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The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. - www.rxroots.com Photos courtesy:Marga Ree

  Separated instrument removal

From: "Marga Ree" Sent: Thursday, 21 December 2006 6:12 AM To: ROOTS Subject: [roots] separated instrument removal Patient had swelling and pain on # 37. Upon access, I couldn't see the separated fragment through the scope, so my first plan was to bypass it. I removed the post with US, and was able to bypass the separated instrument. The time was up, so I applied Ca(OH)2 for a few weeks, and the patient was symptomfree on return. Every separated instrument asks for a specific approach. How to bypass or remove it is dependent of several factors. Important is the type of instrument (NiTi versus SS), the location of the fragment (coronal, middle or apical), the stage in which it was separated (initial negotiation versus final shaping) and the status of the pulp (vital versus necrotic tooth) By attempting to remove an sep. instrument, especially with the use of a staging platform and US tips, I have hogged out a number of teeth in the past. Nowadays, I prefer to bypass the fragment first with small files, which can be done with some patience and experience. Once it is bypassed, it is usually easier to remove it with preservation of tooth structure, but at the same time, if it can't be removed, the case can still have a successful outcome, even in an infected, necrotic case. In this case, there was an isthmus between the mesials, where the fragment was lodged. I made some sort of fish angle out of a # 15 file, and did some endodancing towards the isthmus, in conjuction with a lot of US activated irrigation. Bingo, it came out! Root canal filling of Resilon, fiber post in distal canal and a BU of composite - Marga

Nicely done, wonderful result, Marga - Simon
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