Separated Instrument Removal

Overusing and excessive force are the main reasons behind instrument separation. The tip of the file can become locked in a narrow canal and fracture as the motor tries its best to continuously rotate it. This unfortunate incident prevents the full mechanical and chemical disinfection of the root canal system and therefore reduce the chance of a successful outcome.

Essential factors for the removal of a separated instrument are direct visualisation and unimpeded pathway of exit. The head of this broken file was visible in the mesio-lingual canal using high magnification and illumination.

A platform was created around the head of the broken file using a modified Gates Gliden bur (I removed he non-cutting tip with a bur and a fast handpiece). This allowed me to place an ultrasonic tip close to the head of the broken file and carefully remove dentine circumferentially. Once a sufficient amount of the broken file was exposed the ultrasonic tips was used in an anti-clockwise motion to unwind and remove the file. After much patience - success!!!

What I thought was success was only halfway there. I was able to fully prepared the mesio-lingual canal after removing the separated instrument from that canal - great! Unfortunately the file broke during the removal and a small piece found its way into the distal canal. Luckily this canal was already prepared and only needed irrigating the remove the final piece.

Both the LL6 and LL7 were irrigated thoroughly, dried and obturated with gutta percha using a warm condensation technique. A zinc oxide eugenol seal was placed in the canal orifices and the access cavities were sealed with GIC. Ready for cuspal coverages.

The offending instrument.