Retrieval Of Separated Instrument Research Articles

Retrieval of Separated Endodontic Instrument

Endodontic instrument fracture is a procedural error that creates a significant barrier to routine root canal therapy. A separated instrument results in insufficient cleaning and shaping of the root canals. Inadequate biomechanical preparation has an impact on the result and outcome of root canal treatment. Therefore, retrieval of separated instruments should be considered important. There are many instrument retrieval kits and techniques available for this purpose. In this case report, a separated rotary file was successfully retrieved using a Masserann kit .

Factors Affecting the Removal Time of Separated Instruments

IntroductionSeparated endodontic instruments may adversely affect the outcome of endodontic treatment. The combination of ultrasonic techniques and dental operating microscopes appears to be effective in the removal of separated instruments compared with more randomized techniques. This study evaluated the roles of root canal curvature and separated instrument length on the time needed to loosen and retrieve the instrument fragments. MethodsThe retrieval procedures of 128 separated instruments referred to a private endodontic practice for retreatment by general practitioners were evaluated in patients who were monitored for a minimum of 6 months. Preoperative cone-beam computed tomographic images were used to measure separated instrument lengths in relation to the degrees of canal curvatures. Ultrasonic instruments were used in the initial phase to remove the tooth structure and to loosen the fractured instrument. In the second phase, ultrasonic instruments, wire loops, or XP Shapers (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) were used for fragment removal. The time periods for all procedures were recorded. Statistical analysis was completed applying log-normal regression, structural equation modeling, and linear regression using Stata Version 14.2 software (StataCorp LLC, College Station, TX). ResultsAll separated instruments were successfully retrieved. Using the protocol in this study, 89.8% of the instruments were removed using ultrasonic instruments alone with a mean time of 221 seconds. The instrument removal time was dependent on both the instrument length and the root canal curvature. Additionally, preparation times were proportionately longer with increasing separated instrument lengths when the loop device was required. ConclusionsThe preparation phase appears to have an important role in the retrieval of separated instruments. Preparation times for both non-loop and loop groups demonstrate that length and curvature are independent predictors of the log-transformed time. Generally, procedure times were extended with increasing file lengths and higher degrees of canal curvature.

Retrieval of separated instrument from the root canal– A review of techniques and management of a case

Retrieval of separated instrument from the root canal– A review of techniques and management of a case - IJOHD- Print ISSN No: - 2395-4914 Online ISSN No:- 2395-499X Article DOI No:- 10.18231/2395-499X.2018.0030, International Journal of Oral Health Dentistry-Int J Oral Health Dent

Technique and Management of an Iatrogenic Defect Caused During Retrieval by Treating It as A Canal Extension: A Case Report

Masserann technique is one of the methods suggested for retrieval of separated instruments. However, its application in posterior teeth is risky, difficult, and clinically challenging. This case report illustrates successful application of Masserann technique to retrieve a separated instrument from the middle third of a mesial canal of a mandibular second molar and management of an iatrogenic defect, which was caused during retrieval, by treating it as a canal extension during obturation. This obturation was done with glass ionomer cement based sealer for canal reinforcement. In the absence of other effective techniques, when the separated instrument is tightly lodged in the canal, Masserann technique could be useful for instrument retrieval in posterior teeth. However, its success depends on case selection and clinical skill. Since this technique leads to removal of considerable amount of dentin, use of bonding or adhesive obturation materials could be considered to reinforce and strengthen the root. DOI:10.21276/AOHDR.1897

Cone-beam Computed Tomography Volumetric Analysis and Comparison of Dentin Structure Loss after Retrieval of Separated Instrument by Using Ultrasonic EMS and ProUltra Tips

