Separated file dilemma

Fig. 1

Case no 1 

36 years old female patient referred to our clinic for management of separated file at the coronal one third in maxillary first molar.

Notice here from the pre operative radiograph that there is a narrow canal in the mesial root .

Common reasons for such kind of separation would be errors during the instrumentation by not doing coronal passive pre flaring , glide path and patency followed by correct shaping protocol.

Fig. 2

Case no 2

34 years old male patient referred to our clinic for management

of two separated files in maxillary canine.

Liquid dam was applied for the secondary isolation.

In such a cases when the separated file more than 4.5 mm it’s better to use grasping methods and here tube technique was used for retrieval.

When the the separated file is long - highly engaged the ultrasonic technique only is not effective because the possibility of secondary fracture. 

Fig. 3

So here retrieval done to the long one ‘14mm’ using tube technique 

after exposing 2mm of the file with ultrasonic.

The second one ‘7mm’ file came out during preparation phase with ultrasonic. 

Fig. 4

The working length and post operative radiograph 

Fig. 5

Case no 3

31 years old male patient referred to our clinic for management of two separated files in maxillary second molar at the apical one third of the DB and MB canals which make the case more difficult.

There was a previous attempt to retrieve the files by the referring dentist using ultrasonics without magnification.

Fig. 6

The two separated files retrieved with the use thin ultrasonic at the inner wall of the root under magnification.

Fig. 7

Post operative radiograph.

Fig. 8

Case no 4

27 years old female patient referred to our clinic for management of separated file at the apical one third in maxillary second premolar.

From the pre operative radiograph noticed that There is a possibility of extra canal anatomy.

The separated file retrieved with the use of thin ultrasonic at the inner wall of the root.

Fig. 9

Master cone fit and post operative radiograph .

Fig. 10

Case no 5 

22 years old female patient referred to our clinic for management of two separated files in mandibular first molar.

Fig. 11

The long separated file retrieved using loop technique .

The loop technique should circle the exposed separated instrument up to a length allowing tighten the loop between the flutes in the under cut for firm grasping .

The other file was at the apical one third beyond the curvature so decided to bypass it.   

Fig. 12

Post operative radiograph.

Fig. 13

Post operative and 8 month follow up.

Fig. 14

Case no 6 

42 years old male patine referred to our clinic for management of separated file at maxillary second molar extended beyond the apex in the maxillary sinus .

The clinical examination showed presence of symptomatic apical periodontitis .

After the CBCT evaluation , the non surgical re-treatment done first followed by the micro surgical approach and removal of the file as a treatment option with very high success rate.