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Los principales puntos débiles de los odontólogos a la hora de extraer instrumentos endodóncicos rotos son la visibilidad y accesibilidad limitadas dentro de canales radiculares estrechos y curvados, además del riesgo de romper más el instrumento o dañar la estructura dental.1 Estos retos son decisivos, ya que la retención de un instrumento roto puede provocar una infección persistente, un fracaso en el tratamiento del canal radicular y una posible pérdida dental.2 Una derivación o extracción adecuada es fundamental para prevenir estas complicaciones y garantizar el éxito del tratamiento endodóncico.3 Para evitar estas dificultades de forma eficaz se suelen necesitar el gran aumento y la iluminación coaxial eficaz que proporcionan el microscopio quirúrgico y las herramientas especializadas.4 En la imagen se muestra el reto que supone abordar esta situación clínica sin microscopio, lo que demuestra que es imposible visualizar el fragmento roto a simple vista, sin la ayuda de un microscopio.
El uso del microscopio ha revolucionado mi manera de abordar la extracción de instrumentos endodóncicos rotos. El aumento y la iluminación mejorados proporcionan una visibilidad excepcional, lo que permite la extracción precisa y eficaz, al mismo tiempo que reduce significativamente las complicaciones y mejora enormemente la tasa de éxito.
Uso de herramientas de visualización avanzadas y técnicas especializadas1
El microscopio quirúrgico ha ayudado de forma significativa a abordar estos retos al proporcionar un aumento e iluminación mejorados, lo que incrementa significativamente la visibilidad y la precisión.4 Con la ayuda del microscopio quirúrgico, los odontólogos pueden detectar y explorar de forma precisa los canales radiculares estrechos, además de reducir el riesgo de que se rompa más el instrumento o de dañar la estructura dental y aumentar la tasa de éxito de la extracción del instrumento. Esta mejora de la visualización gracias al microscopio permite extraer de forma meticulosa y eficaz el instrumento, ya que permite a los odontólogos ver los detalles más pequeños que, de otro modo, no serían visibles a simple vista. Esto aumenta la tasa de éxito de los tratamientos endodóncicos y garantiza unos resultados mejores para los pacientes.2,3
Imagen cortesía de: Gianluca Plotino DDS, PhD | Roma, Italia
Imagen preoperatoria que muestra que es imposible visualizar el fragmento roto a simple vista
Imagen cortesía de: Gianluca Plotino DDS, PhD | Roma, Italia
Radiografía preoperatoria
Imagen cortesía de: Gianluca Plotino DDS, PhD | Roma, Italia
Imagen intraoperatoria del fragmento roto visualizado con el microscopio
Imagen cortesía de: Gianluca Plotino DDS, PhD | Roma, Italia
Fragmento roto extraído
Imagen cortesía de: Gianluca Plotino DDS, PhD | Roma, Italia
Radiografía intraoperatoria tras la extracción de la lima rota
Imagen cortesía de: Gianluca Plotino DDS, PhD | Roma, Italia
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.
![Extracción de instrumento endodóncico roto]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/dsc_6196_stageformat.jpg/_jcr_content/renditions/original.image_file.100.33.0,35,1787,631.file/dsc_6196_stageformat.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/dsc_6196_stageformat.jpg/_jcr_content/renditions/original.image_file.360.120.0,35,1787,631.file/dsc_6196_stageformat.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/dsc_6196_stageformat.jpg/_jcr_content/renditions/original.image_file.768.256.0,35,1787,631.file/dsc_6196_stageformat.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/dsc_6196_stageformat.jpg/_jcr_content/renditions/original.image_file.1024.341.0,35,1787,631.file/dsc_6196_stageformat.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/dsc_6196_stageformat.jpg/_jcr_content/renditions/original.image_file.1280.427.0,35,1787,631.file/dsc_6196_stageformat.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/dsc_6196_stageformat.jpg/_jcr_content/renditions/original.image_file.1440.480.0,35,1787,631.file/dsc_6196_stageformat.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/dsc_6196_stageformat.jpg/_jcr_content/renditions/original.image_file.1787.596.0,35,1787,631.file/dsc_6196_stageformat.jpg"} "Extracción de instrumento endodóncico roto")
![Gianluca Plotino DDS, PhD]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/gianluca-plotino.jpeg/_jcr_content/renditions/original.image_file.100.100.0,63,1078,1141.file/gianluca-plotino.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/gianluca-plotino.jpeg/_jcr_content/renditions/original.image_file.360.360.0,63,1078,1141.file/gianluca-plotino.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/gianluca-plotino.jpeg/_jcr_content/renditions/original.image_file.768.768.0,63,1078,1141.file/gianluca-plotino.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/gianluca-plotino.jpeg/_jcr_content/renditions/original.image_file.1024.1024.0,63,1078,1141.file/gianluca-plotino.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/gianluca-plotino.jpeg/_jcr_content/renditions/original.image_file.1078.1078.0,63,1078,1141.file/gianluca-plotino.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/gianluca-plotino.jpeg/_jcr_content/renditions/original.image_file.1078.1078.0,63,1078,1141.file/gianluca-plotino.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/gianluca-plotino.jpeg/_jcr_content/renditions/original.image_file.1078.1078.0,63,1078,1141.file/gianluca-plotino.jpeg"} "Gianluca Plotino DDS, PhD")
