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Surgical endodontics to manage a separated instrument: a case report Tahir Yusuf Noorani Nik Rozainah Nik Abdul Ghani Jawaad Ahmed Asif Irshad Abdul Rahim Dental Update 2024 44:10, 707-709.
Authors
Tahir YusufNoorani
DDS, MResDent, FRACDS, Lecturer
Senior Lecturer, Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia.
Various iatrogenic mishaps can impede adequate biomechanical preparation of the root canal system. Instrument separation can be treated by orthograde retreatment, with or without instrument removal, endodontic surgery or extraction. The aim of this case report is to describe a minor surgical procedure to resect an infected root containing a separated instrument. A fractured instrument was detected in the mesiobuccal root of the maxillary first molar extending beyond the apex. This fractured instrument was serving as a niche for infection and formation of a sinus tract. The fractured instrument could not be retrieved through the root canal, hence the root canal was obturated up to the fractured instrument and the apical half of the mesiobuccal root was resected surgically. At the two years recall the clinical and radiographic outcome was considered favourable.
CPD/Clinical Relevance: Endodontic surgery, while classically being considered as the last resort, becomes important when orthograde retreatment fails to remove the cause of persisting infection.
Article
Adequate biomechanical preparation and obturation followed by a good coronal seal can result in long-term survival of endodontically treated teeth.1 However, adequate cleaning and shaping can be impeded by various iatrogenic mishaps such as ledges, blocked canals and instrument separation.2 Instrument separation prevents complete debridement by blocking access to the apical portions of the root canals for irrigation and decontamination. Instrument separation can be treated by orthograde retreatment with or without instrument removal, endodontic surgery, further treatment or extraction. While broken instruments may be bypassed, removing them is imperative in most instances to ensure complete debridement and long-term success of endodontic treatment.3 Instrument separation is one of the most troublesome incidents, and when the separated instrument extends beyond the apex its retrieval becomes complicated.4 Moreover, those instruments extending beyond the apex can serve as a niche for biofilm accumulation and can eventually lead to formation of a periapical abscess, granuloma or cyst.5 Various methods have been described to remove fractured instruments using hand instruments, ultrasonic devices, an instrument removal system, loop device or surgical method.3,4,6,7 When orthograde retrieval of a broken instrument, especially those extending beyond the apex, is not possible, minor surgical procedure to remove this source of infection becomes crucial.4,8 The aim of this case report is to describe a minor surgical procedure to resect an infected root containing a separated instrument.
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