ROEN0210

30 I I case report _ peri-apical microsurgery _During endodontic treatment, procedural errors may occur, such as the breakage of endodon- ticfiles.Theseaccidentsmaycompromisethetreat- ment and prognosis of the clinical case. Frequently, it is necessary to perform additional procedures to resolve the problem. With the development of cleaning and shaping endodontic systems, there is decreasing frequency of procedural problems in dental practice.1 How- ever, concern persists that rotary NiTi instruments are more susceptible to breakage. This has been the second most common reason for dentists not using rotary instruments.2 A recent study has shown that the incidence of brokeninstrumentsaccountsfor11.7%ofallendo- dontic malpractice cases.3 The incidence of NiTi file fractures has been shown to range from 0.4 to 5% and their use is considered safe.4–6 Fractures can occurthroughtorsionalfailureorasaresultofflex- ural fatigue. _Minimising breakages In order to minimise these incidents, care must be taken as follows: evaluate the tooth anatomy care- fully before treatment; ensure a straight-line access; create a glide path with small hand files; use the crown-down technique; use a torque-controlled motor; keep files moving in and out of the canal; and controlthenumberoftimesfilesareused,discarding files after a specified number and types of canals. Fracturesofendodonticinstrumentsinsidecanals may be classified according to their intra-radicular position as occurring in the cervical, middle or apical thirds.Thesuccessrateforremovingfracturedinstru- ments in the cervical and middle thirds is higher than itisintheapicalthird,andtheincidenceofiatrogenies during the attempt to remove them is lower.7–9 The prognosis of treatment can be altered as a result of the presence of endodontic infection. Cases Fig. 1_Initial clinical aspect. Fig. 2_Initial X-ray. roots2_2010 Peri-apical microsurgery for removal of a fractured endodontic instrument Author_ Dr Leandro A. P. Pereira, Brazil Fig. 1 Fig. 2

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