Tuesday, June 28th, 2022

Broken Instrument Removal: The Endodontic Challenge

Dentists like to show off the curves of root canals that have been treated. Endodontic innovations have made it simpler to reach previously unreachable parts of a root canal, allowing the physician to do 3D cleaning and obturation.

Broken instruments in the middle of treatment are one of any clinician’s worst nightmares. In this article, we will discuss the instrument retrieval and endodontic challenge. 

What is the cause behind it?

1. Instruments with cinematic movements applied incorrectly. 

2. Use of instruments that have already been distorted and are prone to fracture owing to cyclic fatigue.

How to treat it?

Using dental loupes and operating microscopes, practitioners can gain better magnification and lighting thanks to modern visualization techniques. It aids in the visualization of broken instruments’ most coronal aspects, allowing them to be removed without perforating the root canal.

There are 3 alternative options from which a clinician must choose: whether or not to:

  • Remove the fractured segment.
  • Bypass and seal the fragment within the root canal.
  • Go for a true blockage.

The removal of a broken instrument is a standard method of dealing with it. The use of an operating microscope to assist canal expansion to the level of the fractured piece and removal with ultrasonic tips and/or some sort of gripping equipment is widely accepted around the world.

What are the factors to consider for the treatment plan?

  • Status of pulp
  • Root canal infection
  • Root canal anatomy: Anterior teeth with wide and straight canals have a higher success rate than posterior teeth with narrow and curved canals.
  • Position of the instrument: When compared to the middle and coronal thirds, removing an instrument fragment from the apical third is extremely difficult. In general, if one-third of the instrument’s total length is exposed, it can be removed.
  • Broken instrument type: NiTi rotary instruments are more difficult to remove than stainless steel rotary instruments because they fracture at a shorter length. Due to elastic memory, they prefer to straighten up when they break in a curved canal. Stainless steel tools may not shatter during the removal procedure, however, NiTi instruments may fracture and go deeper into the canal, because of heat generation.

You should not attempt to remove the broken instrument unless proper straight-line access to the instrument’s head is established. It’s done in stages, starting with coronal access and then radicular access. 

When non-surgical removal is impossible, such as when an instrument extends beyond the apical foramen and intentional leaving of the broken tool is harmful, a surgical technique is used. Surgery should be performed under local anesthesia only after a thorough history, proper clinical examination, and good quality radiographs.