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Demo | How to bypass a broken file? | Dr. Waleed Kurdi



Management of broken files bypass or removal:

Fracture of endodontic instruments in a root canal is an unfortunate occurrence that may hinder the root canal procedure and negatively impact the endodontic treatment outcome. Fracture of an instrument itself may not cause treatment failure. However, fragments present in the root canal can prevent proper preparation of root canal space. The overall endodontic prognosis following instrument separation is likely to depend on the stage and degree of canal preparation and disinfection at the time of the instrument fracture: the main prognostic factor in such cases is reported to be the existence or non-existence of a preoperative periradicular pathosis.

Historically, it was recommended to leave the fractured instrument in the canal as it will not affect the prognosis and could be retained as the risk of removal was very high (1, 2). However, these publications came before the use of dental microscope and the introduction of specialized ultrasonic tips to manage the broken files, which would limit the risk of complications. So, recently we have 2 options regarding the fractured instrument:
– Bypassing
– Removal

BYPASSING THE FRACTURED INSTRUMENT
Bypassing technique is considered more conservative regarding the amount of dentine removal when compared to removal techniques especially if the fragment is located in the apical one third or beyond the canal curvature. It has been reported that if the file is bypassed, the obturation quality is not compromised (3). This technique depends on locating or catching a tiny space behind the broken instrument with precurved small k-file (6,8,10) in a watch-winding motion associated with EDTA gel to facilitate the task; the moment when you catch that space and your k-file is engaged there, we can start some picking motion along with watch-winding motion till we reach the apex, bypassing should be done till size 20 or 25 k-file (Multiple Radiographs should be done to confirm bypassing after each file size). Then, we have two choices to complete the shaping, either with manual files and step-back technique or with rotary files, but its slightly risky (small taper is preferable here, usually 4% is enough to manage a good obturation for the root canal system). After complete shapin, activation of irrigant solutions with ultrasonic tips behind the broken file may lead to its removal if you are lucky.

FRACTURED INSTRUMENT REMOVAL
It has been reported that, in the presence of a periapical lesion, endodontic treatment which is compromised by mishaps and errors – such as a broken instrument – demonstrated reduced heal­ing (4). Obviously, removal of a broken file will facilitate correct working length control (assuming there is minimum canal curvature), shaping and effective obturation of the root canal system (5). The likelihood percentage of instrument removal by clinicians raging from 53% to 95% (6,7). The wide percentage variation of these results can be due to many factors influencing broken instruments removal, such as:
1) Location, length, type and material of fractured instrument
2) Tooth/canal involved
3) Clini­cian’s skills and available armamentarium (Microscope, ultrasonics and other devices designed for instrument removal)

METHODS FOR REMOVAL
There is a wide variety of techniques available to facilitate instruments removal. These techniques can be chategorized as:
1) Ultrasonics technique
2) Grasping techniques, such as microtube devices, loop, micro tweezer, pliers/forceps ( that will be discussed in the second part 2 of this article)
There is no one removal technique or device that can be used for all fractured instrument cases, each case should be well assisted before choosing the removal technique.
The success of certain devices has been well documented in the case of ultrasonic removal (5,8) but, unfortunately, many of the microtube systems have no such scien­tific evaluation; this presents problems for clinicians in assessing their relative effi­cacy.
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12 comments

  1. For more demos like this… vist that url

    https://bit.ly/3tKPTDK

  2. جزاك الله خير يا دكتور

  3. شكرا جدا دكتور وليد طبقت الكلام والحمدلله الموضوع سهل ، ربنا يجعله في ميزان حسناتك ويزيدك علما

  4. Ahould we use edta gel on file whole bypassing?

  5. شو هو اسم المجسم التعليمي…

  6. د.انا مريضة و الفايل اتكسر بلس عمل خراج بعد اربع سنوات ايه الحل لو الدكتور بيقولى الفايل engaged in canal و بيحاول لكن مش عارف يطلع broken file

  7. doctor u said that the Bc sealer is hydrophilic and this is important can you explain that please?

  8. Where did the broken file go?

  9. What in case of curved canals

  10. والله أمتع فيديو شفته من زمااااااااان بعيد

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