Brocken endodontic instrument removal 
ENDODONTIC CHALLENGES IN DENTISTRY

Broken endodontic instrument removal

Broken endodontic instrument removal 

The primary pain points for dentists in removing broken endodontic instruments include limited visibility, accessibility within narrow and curved root canals and the risk of further fracturing the instrument or damaging the tooth structure.1 These challenges are critical because a retained broken instrument can lead to persistent infection, failure of the root canal treatment and potential tooth loss.2 Proper by-pass or removal is essential to prevent these complications and ensure the success of the endodontic therapy.3 High-magnification and coaxial effective illumination provided by the use of the operative microscope and specialized tools are typically required to navigate these difficulties effectively.4 The challenge of this clinical situation without microscope is shown in the picture, which demonstrate that is impossible to visualize the broken fragment without help from microscope from naked eyes perspective.

Gianluca Plotino DDS, PhD

Using the microscope has revolutionized my approach to the removal of broken endodontic instruments. The enhanced magnification and illumination provide exceptional visibility, allowing for precise and effective removal, significantly reducing complications and greatly improving the success rate.

Gianluca Plotino DDS, PhD

Rome, Italy

Using advanced visualization tools and specialized techniques1

Operating microscope have significantly helped tackle these challenges by providing enhanced magnification and illumination, significantly enhancing visibility and precision.4 With the help of the operating microscope, dentists can accurately detect and navigate within the narrow root canals, reducing the risk of further instrument breakage or tooth damage and increasing the success rate of instrument removal. This improved visualization given using a microscope allows for meticulous and effective instrument retrieval, by enabling dentists to see fine details that are otherwise invisible to the naked eye, thus increasing the success rate of endodontic treatments and ensuring better patient outcomes.2,3 

  • Pre-operative image showing that it is impossible to visualize the broken fragment from naked eye perspective
  • Pre-operative radiograph
  • Intra-operative image of the visualization of the broken fragment under the microscope view
  • The broken fragment removed
  • Intra-operative radiograph after broken file removal
  • Post-operative radiograph
  • Pre-operative image showing that it is impossible to visualize the broken fragment from naked eye perspective
    Image courtesy: Gianluca Plotino DDS, PhD | Rome, Italy

    Pre-operative image showing that it is impossible to visualize the broken fragment from naked eye perspective

  • Pre-operative radiograph
    Image courtesy: Gianluca Plotino DDS, PhD | Rome, Italy

    Pre-operative radiograph

  • Intra-operative image of the visualization of the broken fragment under the microscope view
    Image courtesy: Gianluca Plotino DDS, PhD | Rome, Italy

    Intra-operative image of the visualization of the broken fragment under the microscope view

  • The broken fragment removed
    Image courtesy: Gianluca Plotino DDS, PhD | Rome, Italy

    The broken fragment removed

  • Intra-operative radiograph after broken file removal
    Image courtesy: Gianluca Plotino DDS, PhD | Rome, Italy

    Intra-operative radiograph after broken file removal

  • Post-operative radiograph
    Image courtesy: Gianluca Plotino DDS, PhD | Rome, Italy

    Post-operative radiograph

Download

  • Dentistry Infographic Enhanced Visualization EN

    File size: 490 KB
  • 1

    Cheung G S. Instrument fracture: mechanisms, removal of fragments, and clinical outcomes. Endod Topics 2009;16:1–26.

  • 2

    Panitvisai P, Parunnit P, Sathorn C, Messer H H. Impact of a retained instrument on treatment outcome: a systematic and meta analysis. J Endod 2010;36:775–780.

  • 3

    Parashos, P, Messer HH. Rotary NiTi instrument fracture and its consequences. J Endod 2010;32:1031-1043.

  • 4

    Terauchi Y, Ali WT, Abielhassan MM. Present status and future directions: Removal of fractured instruments. Internat Endod J, 2022;55(Suppl. 3):685–709.