Fig. 1

Female patient age 24 was referred in order to remove a separated instrument from the mesial root of a lower second molar. The patient had been informed from the referring dentist about the complication and was very frustrated. When an instrument brakes inside a root canal, a periapical radiograph must be taken in order to try to identify the location of the fragment. 

According to the European Society of Endodontology (ESE) position statement, limited field of view (LFOV) Cone Beam Computed Tomography (CBCT) should also be considered as a diagnostic tool in cases where treatment complications have occurred. CBCT) provides even more information and can be helpful in treatment planning of such cases. 

Fig. 2

Studying the LFOV CBCT clearly demonstrates the confluent mesial root canal system and the possibility to reach to the apical part via the mesial lingual canal and probably would not impede the cleaning and shaping. Moreover, the impacted third moral does not seam to have affected in any way the second molar. Nevertheless, afterwards the patient has been referred to an oral surgeon in order to extract the impacted tooth after the endodontic treatment.

Fig. 3

Therefore, after explaining to the patient and the referring dentist the benefits in sound dentine preservation of not trying to remove the fragment and the potential risks from the removal attempt, the treatment was initiated. Following administration of local anaesthesia and rubber dam isolation, the rest of the root canal system was cleaned and shaped. Emphasis was given to irrigation with 2,5% NaOCl via activation of the irrigant with the Endoultra device. Final irrigation was done with 17% EDTA.

Fig. 4

View of the coronal part of the instrument under high magnification after the preparation of the canals. No tooth structure has been sacrificed in order to remove the fragment

Fig. 5

Final obturation radiograph with two different angles. It is evident that the mesial root canal system has been obturated beyond the apical limit of the fragment. The whole procedure was carried out in a single session and the technique used was warm vertical compaction of gutta-percha with resin based sealer.


  • CBCT imaging can be very helpful when treating teeth with instrument fracture.
  • Determining the exact location of the fragment influences the decision-making process, especially when canals merge
  • Prognosis of teeth with a instrument fragment is not affected if cleaning and shaping have not been compromised.
  • Every effort must be made to prevent unnecessary dentine removal that leads to weakening of the tooth and increases the possibility for root fracture.


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