Removal of a fractured endodontic instrument:a report of two cases

Casper H Jonker and Carel (Boela) van der Merwe report on the removal of a fractured endodontic instrument.

Abstract

The separation of an endodontic instrument within the root canal system can be one of the most stressful and unpleasant situations the clinician can be confronted with. These fractures often occur due to incorrect use of instruments. The clinician is confronted with a few options when considering this situation. These options can include leaving the fragment where the fracture occurred and incorporating the fragment to form part of the final obturation or removal from the root canal.

Once the decision is made to remove the fractured endodontic instrument, the clinician must realise that the procedure can be one of the most difficult treatments to attempt. According to the literature, there is no standardized method to follow when attempting to remove fractured instruments. The presented cases illustrate effective techniques to remove fractured endodontic instruments from the root canal system. Two cases are discussed where fractured instruments are removed using various manual instruments, ultrasonics, chemicals and the Dental Operating Microscope (DOM). Satisfactory endodontic outcomes were achieved and the fractured instruments were successfully removed without causing iatrogenic damage to the remaining tooth structure.

Introduction

Root canal treatments are attempted with the knowledge that certain unforeseen accidents can occur during any part of the treatment. These accidents can include fracture of instruments, perforation of the root on different levels and the formation of ledges. Once a tooth is exposed to procedural accidents and unforeseen complications, there is an increased risk of failure of the endodontic treatment and reduction of long term prognosis (Iqbal, 2016; Sjögren et al, 1990; Siqueira, 2001).

The complete treatment can be jeopardised from the cleaning and shaping sequence to the ultimate…