IntroductionA separated instrument within the root canal may interfere in the successful outcome of endodontic treatment. The retrieval of fractured instruments might compromise the remaining tooth structure and subsequently resistance to tooth fracture. The aim of this study was to compare the change in volume of root canal and dentin thickness after retrieval of separated instrument by 2 different endodontic ultrasonic tips. MethodsEach of the instruments (EMS Endochuck and ProUltra #6, #7, and #8 tips) was used to remove 40 separated rotary ProTaper F2 instruments from the mesiobuccal roots of mandibular molar under ×15 magnification. Cone-beam computed tomography analysis of the samples was done to evaluate the change in volume, dentin thickness, weight, time taken, and success. ResultsPaired sample t test showed statistically significant (P < .05) difference in volume before and after instrument retrieval in both the EMS group, where the increase was 112.52%, and in the ProUltra group, where the increase was by 55.35%. Intergroup comparison showed statistically significant (P < .05) decrease in dentin thickness; it was more for EMS as compared with ProUltra. Overall decrease in the mean weight of EMS group (18.42%) was more than that of ProUltra group (9.36%). The overall success rate for removal of fractured instrument in this study was 87.5%; however, the difference in success rate was not statistically significant. The mean time taken for retrieval by ProUltra system was 63.89 minutes, whereas it was significantly less (P < .05) for EMS system (50.22 minutes). ConclusionsRemoval of separated instrument with EMS resulted in more significant tooth structure loss as compared to ProUltra.

The use of dental operating microscopes by endodontists in the Middle East: A report based on a questionnaire

Objectives: The purpose of this study was to determine how the Dental Operating Microscope (DOM) is currently being accepted for usage by endodontists in the Middle East. Materials and Methods: A one-page letter and auto-return upon completion computer-based questionnaires were e-mailed to most of the active members of the Middle Eastern endodontic associations. Results: Out of the 47% that are using the DOM, only 35% answered yes to using the DOM as much as anticipated. The reasons for not using the DOM as much as anticipated were positional difficulties (80%) and increased treatment time (75%). The majority of endodontists reported that they always use it during retrieval of separated instruments, negotiating calcified canals and surgical treatment. Conclusions: The findings revealed that endodontists in the younger age-groups are more accepting of the DOM. It was also found that the endodontists that are using the DOM in their practice are not using it as often as they anticipated.

Management of Endodontic Failure

ABSTRACT There are several reasons for a root canal therapy to be unsuccessful. One of the causes for endodontic failure is instrument separation. As a consequence of fracture, access to the apical portion of the root canal is obstructed, leading to improper disinfection. The retrieval of separated instrument followed by obturation to the working length is the treatment option. Many factors can make retrieval difficult. In such cases, management can be done even by bypassing the separated instrument. Another factor for endodontic failure is underobturation. It may be due to block or ledge in the apical third of the canal. Proper instrumentation with frequent confirmation of apical patency during instrumentation can prevent formation of ledge. The inability to treat all the canals is the other cause leading to endodontic failure. Bacteria residing in these canals lead to the persistence of symptoms. Proper evaluation of the radiograph with proper deroofing can prevent chances for missed canals. Combination of all these factors can make retreatment difficult. This case report discusses two endodontic failure cases. In the first case, a premolar tooth with separated instrument and incomplete obturation was treated by retrieval of separated instrument and the obturation of both canals to working length was done. The second one was a molar tooth which had a missed canal, a separated instrument, and an incomplete obturation. Missed canal was negotiated and the fractured instrument was bypassed and root canal was obturated. How to cite this article Kumar MM, Nair KR, Geetha P, Nazar F, Alexander RN, Raj A. Management of Endodontic Failure. Cons Dent Endod J 2017;2(2):60-64.

Retrieval of separated instruments using a combined method with a modified vista dental tip

Biomechanical preparation of the entire root canal system is one of the most important procedures in endodontic treatment. Separation of instruments while preparing root canals presents a compromised situation in which a biologically inert segment is left behind with potential contamination that has the ability to affect the healing process. Management of this procedural error is tedious and requires creativity as well as clinical knowledge and skills. In this report, we demonstrated two cases with separated instrument in which a combined technique of ultrasonic method with microtube tube method was used to retrieve the separated tips using a modified Vista dental tip.

Nonsurgical management of endodontic mishaps in a case of radix entomolaris

Anatomic variations can significantly contribute to the incidence of endodontic mishaps. Perforations and separated instruments form the bulk of such mishaps. Furcal perforations are undesired complications of endodontic treatment, which result in the loss of integrity of the root and further destruction of the adjacent periodontal tissues. Mineral trioxide aggregate (MTA) is a promising material that has been successfully used to repair perforations. This clinical case demonstrates the use of MTA as a repair material for furcal perforation due to an iatrogenic error in radix entomolaris in the mandibular first molar. It also describes the application of ultrasonic technique in the retrieval of separated instrument from the same. Both clinical and radiographic follow-up showed a stable condition without any probing defect, ongoing root resorption, or furcal pathosis.