Encountering a separated instrument is understandably stressful, but it’s a common occurrence that can be managed effectively. Collaboration is key to resolving these situations smoothly. This month, we feature a referred case where there was a large separated instrument lodged within the canal, a scenario that can often cause anxiety for both the patient and the practitioner. However, with the right expertise and tools, resolution was successfully achieved
Treatment:
1, Access and Retrieval: The canal and the separated instrument were accessed through the crown. Utilising a combination of specialised techniques, including ultrasonics and careful hand file bypassing, we could navigate and retrieve the fragment. Using a BTR lasso loop pen was instrumental in this delicate retrieval process.
2, Disinfection and Preparation: Following the retrieval, full chemomechanical disinfection was performed. Irrigation with sodium hypochlorite and EDTA, coupled with ultrasonic activation, ensured thorough canal cleanliness and preparation with patency.
3, Obturating the Canal: The canal was subsequently obturated using gutta percha and Kerr Pulp Canal Sealer through a warm vertical compaction technique. This was aimed at achieving a complete and hermetic seal.
4, Restoration: A composite core was placed to complete the procedure.
Notes and advice:
To ensure the best patient care, it’s crucial for the referring dentist to carefully monitor the case. Keep a close watch on the healing progress, as there might be a need for apical surgery. Additionally, it’s important to observe the UL1 and UL2 closely for potential endodontic retreatment, given the CBCT scan’s indication of possible periapical areas. Currently, it’s uncertain whether these are healing lesions or forming, so reassessment might be necessary. Diligent monitoring and timely actions will aid in achieving successful patient outcomes.
