MANAGEMENT OF SEPARATED INSTRUMENT IN THE ROOT CANAL

The fracture of an instrument is a recognized complication in endodontics. Several factors must however be taken into account to evaluate the prognosis of the tooth in this situation. The objective of the endodontic treatment with (or) without a fractured instrument remains the same, namely to disinfect the root canal and prevent its recontamination. The time at which the file fracture occurred during treatment and the degree of canal infection must be considered when determining the potential effect on treatment outcome. Patients should be informed about an instrument fracturing in the tooth for ethical and legal reasons.Decisions on management should consider the following: (1) the constraints of the root canal accommodating the fragment, (2) the stage of root canal preparation at which the instrument separated, (3) the expertise of the clinician, (4) the armamentaria available, (5) the potential complications of the treatment approach adopted, and (6) the strategic importance of the tooth involved and the presence/or absence of periapical pathosis. Clinical experience and understanding of these influencing factors as well as the ability to make a balanced decision are essential.