A strange situation happened
I was doing a Retratment for lower 2nd molar with acute apical periodontitis with large metal post in the distal canal…
I removed the post start removing Gp… all was fine… until last shaping File while recapitulate with 15 k file it breaks 🙃
Trying to bypass with 10k file…. it also breaks 😵💫😵💫
It was almost an hour passed …patient get tired and me too
I informed the patient that we need a second visit to retrieve the instruments…he was travelling the next day as work abroad and he is in egypt for vacation
What we agreed to do is to obturate and apply resin modified GIC as a semi-permanent restoration until his next vacation in the summer…. and if feels any symptoms … he will contact a colleague in his country to manage the case…
Surprisingly…. after 7 months…. the patient came… tooth fully functional…no symptoms
And the Lesion Healed..😮🤪
Now let’s talk about
(((The Damned Choic)))
doing nothing to broken instrument…. just pretend that it’s not here and complete your RCT as usual
What is the factor influencing success of root canal treatment with broken instrument :
1- Patient General Health
If you choose to leave the broken instrument you will depend on patient immunity a big deal… so no such choice in immunocompromised patients or old patients with chronic diseases… that increases the incidence of failure rather than putting patient health in risk
2- Tooth Condition
Absence of infection as in case of pulpitis is a good success booster…. rather presence of infection (especially chronic) lowers your chances of success
3- The Sequence of the Broken File
Is it the first file introduced to canal… or the last file in your shaping Sequence
During shaping there is an irrigant active in canal and also between file you irrigate
So as the broken instrument is late in your shaping Sequence the chances of success increased
4- Position of The Broken Instrument
As the broken instrument brakes more apically thats means less canal space is not cleaned means more chances of success
5- Obturation Material
Niti or stainless steel are not a good Obturation materials they provide very poor apical seal…. so using Obturation material that can provide good apical seal is a booster for success….. bioceramic sealer or MTA is an excellent choice in these cases
So let’s apply our factors on this case:
1- the patient is a 36 years old male who is healthy with no medical history…no smoking
So factor number 1 is a plus…👍
2- the tooth is obviously has acute apical periodontitis
So factor number 2 is minus…👎
3- i prepared the canal till 30/4 then i broke a 15 file
So factor number 3 is a plus…👍
4- the broken instrument is at the apex…
In fact it fructured when the file reached full working length which means it’s exactly at the apex
So factor number 4 is a plus…👍
5- i used bioceramic sealer ( Endoseal MTA by Maruchi A true MTA in sealer)
So factor number 5 is a plus…👍
May be there is another factors that i don’t think of is also influencing success
Like me using Continuous Irrigation During Instrumentation Technique in shaping and Negative Pressure Irrigation Technique in final irrigation protocol with my awesome, fantastic beautiful ,efficient and Affordable device SafeClean …😁😁😁 Don’t know
This post is not an invitation to do nothing about broken instrument rather than an invitation to think about the subject… encouraging dentists to develop skills and have proper instruments so they can choose more predictable choices…moreover to try as hard as they can to avoid that problem in first place
Enjoy…
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