Broken instrument retrieval with indirect ultrasonics in a primary molar

The separation of a file during pulpectomy is a rare incident in primary teeth due to inherently wider and relatively straighter root canals. A broken instrument hinders the clinician from optimal preparation and obturation of the root canal system invariably leading to failure, although in such teeth, an extraction followed by suitable space maintenance is considered as the treatment of choice. This case report demonstrates successful nonsurgical retrieval of a separated H file fragment in 84.

A 7-year-old girl was referred to the Department of Paedodontics and Preventive Dentistry for endodontic management of a primary tooth 84 with a dento-alveolar abscess. Her medical history was noncontributory. After diagnosing a broken H file in the mesio-lingual canal, the tooth was endodontically treated in two appointments. At the first session, a broken file was successfully retrieved after using low intensity ultrasonic vibrations through a DG 16 endodontic explorer viewed under an operating microscope. After abscess resolution, Vitapex root canal obturation with a preformed metal crown cementation was completed at a second session.

The patient was recalled at 3, 6, 12 and 15 month interval and reported to be clinically asymptomatic and radiographically with complete furcal healing.

Integration of microscopes and ultrasonics in paediatric dental practice has made it possible to save such teeth with a successful outcome. Favourable location of the separated file, relatively straighter root canal system and patient cooperation resulted in successful nonsurgical management in this case.