Management of a Separated Needle during Intraosseous Anesthesia of a Mandibular Molar: A Case Report

Intraosseous (IO) anesthesia has emerged as an effective primary and supplemental technique for achieving profound pulpal anesthesia during root canal treatment, particularly in mandibular molars. However, needle fracture during IO administration is an exceedingly rare complication with no established management protocol. A 29-year-old female presented with symptomatic irreversible pulpitis and symptomatic apical periodontitis in tooth #30, requiring nonsurgical root canal treatment. A first-year postgraduate endodontic student administered IO anesthesia using the QuickSleeper system (Dental HiTec) with a 30-gauge, 16-mm Effitec needle and 4% articaine with 1:100,000 adrenaline. During needle retraction following an unsuccessful injection attempt, forceful manipulation resulted in separation and retention of the needle within the interdental bone between teeth #29 and #30. Needle position was confirmed with an intraoral periapical radiograph, and the patient was informed. After administration of an inferior alveolar nerve block, an envelope flap was elevated. A minimal osteotomy was performed to expose the needle head, and the intact separated needle was retrieved using the BTR pen (Broken Tool Remover; Cerkamed) via a loop/lasso technique. The surgical site was closed with interrupted 5-0 silk sutures. Root canal treatment for tooth #30 was completed in 2 visits. A minimally invasive retrieval approach using the loop/lasso technique resulted in a successful outcome without any postoperative complications.