Removal of separated

instruments

Mateusz Radwański, DMD, PhD

Department of Endodontics
 Introduction
• 0.25% to 6% for SS files and from 1.3% to 10% for NiTi files
• the most common separation site is 2 mm from the tip of the instrument , sizes between
20 to 40
• the highest frequency of instrument separation (77% to 89% of all cases) is detected
during treatment of molars (mandibular > maxillary)
• the separation incidence increases with the degree of canal curvature (7% vs 58%)
• the apical third of the root canal (41% to 82.7% of cases)
Treatment outcome?

• file separation does not adversely affect the outcome of treatment; only the presence
of a periapical lesion or necrotic pulp has this effect
• the treatment stage at which file fracture occurs has not been shown to have a
significant impact on the treatment prognosis

Patients should be informed when instrument fracture occurs during treatment and a
radiograph should be taken to document the file separation.
 Factors that have a relevant impact on successful removal

• Removal of fragments is more predictable in straight or slightly curved canals and in

maxillary and anterior teeth when the separated fragment is in the coronal part and
coronal to the canal curvature
• If one-third of the overall length of the fragment is exposed, the file can be successfully
removed in most cases
• It is easier to remove the file if the root canal cross-section is oval and there is a gap
between the broken fragment and the root canal walls
• type, design and length of separated instruments (NiTi/SS; longer fragments (> 5 mm)
are easier to remove than shorter; aggressive cutting edges)
Methods

• Conservative

❑bypass of the fragment,

❑removal of the fragment
❑instrumentation and obturation coronally to the fragment

• Surgical
 Removal of the
fragment (DOM)

• ultrasonics
creation of a ‘staging platform’ around the
coronal part of the fractured instrument
• microtube devices
extraction tubes involve positioning the
metal tube over the coronal fragment
which has previously been exposed by
trephine drills or ultrasonics [the fragment is
removed mechanically or using cyanoacrylate glue]

• pliers/ forceps
fractured instrument is visible in the pulp
chamber and it is possible to grip the coronal
part of the retained fragment

+ CHEMICAL
 Case #1

MATEUSZ RADWAŃSKI, DMD, PhD

 Case #2

MATEUSZ RADWAŃSKI, DMD, PhD