Broken instruments
Fracture of endodontic instruments during root canal treatment is an unpleasant complication that every dentist/endodontist has to deal with. The most common way is to remove it. Of course, this depends on many circumstances: whether the instrument broke during vital extirpation (not a heavily infected canal) or in an infected canal, whether the instrument broke in the coronal, middle or apical third. Removing a broken file at the cost of weakening the cervical dentin or perforating the root is definitely not the way to go.
We must always remember that the instrument itself does not cause inflammation, so it may remain in an uninfected canal despite unsuccessful removal or bypass. We often see teeth with fractured instruments that were treated many years ago and have no clinical or radiographic evidence of periapical inflammation.
In a case like ours, the broken file has to be removed or completely bypassed. The patient presented to the dentist already swollen and in pain. During the RCT, the instrument broke and completely blocked effective disinfection of the infected apex. Antibiotics were prescribed and the patient was referred to us.
Using a sequence of hand and rotary instruments, we performed a full bypass C+ file 008,010, 015, EDMax 20/04, 25/04 , 30/04
The instrument was not visualised and could not be removed during instrumentation, which was not necessary. It was displaced over the apex during ultrasonic activation of disinfection.
If we have followed the correct disinfection protocol, there is no need to panic and refer for periapical surgery. The inflammation will heal.
