Management of separated endodontic instruments: case reports

Successful management of separated endodontic instruments is difficult, but several techniques are available for the retrieval of a separated instrument (SI). An appropriate treatment plan depends on various factors, including the anatomy and location of the tooth; the size, type, and location of the SI; and the skill of the clinician. However, the selection of the most appropriate management technique based on these factors can be a challenging decision that directly influences the success of the procedure. This article presents 4 symptomatic cases of SIs managed with various modalities as well as 1-year clinical and radiographic follow-up results. The management techniques applied in these cases included the use of ultrasonic tips, the wire loop method, safe-sided H-files, the braiding technique, and bypassing of the file. The medical history of the patients was noncontributory except for a single patient who had type 2 diabetes mellitus, which might have delayed healing. After instrument retrieval, the patients were evaluated clinically for relief of signs and symptoms as well as for their responses to various tests such as percussion, palpation, and tooth mobility. Radiographic evaluation at the 12-month follow-up was used to determine the periapical index. The clinical and radiographic results and patient-reported outcomes were satisfactory in all cases. The 4 cases presented demonstrate that the keys to successful management of an SI are understanding the factors that influence the case and selecting an appropriate therapeutic technique.