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DTME1010

DENTALTRIBUNE Middle East & Africa Edition Practice Matters 9 _Fractured instruments pose a challenge to every endodontist. The difficulty in the retrieval of these instruments ranges from surprisingly easy to downright impossible. The clinical out- come of cases with fractured in- struments depends on several fac¬tors, such as the position of the instrument in the canal, the type of material, the instrument size and canal anatomy.¹ Failure in retrieval of the fractured in- strument does not automatically result in failure of the case.² One can still try to bypass the in- stru¬ment, choose a surgical ap- proach, or even wait and see. However, if we bear ‘nothing ventured, nothing gained’ in mind, then we should always at least try to retrieve the fractured instrument. _Case I A 27-year-old female patient was referred to our practice. She was in good health and had an Ameri¬can Society of Anesthesi- ologists (ASA) score of 1. The pa- tient had some mild clinical symptoms on tooth #30 due to apical periodontitis. She had been told, by the referring den- tist, that there was a fractured in- strumentinhertoothandthatthe instrument had to be removed first in order to allow for decent retreatment. Before starting with the treat- ment, a new diagnostic radi- ograph was taken. In this case, the diagnostic radiograph (Fig. 1) showed not one but two bro- ken instruments in the mesial root, one in each mesial canal. Thereafter, the tooth was iso- lated with the rubber dam and the coronal filling was removed. Straight-line access was estab- lished, as this is im¬perative in order to be able to reach and see the frac¬tured instruments. Gates-Glidden burs (DENTSPLY Maillefer) were used to enlarge the mesial orifices coronally. nostic radiograph (Fig. 1) showed not one but two broken instruments in the mesial root, one in each mesial canal. There- after, the tooth was isolated with the rubber dam and the coronal filling was removed. Straight- line access was established, as this is im¬perative in order to be able to reach and see the frac¬tured instruments. Gates- Glidden burs (DENTSPLY Maillefer) were used to enlarge the mesial orifices coronally. One-and-a-half hours after starting the treat¬ment, the frag- ment had been loosened but was still stuck in the canal. We de- cided to leave it in place for the time being and made a new ap- pointment. Calcium hydroxide paste (UltraCal XS, Ultradent) was put into the coronal part of the mesial canals and the tooth was sealed with glass-ionomer ce-ment (Fuji IX GP Fast, GC) and a cotton pellet. During the next visit, the tooth was again isolated and opened. The calcium hydroxide paste was removed, using 10 % Removal of a fractured in- strument:Two case reports Author_ Dr Rafaël Michiels, Belgium AD Fig. 1 Fig. 2 Fig. 1_Diagnostic radiograph, showing two separated instruments in the mesial root. Fig. 2_A modified Gates-Glidden bur used for creating a plateau above the instrument.