How to remove broken endodontic file

Damage to the endodontic file is a situation that no one wants to see, but when it does happen, how should the dentist deal with the damaged endodontic file? What are the precautions when removing a damaged endodontic file?

 

What to do with damaged endodontic files?

What are the precautions when removing a damaged endodontic file?

In conclusion

 

What to do with damaged endodontic files?

Even with the best precautions, the endodontic file can still be separated in the root canal. Although there are many file removal systems on the market today, the chance of successfully removing damaged files mainly depends on its position in the root canal and the shape of the root canal. A study showed that Niti taper file instruments for removing fractures are more affected by tooth anatomy, degree of root canal curvature, and fragment location than a specific technique. It is concluded that the success of file removal is limited, which increases the risk of perforation. After the root strength is reduced, it is recommended not to routinely try to remove files other than the curved part of the root11. The usual method of initial attempts to delete damaged files is to use an ultrasound instrument. If the file cannot be removed by endodontic techniques, surgical methods may be considered. Endodontic surgery can usually eliminate any pathology and/or symptoms that occur after the file is damaged. If the unoperated pulp tissue cannot be removed due to root canal obstruction caused by root canal rupture, then the existing preoperative pathology and/or symptoms have not improved, and surgery may also be a successful method.

 

The cause of failure of endodontic treatment after a ruptured endodontic file is the inability to remove the remaining undebrided important or non-essential dental pulp tissue due to the obstacle of the separation file. In most cases, the broken pulp is not confirmed by Saunders. Compared with the canine teeth sealed with gutta-percha, sealant and separate instruments, the bacterial leakage of the teeth sealed with gutta-percha and sealant There is no significant difference. The prognosis of the teeth with a separate endodontic file depends on the number of undebrided and unobstructed canals left under the broken instrument when the instrument cannot be removed or bypassed. In order to maintain or improve the prognosis of teeth with broken teeth that cannot be removed by conventional endodontic treatment, clinicians should actively adopt its device technology. As mentioned above, using a manual file before using a large taper rotary file will help establish a gliding path to the apical area, thereby helping to reduce file separation. Most pulp fractures occur in curved tubes、, and the shape of this tube is observed in the posterior teeth in most cases. In a study by Marroquin, it was reported that the average hole diameter of the upper and lower molars was between #20 and #30 files. Therefore, the use of a manual file with a working length of #20 to #30 can improve the cleanliness of the root canal tissue in the root canal part, which can provide better transition and can better transition to the large taper rotary file.

 

Another advantageous method is to pre-flare the coronal portion of the catheter before placing the large taper rotary file at the working length. This will not only reduce the chance of pulp rupture, but will also allow more irrigation fluids  to enter the canal. The combination of irrigating fluid and the tip area of the hand will help remove important or unimportant pulp tissue. The success of endodontic treatment depends on the critical concentration of critical or non-critical pulp tissue removed. In fact, it is impossible to quantitatively determine the exact critical tissue volume for each patient, because each patient’s body responds to infection and/or inflammation differently. Therefore, proper debridement and obstruction of the root canal system in combination with restorative teeth is still a necessary condition for long-term success. By sticking to these methods, when the large taper rotary file does break and cannot be removed, the amount of debris beyond the separation point of the file can be reduced. Therefore, the long-term prognosis of endodontic treatment can be expected to be better. It is important to note that when a damaged endodontic file cannot be deleted, the clinician must inform the patient and record the event in the patient's record. Although it is not inappropriate to break the pulp deformity in the root canal, if the clinician neglects to tell the patient, in most cases, the timeliness of the improper behavior claim can exist for many years from the time the tooth is broken.

 

What are the precautions when removing a damaged endodontic file?

The ability to access and remove damaged pulp will be affected by the cross-sectional diameter, root canal length and curvature, and further by the depth of the external depression. According to experience, if one-third of the total length of the blockage can be exposed, it can usually be removed. If the broken instrument is located at the crown, middle, or third of the root, the clinician needs to perform radiographic visualization. The instruments located in the root canal can usually be removed. If the separate instrument partially surrounds the curvature, and if a safe passage can be established in its most coronal range, it can usually still be removed.

 

Separate rotating Niti taper files are a common problem in endodontic treatment. Recognizing that the main cause of hand file fracture is periodic fatigue and torsional stress, clinicians can best prevent this from happening by using a manual file before using the large taper rotary file to form a path leading to the root canal. Straight line (glide path), and pre-dilate the coronary artery before using the large taper rotary file on the third part of the apex. In addition, the use of a "pecking" action on the electric slow-speed mobile phone and not allowing the Niti taper file to be tied into the root canal will greatly reduce the possibility of file breakage. If the file does break, the success of the removal depends on the specific technology used, and more on its location in the canal. The prognosis of the separated file is still favorable, especially if measures have been taken to reduce the critical concentration of canal debris through manual instruments and chemical washing before the insertion of the large taper rotary file.

 

In conclusion

To avoid damage to the endodontic file, in addition to paying attention to the method of using the endodontic file during treatment, it is also necessary to ensure that the equipment purchased comes from a qualified supplier. If you are looking for a high-quality endodontic file at a reasonable price, Osakadent Co.,Ltd. will provide you with the best products.