Removal of a separated endodontic instrument in the mesiolingual canal of a lower second molar: case report

Authors

DOI:

https://doi.org/10.33448/rsd-v11i5.28400

Keywords:

Endodontics; Root canal treatment; Root canal preparation.

Abstract

During endodontic treatment, incidents such as instrument fracture inside the root canals can happen. Such complications are caused by torsion or fatigue of the instrument. Therapeutic alternatives include chemical-mechanical preparation up to the fractured fragment; the chemical-mechanical preparation surpassing the fragment; or removal of the instrument via the canal or by apical microsurgery. This paper aims to report the case of a patient referred for endodontic treatment of tooth 47, presenting a fractured endodontic instrument in one of the canals. It was described by the first operator that, during the chemical-mechanical preparation, a reciprocating instrument fractured in the mesiolingual canal. After clinical and radiographic examinations, it was decided to include in the treatment planning the attempt to remove the fragment via the canal, with the aid of operative microscopy and ultrasonic inserts. During the process, the fractured instrument broke again. As its visualization was still maintained, the removal attempt was continued. After the successful procedure, endodontic treatment was performed and completed. After a five-month observation period, the patient remained asymptomatic. Removal of a fractured endodontic instrument via canal is generally the choice option for such complications, as the shaping and disinfection of the canals are more efficient, enabling a high rate of treatment success. However, the professional must pay attention to avoid further accidents or procedural errors. It was concluded that the removal of the endodontic instrument fragment was performed satisfactorily, being a valid attempt for greater predictability of endodontic treatment, when the benefits of the procedure outweigh the risks.

References

Arslan, H., Doğanay Yıldız, E., Taş, G., Akbıyık, N., & Topçuoğlu, H. S. (2020). Duration of ultrasonic activation causing secondary fractures during the removal of the separated instruments with different tapers. Clinical oral investigations, 24(1), 351–355.

Bhandi, S., Seracchiani, M., Donfrancesco, O., Reda, R., Mazzoni, A., Nottola, S., Familiari, G., Testarelli, L., & Gambarini, G. (2021). Nickel-Titanium Rotary Instruments: An In Vitro Comparison (Torsional Resistance of Two Heat-treated Reciprocating Files). The journal of contemporary dental practice, 22(4), 361–364.

Fu, M., Zhang, Z., & Hou, B. (2011). Removal of broken files from root canals by using ultrasonic techniques combined with dental microscope: a retrospective analysis of treatment outcome. Journal of endodontics, 37(5), 619–622.

Gavini, G., Santos, M. D., Caldeira, C. L., Machado, M., Freire, L. G., Iglecias, E. F., Peters, O. A., & Candeiro, G. (2018). Nickel-titanium instruments in endodontics: a concise review of the state of the art. Brazilian oral research, 32(suppl 1), e67.

Madarati, A. A., Hunter, M. J., & Dummer, P. M. (2013). Management of intracanal separated instruments. Journal of endodontics, 39(5), 569–581.

Martins, J., Silva, E., Marques, D., Pereira, M. R., Vieira, V., Arantes-Oliveira, S., Martins, R. F., Braz Fernandes, F., & Versiani, M. (2022). Design, Metallurgical Features, and Mechanical Behaviour of NiTi Endodontic Instruments from Five Different Heat-Treated Rotary Systems. Materials (Basel, Switzerland), 15(3), 1009.

McGuigan, M. B., Louca, C., & Duncan, H. F. (2013). Endodontic instrument fracture: causes and prevention. British dental journal, 214(7), 341–348.

Oliveira, MDC. (2003). Remoção de instrumento endodôntico fraturado no interior do canal radicular. Caso Clínico. J. Bras. Endod, 4(14), 186-190.

Parashos, P., & Messer, H. H. (2006). Rotary NiTi instrument fracture and its consequences. Journal of endodontics, 32(11), 1031–1043.

Poy, M. E. R., Solda, C., Vanni, J.R. (2018). Prevalência de fraturas de instrumentos endodônticos de NiTi durante o tratamento endodôntico. Journal of Oral Investigations, 7(1):3-13.

Pruett, J. P., Clement, D. J., & Carnes, D. L., Jr (1997). Cyclic fatigue testing of nickel-titanium endodontic instruments. Journal of endodontics, 23(2), 77–85.

Ribeiro Camargo, C. H., Bittencourt, T. S., Hasna, A. A., Palo, R. M., Talge Carvalho, C. A., & Valera, M. C. (2020). Cyclic fatigue, torsional failure, and flexural resistance of rotary and reciprocating instruments. Journal of conservative dentistry. JCD, 23(4), 364–369.

Ruddle C. J. (2004). Nonsurgical retreatment. Journal of endodontics, 30(12), 827–845.

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.

Simon, S., Machtou, P., Tomson, P., Adams, N., & Lumley, P. (2008). Influence of fractured instruments on the success rate of endodontic treatment. Dental update, 35(3), 172–179.

Solomonov, M., Webber, M., & Keinan, D. (2015). Fractured Endodontic Instrument: A Clinical Dilemma Retrieve, Bypass or Entomb? The Journal of the Michigan Dental Association, 97(9), 44–46.

Souter, N. J., & Messer, H. H. (2005). Complications associated with fractured file removal using an ultrasonic technique. Journal of endodontics, 31(6), 450–452.

Terauchi, Y., Sexton, C., Bakland, L. K., & Bogen, G. (2021). Factors Affecting the Removal Time of Separated Instruments. Journal of endodontics, 47(8), 1245–1252.

Vatanpour, M., Toursavadkouhi, S., & Sajjad, S. (2022). Comparison of three irrigation methods: SWEEPS, ultrasonic, and traditional irrigation, in smear layer and debris removal abilities in the root canal, beyond the fractured instrument. Photodiagnosis and photodynamic therapy, 37, 102707.

Walia, H. M., Brantley, W. A., & Gerstein, H. (1988). An initial investigation of the bending and torsional properties of Nitinol root canal files. Journal of endodontics, 14(7), 346–351.

Zupanc, J., Vahdat-Pajouh, N., & Schäfer, E. (2018). New thermomechanically treated NiTi alloys - a review. International endodontic journal, 51(10), 1088–1103.

Published

09/04/2022

How to Cite

DUARTE, M. M.; MACEDO, I. F. A.; CHAVES, H. G. dos S.; ARAÚJO, C. V. Removal of a separated endodontic instrument in the mesiolingual canal of a lower second molar: case report. Research, Society and Development, [S. l.], v. 11, n. 5, p. e36411528400, 2022. DOI: 10.33448/rsd-v11i5.28400. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/28400. Acesso em: 21 nov. 2024.

Issue

Section

Health Sciences