CLINICAL APPROACH TO THE MANAGEMENT OF FRACTURED INSTRUMENTS USING ULTRASONICS AND THE INSTRUMENT RETRIEVAL SYSTEM UNDER THE DENTAL OPERATING MICROSCOPE

Abstract

Background: Instrument separation has become a major concern in the endodontic practice today. In cases where the fractured fragment completely blocks the canal, the access of disinfecting irrigants to the root canal system is limited. Literature suggesting the guidelines on the management of broken instruments is scanty. This study was aimed to establish a preliminary guideline in the management of cases with instrument fracture using the Ultrasonic tips, the Instrument Retrieval System (IRS) and Instrument bypass under the Dental Operating Microscope (DOM).
 Methods: 40 cases were selected with fractured instruments and categorized as follows-location coronal or apical to curvature- size of greater than or less than 5 mm. Patients were informed about the procedure and its complications, following which consent was taken. Management was planned in three stages. Instrument retrieval with the aid of Ultrasonics was performed under the DOM in stage 1. Retrieval using IRS was performed in stage 2. Instrument bypass was performed in stage 3. Success rate was compared using statistical analysis by the StatPac software.
 Results and conclusion: Fractured fragments with a length of less than 5mm and straight line access was retrieved successfully under the DOM using the Ultrasonics in 87.5% cases. Retrieval of fragments greater than 5mm and with a straight line access was successful with the added use of the Instrument Retrieval system/ Instrument extractor in 71.4% cases.
 Keywords: Ultrasonic, Instrument Retrieval System, Dental Operating Microscope, instrument bypass, fractured instrument
 Key Message: Instrument fracture in an endodontic practice is a stressful event. With the widespread use of rotary instruments, the incidence of instrument separation has increased. With increasing referral of such cases, management of these cases with a predictable outcome has become important in endodontic specialty. An attempt has been made to lay down guidelines regarding management of cases with fractured instruments.