![Imagen preoperatoria que muestra que es imposible visualizar el fragmento roto a simple vista]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.100.75.74,0,1207,850.file/figure-1.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.360.270.74,0,1207,850.file/figure-1.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.768.576.74,0,1207,850.file/figure-1.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.1024.768.74,0,1207,850.file/figure-1.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.1133.850.74,0,1207,850.file/figure-1.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.1133.850.74,0,1207,850.file/figure-1.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.1133.850.74,0,1207,850.file/figure-1.jpeg"} "Imagen preoperatoria que muestra que es imposible visualizar el fragmento roto a simple vista")
![Radiografía preoperatoria]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.100.75.14,0,915,676.file/figure-2.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.360.270.14,0,915,676.file/figure-2.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.768.576.14,0,915,676.file/figure-2.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.901.676.14,0,915,676.file/figure-2.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.901.676.14,0,915,676.file/figure-2.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.901.676.14,0,915,676.file/figure-2.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.901.676.14,0,915,676.file/figure-2.jpg"} "Radiografía preoperatoria")
![Imagen intraoperatoria del fragmento roto visualizado con el microscopio]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.100.75.240,0,1680,1080.file/figure-3.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.360.270.240,0,1680,1080.file/figure-3.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.768.576.240,0,1680,1080.file/figure-3.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.1024.768.240,0,1680,1080.file/figure-3.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.1280.960.240,0,1680,1080.file/figure-3.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.1440.1080.240,0,1680,1080.file/figure-3.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.1440.1080.240,0,1680,1080.file/figure-3.jpeg"} "Imagen intraoperatoria del fragmento roto visualizado con el microscopio")
![Fragmento roto extraído]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.100.75.246,0,4043,2848.file/figure-4.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.360.270.246,0,4043,2848.file/figure-4.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.768.576.246,0,4043,2848.file/figure-4.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.1024.768.246,0,4043,2848.file/figure-4.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.1280.960.246,0,4043,2848.file/figure-4.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.1440.1080.246,0,4043,2848.file/figure-4.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.1920.1440.246,0,4043,2848.file/figure-4.jpeg"} "Fragmento roto extraído")
![Radiografía intraoperatoria tras la extracción de la lima rota]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.100.75.0,12,1619,1226.file/figure-5.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.360.270.0,12,1619,1226.file/figure-5.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.768.576.0,12,1619,1226.file/figure-5.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.1024.768.0,12,1619,1226.file/figure-5.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.1280.960.0,12,1619,1226.file/figure-5.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.1440.1080.0,12,1619,1226.file/figure-5.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.1619.1214.0,12,1619,1226.file/figure-5.jpeg"} "Radiografía intraoperatoria tras la extracción de la lima rota")
![Radiografía posoperatoria]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.100.75.0,15,1612,1224.file/figure-6.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.360.270.0,15,1612,1224.file/figure-6.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.768.576.0,15,1612,1224.file/figure-6.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.1024.768.0,15,1612,1224.file/figure-6.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.1280.960.0,15,1612,1224.file/figure-6.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.1440.1080.0,15,1612,1224.file/figure-6.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.1612.1209.0,15,1612,1224.file/figure-6.jpeg"} "Radiografía posoperatoria")
![Imagen preoperatoria que muestra que es imposible visualizar el fragmento roto a simple vista]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.100.56.0,65,1280,785.file/figure-1.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.360.203.0,65,1280,785.file/figure-1.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.768.432.0,65,1280,785.file/figure-1.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.1024.576.0,65,1280,785.file/figure-1.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.1280.720.0,65,1280,785.file/figure-1.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.1280.720.0,65,1280,785.file/figure-1.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-1.jpeg/_jcr_content/renditions/original.image_file.1280.720.0,65,1280,785.file/figure-1.jpeg"} "Imagen preoperatoria que muestra que es imposible visualizar el fragmento roto a simple vista")
