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VOLUME 4 , ISSUE 2 ( July-December, 2019 ) > List of Articles

CASE REPORT

Management of Instrument Separation: A Case Series

Radhakrishnan K Nair, Nisha Kurup

Keywords : 169L tungsten carbide bur, Case series, Distal canal, File braiding technique, Instrument separation, Magnification, ProTaper gold F2, Ultrasonics

Citation Information : Nair RK, Kurup N. Management of Instrument Separation: A Case Series. Cons Dent Endod J 2019; 4 (2):39-43.

DOI: 10.5005/jp-journals-10048-0049

License: CC BY-NC 4.0

Published Online: 18-07-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background: During routine endodontic therapy, a clinician may encounter many procedural errors which alter the course and outcome of treatment. One of the most frequent types of procedural error is instrument separation. A separated instrument prevents complete cleaning and shaping of the root canal. Hence, every attempt must be made to retrieve the broken instrument. The clinician has to evaluate the options of attempting retrieval, and bypassing or leaving the fragment as it is. There are various instrument retrieval kits and chairside techniques available for this purpose. Case description: The present case series describes the management of a separated rotary file and a separated bur head from the root canals of mandibular second molar and maxillary canine, respectively. A 14-year-old female patient undergoing root canal treatment in relation to 47 had an accidental breakage of ProTaper gold F2 rotary file in the apical third of distal canal of 47. Attempts were made to retrieve the instrument with ultrasonically activated files under dental operating microscope and was successfully managed. A 47-year-old female patient undergoing root canal treatment in relation to 13 had an accidental blockage of the canal with 169L carbide bur in the apical third of canal. The fractured fragment was retrieved with file braiding technique. Conclusion: This case series has described conservative and simple techniques for removal of fractured instruments from the root canals of an anterior and posterior tooth.


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  1. Grossman LI. Endodontic case reports. Den Clin North Am 1974;18(2):509–527.
  2. Sternberg RN. Retrieval of broken instrument from root canal. Oral Surg Oral Med Oral Path 1977;44(2):325. DOI: 10.1016/0030-4220(77)90288-2.
  3. Meidinger DL, Kabes BJ. Foreign object removal utilizing the Cavi-Endo ultrasonic instrument. J Endod 1985;11(7):301–304. DOI: 10.1016/S0099-2399(85)80161-8.
  4. Fors UGH, Berg JO. A method for the removal of broken endodontic instruments from root canals. J Endod 1983;9(4):156–159. DOI: 10.1016/S0099-2399(83)80038-7.
  5. Souyave LC, Inglis AT, Alcalay M. Removal of fractured endodontic instruments using ultrasonics. Br Dent Jl 1985;159(8):251–253. DOI: 10.1038/sj.bdj.4805695.
  6. Feldman G, Solomon C, Notaro P, et al. Retrieving broken endodontic instruments. J Am Dent Asso 1974;88(3):588–591. DOI: 10.14219/jada.archive.1974.0113.
  7. Madarati AA, Hunter MJ, Dummer PM. Management of intracanal separated instruments. J Endod 2013;39(5):569–581. DOI: 10.1016/j.joen.2012.12.033.
  8. Fu M, Zhang Z, Hou B. Removal of broken files from root canals by using ultrasonic techniques combined with dental microscope: a retrospective analysis of treatment outcomes. J Endod 2011;37(5): 619–622. DOI: 10.1016/j.joen.2011.02.016.
  9. Gambarini G. Cyclic fatigue of ProFile rotary instruments after prolonged clinical use. Int Endod J 2001;34(5):386–389. DOI: 10.1046/j.1365-2591.2001.00259.x.
  10. Crump MC, Natkin E. Relationship of broken root canal instruments to endodontic case prognosis: a clinical investigation. J Am Dent Assoc 1970;80(6):1341–1347. DOI: 10.14219/jada.archive.1970. 0259.
  11. Al Fouzan KS. Incidence of rotary ProFile instrument fracture and the potential for bypassing in vivo. Int Endod J 2003;36(12):864–867. DOI: 10.1111/j.1365-2591.2003.00733.x.
  12. Pettiette MT, Conner D, Trope M. Procedural errors with the use of nickel titanium rotary instruments in undergraduate endodontics. J Endod 2002;28(3):259.
  13. Nevares G, Cunha RS, Zuolo ML, et al. Success rates for removing or bypassing fractured instruments: a prospective clinical study. J Endod 2012;38(4):442–444. DOI: 10.1016/j.joen.2011.12.009.
  14. Atkinson AS. The significance of blade geometry in the cutting efficiency of tungsten carbide dental burs at ultrahigh speeds. Br Dent J 1983;155(6):187–193. DOI: 10.1038/sj.bdj.4805171.
  15. Hulsmann M. Methods for removing metal obstruction from root canal. Endod Dent Traumatol 1993;9(4):223–237. DOI: 10.1111/j.1600-9657.1993.tb00278.x.
  16. Chenail BL, Teplitsky PE. Orthograde ultrasonic retrieval of root canal obstruction. J Endod 1986;13:186–190. DOI: 10.1016/S0099-2399(87)80138-3.
  17. Shen Y, Peng B, Cheung GS. Factors associated with the removal of fractured NiTi instruments from the root canal systems. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98(5):605–610. DOI: 10.1016/j.tripleo.2004.04.011.
  18. Hulsmann M. Removal of silver cones and fractured instruments using canal finder system. J Endod 1990;16(12):596–600. DOI: 10.1016/S0099-2399(07)80203-2.
  19. Hulsmann M, Schinkel I. Influence of several factors on the success or failure of removal of fractured instruments from the root canal. Endod Dent Traumatol 1999;15(6):252–258. DOI: 10.1111/j.1600-9657.1999.tb00783.x.
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