Abstract
Fracture of an endodontic instrument within the root canal system can occur due to incorrect use of instruments, and clinicians are confronted with a few removal options when considering this situation. The purpose of this article is to present the removal of a fractured endodontic file from the periapical region of the right upper central incisor, that caused a nasal floor perforation and otorhinolaryngological symptoms, with the aid of a dental operating microscope (DOM) and cone bean computed tomography (CBCT). Success was achieved when the fragment was visible and removed from the nasal fossa. The standardized techniques of removal or bypassing fracture file were not effective, and success was obtained with the aid of CBCT that made possible the visualization of the broken file inside the nasal fossa.
Highlights
Among the phases of endodontic treatment, biomechanical preparation deserves special attention, when accidents are more prone to occur such as deviations, perforations and instrument fractures, since some teeth can present intrinsic factors as complex anatomy with the presence of sharp curvatures, atresia and calcifications (Cujé, et al, 2010; Ungerechts, et al, 2014; Sarao, et al, 2020)
This work aimed to report a case in a descriptive and qualitative way according to Pereira et al (2018), about a specific subject, detailed to highlight its particularities and expose the treatment of an accident caused by a fracture of an endodontic file in the region of the upper right central incisor, which resulted in perforation of the nasal fossa and consequent otorhinolaryngological symptoms to the patient
The patient complained of nasal discomfort after endodontic treatment, done one week before, such as increased sneezing, crusting and foul smell
Summary
Among the phases of endodontic treatment, biomechanical preparation deserves special attention, when accidents are more prone to occur such as deviations, perforations and instrument fractures, since some teeth can present intrinsic factors as complex anatomy with the presence of sharp curvatures, atresia and calcifications (Cujé, et al, 2010; Ungerechts, et al, 2014; Sarao, et al, 2020).The prevalence of fractured instruments ranges from 0.5-5% and it can occur within or beyond the root canal (Nevares, et al, 2012). When an instrument fractures beyond the root foramen, periapical and otorhinolaryngological problems may occur (Wang, et al, 2010; Panitvisai, et al, 2010), and frequently, removal of the fractured instrument is the best option. Technological advancements such as the dental operating microscope (DOM), ultrasonics and cone beam computed tomography (CBCT), have improved diagnosis and enhance visualization of the operative field. The present case reports a file fracture instrument removal, that perforated the nasal floor
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