Surgical Management of Extruded Fractured Instrument Beyond the Periapical Area: A Case Report with Two-year Follow-up

@#A fractured instrument is an undesirable endodontic mishap that can prevent complete root canal disinfection, thereby affecting the root canal treatment outcome. The present case discussed the surgical management of an extruded fractured barbed broach at the apical third of maxillary right first premolar. A 28-year-old female presented with an endodontic failure on tooth 14 and was diagnosed as previously root canal treated with symptomatic apical periodontitis. Radiographic examination revealed a straightline radiopacity structure that was 2 mm in length extruded from the apical root-end, suggesting a fractured instrument. The case was successfully managed through endodontic microsurgery. The present case emphasises the significance of cone-beam computed tomography as a valuable tool for diagnosis and investigation, while also offering supplementary information for the planning of surgical treatment.

Alternative Techniques to Remove Fractured Instrument Fragments from the Apical Third of Root Canals: Report of Two Cases

This paper describes two cases of instrument fragment removal from the apical thirds of root canals using a customized extractor and a modified needle technique, respectively. In case 1, a customized extractor was manufactured to remove a bur fragment located in the apical root canal of a maxillary central incisor. The use of this extractor enabled successful and conservative removal of the instrument fragment. In case 2, a modified injection needle was used as a trepan to gain access around an instrument fragment located in the curved apical portion of the mesiobuccal canal of a mandibular molar. A segment of steel wire was inserted into the needle lumen to engage the metallic fragment, enabling its removal with counter-clockwise rotation and a simultaneous pull-out motion. Alternative and creative methods are useful for the management of intracanal metallic fragments during root canal treatment.

Este relato descreve dois casos de remoção de fragmentos de instrumentos de terços apicais de canais radiculares utilizando um extrator personalizado e técnica da agulha modificada, respectivamente. No Caso 1, um extrator foi fabricado para remover fragmento de broca localizado no terço apical do canal radicular de um incisivo central superior. O uso deste extrator permitiu a remoção bem sucedida e conservadora do fragmento de instrumento. No Caso 2, uma agulha para anestesia modificada foi utilizada como um trépano para ganhar acesso ao redor de um fragmento de instrumento localizado na porção apical curva do canal mésio-vestibular de um molar inferior. Um segmento de fio de aço foi inserido no lúmen da agulha para envolver o fragmento metálico, permitindo sua remoção com rotação no sentido anti-horário e simultâneo movimento de retração. Métodos alternativos e criativos são úteis para a remoção intracanal de fragmentos metálicos durante o tratamento endodôntico.

Clinical evaluation of using dental operating microscope combines ultrasonic root canal technique in removing fractured root canal instruments / 中国医师杂志

Objective To evaluate the clinic effect of dental operating microscope ( DOM) and ul-trasonic root canal technique in removing fractured root canal instruments .Methods Eight cases with frac-tured instruments located in different parts of root canals were treated with ultrasonic technique under DOM and the results were analyzed .The fractured instruments were divided into stainless steel file , Ni-Ti file and post according to material type .Results Twenty-seven fractured instruments were removed and the total success rate was71.1%.Among them, the success rate of stainless steel file was 71.4%,of Ni-Ti file was 37.5%and of post was 100%.No root canal perforation occurred .According to the place fractured instru-ments located , the success rate of stainless steel file located at upper 1/3 root canals was 100%,at middle 1/3 was 81.8%and at apex 1/3 was 33.3%;the success rate of Ni-Ti file located at middle 1/3 was 60%and at apex 1/3 was 0.In bent root canals , the success rate of stainless steel file located at bent part crown square was 86.7%and at bent part apex square was 20%;the success rate of Ni-Ti file located at bent part crown square was 60%and at bent part apex square was 0.Conclusion DOM combined with ultrasonic root canal technique in removing fractured instruments is effective , but the success rate is relatively low for Ni-Ti files and the cases fractured instruments located at root canal apex 1/3 or bent part apex square .