Removal of a fractured endodontic instrument from primary molar root canal: a case report
DOI:
https://doi.org/10.20453/reh.v35i2.6441Keywords:
primary tooth, pediatric dentistry, pulpectomy, case reportAbstract
The pediatric dentist may encounter the fracture of an endodontic instrument during pulp treatment. In such cases, removal of the object is necessary, as it may lead to abscess formation, root resorption, and tooth mobility, which could ultimately affect the permanent tooth. The technique used to remove the instrument will depend on its location. This case presents a 4-year and 11-month-old girl who, upon clinical examination, reported pain on vertical percussion. The radiographic evaluation revealed the presence of a radiopaque image in the mesiobuccal root of tooth 54, consistent with the fracture of an endodontic instrument. This fragment, approximately 7 mm in length, extends from the cervical third to the apical region. The final diagnosis was symptomatic apical periodontitis in tooth 54, associated with a previous root canal treatment and a fractured instrument in the mesiobuccal canal. The fractured instrument was successfully removed with favorable results. During the six-month follow-up, a reduction in the widening of the periodontal ligament space in the mesial root was observed, along with the absence of interradicular radiolucency.
Downloads
References
Avoaka-Boni MC, Désiré Kaboré WA, Gnagne-Koffi YN, Djolé SX, Kouadio KT. Frequency of complications during endodontic treatment: a survey among dentists of the town of Abidjan. Saudi Endod J [Internet]. 2020; 10(1): 45-50. Disponible en: http://doi.org/10.4103/sej.sej_60_19
Gamarra JR, Lévano SA, Ruiz VJ, Melgar RA. Frecuencia de tratamientos pulpares en una población pediátrica peruana: un estudio retrospectivo en un centro dental especializado de 2015 a 2019. Odovtos Int J Dent Sc [Internet]. 2022; 24(1): 134-146. Disponible en: https://doi.org/10.15517/ijds.2021.46605
Vouzara T, Chares M, Lyroudia K. Separated instrument in endodontics: frequency, treatment and prognosis. Balk J Dent Med [Internet]. 2018; 22(3): 123-132. Disponible en: http://doi.org/10.2478/bjdm-2018-0022
Tulsani S, Mahajan AP, Patil S, Kulkarni VK, Khavnekar SS. Dealing with an intruder in primary teeth - A case report. Clin Dent [Internet]. 2022; 16(6): 26-29. Disponible en: https://publication.ida.org.in/IndexMain.htm#/viewArticle/30589
Rahul M, Kapur A, Gauba K, Goyal A. Management of endodontic instrument separation in primary teeth. J South Asian Assoc Pediatr Dent [Internet]. 2020; 3(1): 34-38. Disponible en: https://doi.org/10.5005/jp-journals-10077-3039
Garrocho-Rangel A, Sánchez-Reynoso A, Rosales-Berber MÁ, Ruiz-Rodríguez S, Pozos-Guillén AJ. Clinical management of intra-pulp canal broken endodontic files in primary teeth: literature review. Odovtos Int J Dent Sc [Internet]. 2021; 23(2): 14-18. Disponible en: https://archivo.revistas.ucr.ac.cr/index.php/Odontos/article/view/43859/44018
Sandhu MK. Techniques for removal of intracanal separated instruments (part 2). Int J Appl Dent Sci [Internet]. 2021; 7(4): 38-46. Disponible en: https://doi.org/10.22271/oral.2021.v7.i4a.1351
Almeida LH, Krüger MM, Pilownic KJ, Costa VP, Romano AR, Pappen FG. Root canal filling techniques for primary molars: an in vitro evaluation. G Ital Endodon [Internet]. 2019; 33(1): 14-20. Disponible en: https://doi.org/10.32067/gie.2019.33.01.01
Rastogi S, Banga KS, Sharma S, Srivastava D. Management of a separated paste carrier in the mandibular central incisor. J Dent Res Rev [Internet]. 2020; 7(3): 134-37. Disponible en: https://journals.lww.com/jdrr/fulltext/2020/07030/management_of_a_separated_paste_carrier_in_the.9.aspx
Bucay LK, Loor JS, Aguilar GS, Vélez MV. Estrategias de retiro de instrumento fracturados en la práctica endodóntica. RECIMUNDO [Internet]. 2023; 7(2): 163-170. Disponible en: https://doi.org/10.26820/recimundo/7.(2).jun.2023.163-170
Maciel PF, Veras IT, Neto SP, Cardoso RM, Alves NC, Ferreira GS. Different techniques to remove a fractured endodontic instrument in an upper first molar: case report. J Surg Clin Dent [Internet]. 2020; 21(1): 5-9. Disponible en: https://www.mastereditora.com.br/periodico/20200511_103455.pdf
Cherif MR, Douki N, Kikly A. An effective approach to remove a fractured endodontic instrument. Medicon Dent Sci [Internet]. 2022; 1(1): 12-15. Disponible en: https://themedicon.com/pdf/mcds/MCDS-01-004.pdf
Quispe D, Sacoto F, Pacheco LA, Claure D. Estrategias de retiro de instrumentos fracturados en la práctica endodóntica: revisión de la literatura. Odontol Act [Internet]. 2022; 7(2): 71-80. Disponible en: https://doi.org/10.31984/oactiva.v7i2.750
Dantas PM, Torres RC, Macedo Filho RA, Marinho SA. Endodontic instruments fracture in root canal: integrative review. J Clin Images Med Case Rep [Internet]. 2021; 2(5): 1374. Disponible en: https://jcimcr.org/pdfs/JCIMCR-v2-1374.pdf
Chandak M, Sarangi S, Dass A, Khubchandani M, Chandak R. Demystifying failures behind separated instruments: a review. Cureus [Internet]. 2022; 14(9): e29588. Disponible en: https://doi.org/10.7759/cureus.29588
American Academy of Pediatric Dentistry. Behavior Guidance for the Pediatric Dental Patient [Internet]. En: The Reference Manual of Pediatric Dentistry. Chicago: AAPD; 2024. pp. 358-378. Disponible en: https://www.aapd.org/globalassets/media/policies_guidelines/bp_behavguide.pdf
Pruthi PJ, Nawal RR, Talwar S, Verma M. Comparative evaluation of the effectiveness of ultrasonic tips versus the Terauchi file retrieval kit for the removal of separated endodontic instruments. Restor Dent Endod [Internet]. 2020; 45(2): e14. Disponible en: https://doi.org/10.5395/rde.2020.45.e14
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Flor de María Salvador-Salazar, María Elena Díaz-Pizán, Gilmer Torres-Ramos
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain the copyright and cede to the journal the right of first publication, with the work registered with the Creative Commons License, which allows third parties to use what is published as long as they mention the authorship of the work, and to the first publication in this journal.
