Removal of fractured endodontic NiTi file in the apical third of the root canal using an alternative approach. A case report
Keywords:Endodontics; Root canal therapy; Separated instrument; Instrument removal.
This case report presents an alternative approach for the removal of a fractured endodontic instrument from the apical third of the root canal. A 52-years-old female patient was referred for specialized endodontic treatment of the maxillary left first molar due to the presence of a periapical lesion and root canal calcification. After clinical and radiographic examination, the calcification was confirmed. During biomechanical preparation, the fracture of a size 25/.06 NiTi reciprocating file (ProDesign R) occurred in the apical third of the palatine canal. The patient was informed about the complication and agreed with the attempt to remove the fragment. Firstly, a slight wear of the dentinal walls around the fragment was made using ultrasonic inserts under magnification. Then, a customized extractor was made using a hypodermic needle and a handling file whose mechanism is similar to the removal method previously described by Masserann. For this, the hypodermic needle was inserted in the root canal and the handling file was adapted in the needle lumen, with the function of fixing the fragment and removing it from the canal through the opposite movement performed by the fractured file. After associating the technique with a hypodermic needle and using ultrasound and an operating microscope to perform the procedure, the fragment was successfully removed. The association of techniques to remove fragments using only items already present in the endodontic arsenal can eliminate the need for surgical treatment and improve the prognosis of endodontic treatment through a safe, simple and cost-effective method that can be performed in the endodontic clinical routine.
Alapati, S. B., Brantley, W. A., Svec, T. A., Powers, J. M., Nusstein, J. M., & Daehn, G. S. (2005). SEM observations of nickel-titanium rotary endodontic instruments that fractured during clinical Use. Journal of Endodontics, 31(1), 40-43. doi: 10.1097/01.don.0000132301.87637.4a
Bahcall, J. K., Carp, S., Miner, M., & Skidmore, L. (2005). The causes, prevention, and clinical management of broken endodontic rotary files. Dentistry Today, 24(11), 74, 76, 78-80. URL: https://www.dentistrytoday.com/endodontics/310-the-causes-prevention-and-clinical-management-of-broken-endodontic-rotary-files
Brito-Junior, M., Normanha, J. A., Camilo, C. C., Faria-e-Silva, A. L., Saquy, P. C., Ferraz, M. A., et al. (2015). Alternative techniques to remove fractured instrument fragments from the apical third of root canals: report of two cases. Brazilian Dental Journal, 26(1), 79-85. doi: 10.1590/0103-6440201302446
Cheung, G. S. (2009). Instrument fracture: mechanisms, removal of fragments, and clinical outcomes. Endodontic Topics, 16(1), 1-26. doi: 10.1111/j.1601-1546.2009.00239.x
Chhina, H., Hans, M. K., & Chander, S. (2015). Ultrasonics: a novel approach for retrieval of separated instruments. Journal of Clinical and Diagnostic Research, 9(1), ZD18-20. doi: 10.7860/JCDR/2015/11056.5473
Di Fiore, P. M., Genov, K. A., Komaroff, E., Li, Y., & Lin, L. (2006). Nickel-titanium rotary instrument fracture: a clinical practice assessment. International Endodontic Journal, 39(9), 700-708. doi: 10.1111/j.1365-2591.2006.01137.x
Drago, M., Junior, M. Â. S., Cipriano, D. F., Oliveira, F. J. P. d., & Pereira, R. d. S. (2011). Deformation of the outer surface of the Protaper® Universal files. RevOdonto, 18(3), 160-169. URL: http://revodonto.bvsalud.org/pdf/rpg/v18n3/a06v18n3.pdf
