Anyone performing endodontics occasionally has a separated instrument. This case was referred for removal of a separated instrument.
The file is in the MB#2 canal. Since it is in the upper third of the canal, good visualization with a microscope and proper ultrasonic technique will make this file removal possible.
After finding the file, careful ultrasonic instrumention is used to remove dentin around the file - opening up the MB groove. This is done carefully without touching the file itself. We want to expose 2-3 mm of the file before we begin vibrating the file itself.
Too much contact with the file in this early stage can cause a coronal piece of the file to break off, making it more difficult.
Once the coronal coronal 2-3mm of the file has been accessed, the ultrasonic is placed on the most apical part of the file to begin vibrating it. This should loosen the file and vibrate it out. If the file breaks again, then repeat step one.
The file was removed and the MB#2 canal instrumented.
Removal of the separated instrument complete.
Use of an operating microscope is essential in effective removal of a separated instrument.
6 comments:
All sounds good in case of a large instrument like this one broken in the middle third, What looks difficult to me is the classic case of a protaper F2 breakage, 2 mm in length at the apical third. Exposing it or troughing the dentin around it is difficult as the ultrasonic tips cuts through the root dentin there. What would you prefer to do in such a case?
A breakage in the apical third is very challenging, especially if there is curvature of the root.
If I can visualize the file, I'll take an ultrasonic after it. Sometimes I'll even bend the ultrasonic tip slightly. However if there is risk of perforation, I stop. If I suspect I will be doing an endodontic surgery, sometimes, I'll obturate that canal with MTA.
Did you finish the case, or did you send the patient back to the referring GP for him/her to finish it?
In this specific case, the patient requested to return to her G.P. for insurance purposes, despite our recommendation to complete treatment at the same time.
I broke an F1 protaper file at the apical third of the canal. at the last 3mm. it is very curved. what is the next step for me? do i obturate that canal with guttapercha? or does the patient need surgery? how do i prepare the rest of the canal length?
Dear Anonymous,
If an F1 separated in the apical third of a very curved canal, it's not likely it will be retrieved. I would clean the canal up to the file with copious irrigation. Then I would inform the patient that there has been a separation. Then I would put the patient on recall. If the canal was irrigated well before the separation, you may not have any problem. I would not plan a surgery unless there is failure to heal following recall.
I would explain to the patient that the file can be removed surgically, but it only makes sense to do that if there is failure to heal.
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