Fig. 1

The first one is bypass which means (Create a path next to the separated instrument). The bypass is the game of hands, this method of management in most cases does not need magnification. It always depend on factors like (patience, time and experience) to pass the separated instrument. So, before I talk about the other ways for management SI we always ask an important question, which method bypass or retrieval should be used. The answer of this question depends on the case data like (visible or invisible and site of fracture). After explaining the first method now we can talk about the second  one (retrieval), the important point that must be mentioned here is that this method cannot be done without the presence of magnification and the required tools. The diagram below shows the steps of this method:

Fig. 2

First case. 53-year-old patient was refer to my clinic for management of separated instrument and complete RCT 

A pre opertive showed a separated instrument In the mesial canal with the apex so for be conservative with root go for bypass. 

Fig. 3

Second case talk about retrieval, x-ray showed long separated instrument extending outside the canal , and the patient refused any surgical intervention.

Fig. 4

After removing the dentin around the head of separated instrument then use tube tech. For removing it and check W.L.

Fig. 5

Final x-ray after obturation 

Fig. 6

Another case for retrieval of separated instrument from lower first molar by using loop tech. 

This video explains all  the steps 

Fig. 7

Fourth case was another fishing for upper first premolar by using tube tech. 

Fig. 8

The fifth case shows surgical intervention for removing the separated instrument beyond the apex.

Fig. 9

Final x-ray obturation with MTA after surgical removal for the separated instrument. 

Fig. 10


Graduated from Uruk dental collage-Iraq 2018-2019 


The most important thing the dentist must take into account when removing any broken instrument inside the root is to know how to deal with the root and to reduce the amount of dentin removal to maintain a longer life of the tooth, in addition to knowing when to stop and do not forget that the availability of the required equipment and experience is a factor very important.


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