Prevention and management of fractured instruments in endodontic treatment

Figure 1 (A-C) preoperative and (D-E) 5-year follow-up radiographs: (D) complete healing, (E) uncertain healing, and (F) no healing.

Figure 2 The extractor is inserted into the groove and locked the end of the fragment by the screw tightened between the plunger and the internal embossment. A: Periapical radiograph: Separated instrument is visible in middle 3^rd of calcified root canal in maxillary right lateral incisor; B and C: Making a channel around the separated instrument to keep the broken instrument in the center of the tube of Masserann Kit; D and E: Engaging tube of Masserann Kit with the separated instrument and removal of the fragment from root canal.

Figure 3 Schematic diagram of the intracanal fragment dissolution test. CE: Counter electrode; RE: Reference electrode.

Figure 4 Procedures for removing a separated file from a root canal using the new file removal system. A: Initial canal with a separated file; B: Canal enlarged with CBA; C: Dentin removal around the separated file with CBB; D: Ultrasonic tip troughed semicircularly around the separated file to create space for the file-removal device; E: troughing semicircularly on the remaining half of the separated file for complete exposure; F: Placement of the loop over the separated file; G: Fastening the loop to grab the separated file; H: Removal of the separated file from the root canal.

Figure 5 A modified 18-gauge needle and cyanoacrylate glue were used to retrieve a separated nickel-titanium instrument from the mesiolingual canal of a mandibular first molar. A: Radiograph showing separated instrument; Radiograph showing dentine surrounding the coronalend of the separated fragment removed with GG drill; B: An 18-guage needle, modified by cutting with a carborundum disc from the tip to transform it into a microtube; C: Separated instrument fragment removed adhered to the microtube; D: Radiograph confirming instrument removal; Working length reconfirmed; Post-obturation radiograph; E: Two-year follow up radiograph.

Figure 6 A separated hand instrument in a second molar was retrieved from the mesiobuccal root, which was close to the mandibular canal, using tooth replantation. A: Broken instrument near to the mandibular canal; B: After extraction; C: Measured broken instrument of 7 mm; D: After obturation; E: After separators were placed; F: Extra coronal splinting with orthodontic wires were prepared; G: Post operative Radiograph; H and I: Four weeks after Band removal; J: Three months follow-up Radiograph; K: One year follow-up radiograph; L: One year clinical radiograph.