Diverse Strategies in Managing Separated Endodontic Instruments: Case Series

Endodontists face the challenge of managing sperated instruments in root canals. The aim of this work is to illustrate the decision-making process in different cases. Case 1: It is about a chronic apical periodontitis in tooth 26. A rotary file seperated during shaping of the mesial-buccal canal. The file was bypassed. The canals were filled using a bioceramic-based sealer. Case 2: A patient was referred with a seperated k15-file in tooth 46. The file was retrieved using ultrasonic tips under a dental operating microscope. Endodontic filling was performed using a resin-based sealer. Case 3: A patient was referred for a broken file in tooth 36. The S1-Manual Protaper file was retrieved using a Broken Tool Remover BTR-Pen. The canals were obturated using a resin-based sealer. For managing fractured instruments, there are three orthograde treatment options: abstention, bypassing² or retrieval. The latter is most favorable in cases with periapical involvement. Several factors are considered in these cases: visibility, location, root canal anatomy, and the structure of the remaining tooth tissue. This treatment requires special assistance because of the risk of complications; pushing the file apically, excessive loss of dentine, decreased root fracture resistance, increase in the temperature of the external root surface and the occurrence of a ledge and canal transportation. Clinicians should balance between successful removal of the broken instrument and maintaining the maximum amount of tooth tissue in terms of quality and quantity.