Retrieval of multiple separated endodontic instruments using ultrasonic vibration: Case report

This report describes the management of a complicated clinical case with three instruments fractured in one tooth. A 32-year-old patient presented with three ProTaper rotary files fractured in the upper right second molar (S2 and F2 in the disto-buccal canal and S1 in the mesio-buccal canal). A staging platform was prepared in the distal canal coronal to the fragments. Under dental microscope magnification, an Endo-4 ultrasonic tip was activated to dislodge the more coronal fragment (S2) by trephining dentine around the coronal aspect of the fragment. After 11 min, the fragment became loose and was removed. Following the same protocol and using an Endo-5 ultrasonic tip, the second fragment (F2) was removed in approximately 17 min. The first attempt to remove the S1 fragment from the mesio-buccal canal was not successful. An attempt to bypass this fragment using a K-file also failed. A second attempt using the ultrasonic technique resulted in a secondary fracture of the coronal aspect of the fragment. An Endo-5 ultrasonic tip was used to dislodge the fragment, which was successfully removed in 7 min. This report concludes that once a fractured file is bypassed, the instrumentation of a root canal is best completed with hand files. Clinicians should identify their limitations and consider referring cases that are beyond their abilities. Good experience and an appropriate armamentarium enable successful management of complicated cases. Ultrasonic vibration and dental microscope magnification contribute to successful removal of fractured instruments.