Methods to Retrieve Separated Instruments in Endodontics

Abstract

During the root canal procedure, an instrument can fracture occasionally which might block access to the apical terminus (1). The instrument may be a hand or a rotary file, Peaso reamer, Gates Glidden drill, Lentulo spiral, or some non-endodontic instruments (1,2). The hand instruments have a separation rate of 0.25% (3) whereas for rotary instruments it ranges between 1.68% and 2.4% (3,4), for stainless steel instruments it is between 0.25% and 6%, and for Ni-Ti instruments, it ranges from 1.3% to 10% (5-15). The reason for the separation of an endodontic instrument may be the presence of a curved canal, overusing the same file, loss of tactile sensation, over instrumentation, etc (16). When separation occurs every clinician has the choice of whether to 1. Leave the instrument in the root canal, 2. Bypass the instrument, 3. Retrieve the separated instrument by surgical or non-surgical methods. Leaving the separated instrument in the canal is not always preferable because it may affect the outcome of root canal therapy (17). So, attempts should be made to either bypass or retrieve the instrument. The success of fractured instrument retrieval mainly depends on the anatomy of the root canal, the fragment location, its length, the curvature, and the diameter of the root canal (18). This review mainly describes the recent trends in retrieving the separated endodontic and non-endodontic instruments.