Accidents in Endodontic A Case Report

Journal of Nepal Dental Association (2009), Vol. 10, No. 1, Jan.-Jun.
, 61-64
Case Note
Accidents in endodontics: A case report

Saini D1, Saini R2
Lecturer, 2Senior Lecturer, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan,
1
Malaysia.
Abstract
Endodontic practice is not risk-free; a variety of technical accidents can complicate root canal treatment, influencing
the prognosis and prejudicing the chances of the success. Fracture of endodontic instruments within root canals is
not an uncommon incident in endodontic therapy. The prognosis of such teeth depends upon preoperative condition
of periradicular tissues and instrument retrieval. An attempt to remove broken instruments should be undertaken in
every case. There have been many different devices and techniques developed to retrieve instruments fractured
during endodontic procedures. This report describes a case of broken instrument and its retrieval. During cleaning
and shaping procedure while performing root canal treatment with a rotary instrument, the instrument fractured at
the junction of middle and apical third of the canal. Two Hedstrom-files were used with 5% NaOCl irrigation and
the instrument was retrieved followed by conventional obturation using gutta percha points with lateral compaction
method.
Key Words: Broken instruments, Endodontic failures, Ni Ti instruments
Introduction
For the success of endodontic treatment in general removal of fractured instruments from root canals can
dental practice, a clinician should have good knowledge be difficult and time-consuming, with a reported success
regarding the management of procedural mishaps. rate ranging from 55% to 79%9. There have been many
Fracture of endodontic instruments within root canals methods proposed for the removal of broken instruments
is one of the most problematical incidents1. Evaluation in root canals. Methods using chemical agents such as
of endodontic recall radiographs have indicated that the iodine trichloride, mechanical methods such as hand
frequency of remaining fragments ranges between 2% instrumentation, ultrasonic devices, canal finder system,
and 6% of the cases investigated2. However, it has been Masseran Kit, Endo Extractor System, and several
shown that less than 1% of endodontic failures are due kinds of pliers10. Various surgical methods along with
to instrument fractures3. microscopes have also been used. This paper describes
a case of broken rotary instrument and its removal
Since the introduction of nickel-titanium (NiTi) instruments followed by completion of root canal treatment.
both NiTi hand files and rotary instruments have been
gaining popularity4. A major reason for their selection Case report
is the much greater flexibility of NiTi files compared to A 28 year old man reported to the university-based
their stainless steel counterparts. This offers distinct dental clinic with a complaint of localized bleeding
clinical advantages in curved root canals5,6. Despite their from the gingiva in relation to his right maxillary second
undeniably favorable qualities, there is a potential risk premolar. Clinical examination revealed a class II carious
of “unexpected” fracture with NiTi instruments7,8. Broken lesion and a gingival polyp in relation to the tooth.
instruments usually prevent access to the apex, and the Radiograph revealed deep carious lesion involving the
prognosis of teeth with broken instruments in the curved enamel, dentin and pulp. Well-circumscribed periapical
canals may be lower than for the normal ones. The radiolucency was also visible (Fig. 1).
Correspondence
Dr. Deepti Saini, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
E-mail: [email protected]
61 J. Nepal Dent. Assoc. (2009), Vol. 10, No.1

The tooth was anesthetized and the polyp was excised shaping of palatal canal with S1 file some obstruction
using a no. 15 bard parker’s blade. This was followed was encountered. Retrieval of the instrument revealed
by pulp extirpation and working length determination. that the instrument had fractured at the tip. This was
Working length radiograph revealed buccal and palatal confirmed with a radiograph which showed a broken
canals. Initial biomechanical preparation with hand instrument tip wedged near the curvature at the junction
instruments up to no. 20 was done under copious of middle and apical third of the palatal canal (Fig. 2).
irrigation with sodium hypochlorite, and 15% EDTA (RC- To retrieve the fragment, canal was irrigated with 5%
Prep) was used for chelation. Patient was later recalled sodium hypochlorite, and 15% EDTA was used. Initially
for the completion of biomechanical preparation. Initial one H-file was used to bypass the broken tip, followed
cleaning and shaping was done with hand files and by another H-file which was inserted gradually. Then
finally no. 20 stainless steel file was used to make a under copious irrigation these files were rotated in
glide path for the rotary instruments. After confirming the order to grasp and pull out the fragment. Repeating this
access with no. 20 stainless steel files, protaper rotary procedure engaged the fragment and it was withdrawn.
files were used. Initially Sx file was used for preparing A radiograph was taken to confirm its complete removal
both the canals later followed by S1 file. Completing (Fig. 3). This was followed by conventional cleaning and
the access in buccal canal with S1 file, instrument shaping of the canals and obturation was done using
was introduced into palatal canal. While cleaning and gutta percha with lateral condensation method (Fig. 4).
Fig. 1: Diagnostic radiograph showing caries involving enamel Fig. 2: Fractured segment at the junction of middle and apical
dentin and pulp along with well circumscribed periapical third of the palatal root
radiolucency
Fig. 3: Radiograph showing clear canal after removal of the Fig. 4: Radiograph showing obturated canals
fractured segment
J. Nepal Dent. Assoc. (2009), Vol. 10, No.1 62

Discussion Conclusion
Although various techniques and devices for retrieving By being little meticulous with our techniques and
the fragment have been described, no standardized better application of our knowledge regarding various
procedure for the successful removal of broken instruments, root canal anatomy and methods of
instrument in the root canal exists9,10. Each individual performing root canal treatment, endodontic accidents
case may require a different approach depending on can be reduced but still they are not inevitable. Despite
various factors like tooth anatomy, size of fragment, these accidents, there are chances of treatment success
location of fragment etc. Instrument fragment retrieval with several approaches to the broken instrument
can be tried starting with the simplest and least invasive removal being available. To begin with, the simplest and
method like using endodontic files along with copious easily available technique must be the goal.
irrigation as was used in this case.
References
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63 J. Nepal Dent. Assoc. (2009), Vol. 10, No.1

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Journal of Nepal Dental Association (2009), Vol. 10, No. 1, Jan.-Jun.

Accidents in endodontics: A case report

Key Words: Broken instruments, Endodontic failures, Ni Ti instruments

61 J. Nepal Dent. Assoc. (2009), Vol. 10, No.1

J. Nepal Dent. Assoc. (2009), Vol. 10, No.1 62

63 J. Nepal Dent. Assoc. (2009), Vol. 10, No.1

J. Nepal Dent. Assoc. (2009), Vol. 10, No.1 64

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