![Radiografía preoperatoria]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.100.56.13,1,905,503.file/figure-2.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.360.203.13,1,905,503.file/figure-2.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.768.432.13,1,905,503.file/figure-2.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.892.502.13,1,905,503.file/figure-2.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.892.502.13,1,905,503.file/figure-2.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.892.502.13,1,905,503.file/figure-2.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-2.jpg/_jcr_content/renditions/original.image_file.892.502.13,1,905,503.file/figure-2.jpg"} "Radiografía preoperatoria")
![Imagen intraoperatoria del fragmento roto visualizado con el microscopio]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.100.56.167,0,1921,986.file/figure-3.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.360.203.167,0,1921,986.file/figure-3.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.768.432.167,0,1921,986.file/figure-3.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.1024.576.167,0,1921,986.file/figure-3.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.1280.720.167,0,1921,986.file/figure-3.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.1440.810.167,0,1921,986.file/figure-3.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-3.jpeg/_jcr_content/renditions/original.image_file.1753.986.167,0,1921,986.file/figure-3.jpeg"} "Imagen intraoperatoria del fragmento roto visualizado con el microscopio")
![Fragmento roto extraído]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.100.56.412,593,4218,2734.file/figure-4.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.360.203.412,593,4218,2734.file/figure-4.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.768.432.412,593,4218,2734.file/figure-4.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.1024.576.412,593,4218,2734.file/figure-4.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.1280.720.412,593,4218,2734.file/figure-4.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.1440.810.412,593,4218,2734.file/figure-4.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-4.jpeg/_jcr_content/renditions/original.image_file.1920.1080.412,593,4218,2734.file/figure-4.jpeg"} "Fragmento roto extraído")
![Radiografía intraoperatoria tras la extracción de la lima rota]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.100.56.0,248,1618,1159.file/figure-5.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.360.203.0,248,1618,1159.file/figure-5.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.768.432.0,248,1618,1159.file/figure-5.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.1024.576.0,248,1618,1159.file/figure-5.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.1280.720.0,248,1618,1159.file/figure-5.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.1440.810.0,248,1618,1159.file/figure-5.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-5.jpeg/_jcr_content/renditions/original.image_file.1618.910.0,248,1618,1159.file/figure-5.jpeg"} "Radiografía intraoperatoria tras la extracción de la lima rota")
![Radiografía posoperatoria]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.100.56.0,169,1611,1076.file/figure-6.jpeg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.360.203.0,169,1611,1076.file/figure-6.jpeg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.768.432.0,169,1611,1076.file/figure-6.jpeg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.1024.576.0,169,1611,1076.file/figure-6.jpeg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.1280.720.0,169,1611,1076.file/figure-6.jpeg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.1440.810.0,169,1611,1076.file/figure-6.jpeg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/dentistry/endodontic-instrument-removal/figure-6.jpeg/_jcr_content/renditions/original.image_file.1611.906.0,169,1611,1076.file/figure-6.jpeg"} "Radiografía posoperatoria")
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![ZEISS OPMI pico]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-pico/images/dentistry-opmi-pico-floor-stand.jpg/_jcr_content/renditions/original.image_file.100.100.file/dentistry-opmi-pico-floor-stand.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-pico/images/dentistry-opmi-pico-floor-stand.jpg/_jcr_content/renditions/original.image_file.360.360.file/dentistry-opmi-pico-floor-stand.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-pico/images/dentistry-opmi-pico-floor-stand.jpg/_jcr_content/renditions/original./dentistry-opmi-pico-floor-stand.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-pico/images/dentistry-opmi-pico-floor-stand.jpg/_jcr_content/renditions/original./dentistry-opmi-pico-floor-stand.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-pico/images/dentistry-opmi-pico-floor-stand.jpg/_jcr_content/renditions/original./dentistry-opmi-pico-floor-stand.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-pico/images/dentistry-opmi-pico-floor-stand.jpg/_jcr_content/renditions/original./dentistry-opmi-pico-floor-stand.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/opmi-pico/images/dentistry-opmi-pico-floor-stand.jpg/_jcr_content/renditions/original./dentistry-opmi-pico-floor-stand.jpg"} "ZEISS OPMI pico")
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