Endodontic Management of Separated Instruments: Two Case Reports

Endodontic Management of Separated Instruments: Two Case Reports Poster Abstract Zülal Büşra Sayın1 , Ecenur Tuzcu Sarıyer1 1 Kütahya Health Sciences University Objective: The presence of a separated instrument is a significant complication that can negatively affect the success of root canal treatment. This case report aims to demonstrate different clinical management approaches for separated instruments during endodontic therapy. Case Description: Case 1: A healthy 19-year-old female presented with percussion sensitivity on tooth #26. Radiographic evaluation revealed a previously treated tooth with an unfilled mesial canal and short obturation in the palatal canal. Retreatment was indicated. During removal of the previous filling, a retreatment file fractured in the coronal third of the distal canal. In the second session, the fragment was successfully removed using an ultrasonic device. Chemo-mechanical preparation and passive ultrasonic irrigation were completed, followed by obturation and coronal restoration. Follow-up visits confirmed the tooth remained asymptomatic. Case 2: A healthy 18-year-old male presented with a large periapical lesion associated with tooth #22, which was asymptomatic and non-vital. After chemo-mechanical preparation, calcium hydroxide was placed as an intracanal medicament. During the second session, a #10 K-file fractured within the hardened medicament, located 0.5–1 mm beyond the apical constriction. The fragment could not be retrieved; however, ultrasonic activation enhanced irrigation and disinfection, allowing completion of treatment. At 18-month followup, the tooth remained asymptomatic, and complete radiographic healing of the lesion was confirmed. Results: In the first case, the separated instrument was successfully removed and the tooth remained asymptomatic. In the second, despite the retained fragment, disinfection was sufficient to achieve complete periapical healing. Conclusion: Separated instruments may compromise prognosis but can be effectively managed with accurate diagnosis, appropriate tools, and meticulous clinical techniques. These cases highlight the effectiveness of ultrasonic systems and the success of conservative endodontic approaches. Keywords: Instrument fracture; Periapical lesion; Ultrasonic device