment was the removal of filling materials. Then, the bypass of the separated instrument allowed preparation, disinfection and obturation of the canal. Finally, the perforation was repaired using a bioceramic cement, providing a tight seal of the defect and promoting periodontal ligament regeneration.
The use of modern techniques including magnification, ultrasonics and innovative materials enhanced the prognosis of root canal retreatment. This case highlights the importance of careful management of procedural errors and the effectiveness of contemporary endodontic techniques in achieving favorable outcomes in complex cases.