Frota, L. M., Aguiar, B. A., Aragão, M. G., & de Vasconcelos, B. C. (2016). Removal of Separated Endodontic K-File with the Aid of Hypodermic Needle and Cyanoacrylate. Case Reports in Dentistry, 2016, 3970743. doi: 10.1155/2016/3970743
Gambill, J. M., Alder, M., & del Rio, C. E. (1996). Comparison of nickel-titanium and stainless steel hand-file instrumentation using computed tomography. Journal of Endodontics, 22(7), 369-375. doi: 10.1016/S0099-2399(96)80221-4
Grossman, L. I. (1969). Guidelines for the prevention of fracture of root canal instruments. Oral Surgery, Oral Medicine, and Oral Pathology, 28(5), 746-752. doi: 10.1016/0030-4220(69)90423-x
Hulsmann, M. (1990). Removal of silver cones and fractured instruments using the Canal Finder System. Journal of Endodontics, 16(12), 596-600. doi: 10.1016/s0099-2399(07)80203-2
Lopes, H. P., de Souza, L. C., Vieira, V. T. L., Silveira, A. M. V., Vieira, M. V. B., & Elias, C. N. (2012). Fratura dos instrumentos endodônticos: recomendações clínicas. Revista Brasileira de Odontologia, 68(2), 152. doi: 10.18363/rbo.v68n2.p.152
Madarati, A. A., Hunter, M. J., & Dummer, P. M. (2013). Management of intracanal separated instruments. Journal of Endodontics, 39(5), 569-581. doi: 10.1016/j.joen.2012.12.033
Martin, B., Zelada, G., Varela, P., Bahillo, J. G., Magan, F., Ahn, S., et al. (2003). Factors influencing the fracture of nickel-titanium rotary instruments. International Endodontic Journal, 36(4), 262-266. doi: 10.1046/j.1365-2591.2003.00630.x
Monteiro, J. C., Kuga, M. C., Dantas, A. A., Jordao-Basso, K. C., Keine, K. C., Ruchaya, P. J., et al. (2014). A method for retrieving endodontic or atypical nonendodontic separated instruments from the root canal: a report of two cases. The Journal of Contemporary Dental Practice, 15(6), 770-774. doi: 10.5005/jp-journals-10024-1615
Parashos, P., & Messer, H. H. (2006). Rotary NiTi instrument fracture and its consequences. Journal of Endodontics, 32(11), 1031-1043. doi: 10.1016/j.joen.2006.06.008
Shahabinejad, H., Ghassemi, A., Pishbin, L., & Shahravan, A. (2013). Success of ultrasonic technique in removing fractured rotary nickel-titanium endodontic instruments from root canals and its effect on the required force for root fracture. Journal of Endodontics, 39(6), 824-828. doi: 10.1016/j.joen.2013.02.008
Shen, Y., Peng, B., & Cheung, G. S. (2004). Factors associated with the removal of fractured NiTi instruments from root canal systems. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 98(5), 605-610. doi: 10.1016/j.tripleo.2004.04.011
Sjogren, U., Hagglund, B., Sundqvist, G., & Wing, K. (1990). Factors affecting the long-term results of endodontic treatment. Journal of Endodontics, 16(10), 498-504. doi: 10.1016/S0099-2399(07)80180-4
Terauchi, Y., O'Leary, L., & Suda, H. (2006). Removal of separated files from root canals with a new file-removal system: Case reports. Journal of Endodontics, 32(8), 789-797. doi: 10.1016/j.joen.2005.12.009
Thirumalai, A. K., Sekar, M., & Mylswamy, S. (2008). Retrieval of a separated instrument using Masserann technique. Journal of Conservative Dentistry, 11(1), 42-45. doi: 10.4103/0972-0707.43417
Thompson, S. A. (2000). An overview of nickel-titanium alloys used in dentistry. International Endodontic Journal, 33(4), 297-310. doi: 10.1046/j.1365-2591.2000.00339.x
Wolf, T. G., Paque, F., Zeller, M., Willershausen, B., & Briseno-Marroquin, B. (2016). Root Canal Morphology and Configuration of 118 Mandibular First Molars by Means of Micro-Computed Tomography: An Ex Vivo Study. Journal of Endodontics, 42(4), 610-614. doi: 10.1016/j.joen.2016.01.004
How to Cite
Copyright (c) 2021 Caroline Loureiro; Flávia Alfredo Plazza; Rogério de Castilho Jacinto; Luciano Tavares Angelo Cintra; João Eduardo Gomes-Filho
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.