Management of Broken Instruments

The presence of a broken file during root canal treatment can pose a challenge for dentists. A broken file within a root canal may occur due to various reasons, such as excessive force, pre-existing defects in the file or complicated root canal anatomy. The reported frequency rate for fractured instruments varies from 0.7% to 6% of cases. The management of a broken file depends on several factors, including the location of the file fragment and the stage of the root canal procedure. Here are some general approaches to managing a broken endodontic file:

1. Assessment and Diagnosis:
The dentist will use X-rays and clinical examination to assess the location, size and orientation of the broken file within the root canal. This information is necessary to aid in determining the appropriate course of action.

2. Continuation of Treatment:
In some cases, if the broken file is located in a position that does not impede the progress of the root canal treatment and the tooth is responding well to treatment, the dentist may choose to continue with the procedure.

3. Attempt Retrieval:
If the broken file is accessible and its removal is deemed necessary, the dentist may attempt to retrieve it using specialized instruments. Various techniques and devices, such as ultrasonics, microscopes, and specialized retrieval kits may be used to aid in file removal.

4. Bypassing the File:
If file retrieval is not feasible or deemed too risky, the dentist may choose to bypass the broken file by creating a new path within the root canal. This involves using smaller files to navigate around the obstruction.

5. Sealing and Completion:
Once the root canal is cleaned, shaped, and filled, the dentist will seal the canal to prevent further infection. In some cases, a post and core restoration or a crown may be recommended to provide additional support and protection to the tooth.

6. Monitoring:
Patients will be closely monitored during follow-up appointments to ensure the tooth is healing properly. Regular X-rays may be taken to assess the status of the root canal and the surrounding bone.

It's important to note that not all broken files require immediate intervention, and the decision on how to manage a broken file depends on the specific circumstances of each case. Dentists will carefully consider the risks and benefits of various approaches to determine the most appropriate course of action.

Reference :
1. Elisican. Broken instruments - clinical decision making algorithm [Internet]. 2020
[cited 2023 Dec 18]. Available from:
https://www.aae.org/specialty/brokeninstruments-clinical-decision-making-algorithm/

2. Spili P, Parashos P, Messer H. The impact of instrument fracture on outcome of
endodontic treatment. J Endod 2005;31:845-850

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