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In fact, broken instruments are not the direct cause of endodontic therapy failure; rather, they may lead to accompanying uncleaned and unfilled spaces within the root canal system. Breaking files is not malpractice; however, failing to inform a patient that a separation has occurred is. There are basically three possible approaches that may be encountered when treating these cases: (I) Retrieval, (II) Bypass and sealing the fragment within the root canal space, (III) True blockage. Success of retrieval depends on the canal anatomy, what type of metal the piece is made out of (stainless steel files tend to be easier to remove), the location in the canal of the fragment, the plane in which the canal curves, the length of the separated fragment, and the diameter of the canal itself (7). Prior to commencing retrieval efforts, special attention is directed toward preoperative radiographs and working films to better appreciate the thickness of the dentinal walls. Radicular access is the second step required in the successful removal of a broken instrument. When the canal, coronal to fractured instrument, has been optimally shaped, then bypass techniques may be employed to remove a broken file segment.
On occasions, the clinician may create excellent coronal and radicular accesses, bypass the fractured instrument, but could not retrieve the fractured instrument. If the fractured instrument cannot be bypassed, then microsonic techniques may be employed to remove a broken file segment. Attempting to remove a fragment without adequate visualization highly risks perforation, as root curvatures can easily mislead the clinician to remove dentin where it will have little benefit toward file removal. An appropriately sized ultrasonic instrument is selected, such that its length will reach the broken obstruction and its diameter will passively fit into the previously shaped canal. Chemical preparation refers to use of an irrigant or combination during and after biomechanical preparation of root canal.
Earlier in 1940 water was commonly used irrigant since it was readily available ,inexpensive and provided a lubricating effect like all non viscous fluids. Naocl is the most effective agent at a concentration of 5.2% ,spores of Bacillus subtilis were destroyed on 1 min exposure.
Dilution decreases antimicrobial property, tissue dissolution property and debridement property.



Glycerol is added to prevent decomposition and to utilize the slippery effect of the compound. The best use of glyoxide is in narrow and or curved canals,utilizing the slippery effect of the glycerol.
The patient had been referred to a periodontist who subsequently recommended extraction of tooth 4.6 which had a non-healing lesion following initial endodontic treatment.
Having discussed the options for treatment with the patient and stressing the guarded prognosis due to the potential of a vertical root fracture, the patient was still interested in having the treatment as outlined in order to try to retain the tooth. The Zendo Academy advisory team is comprised of opinion leaders dedicated to the advancement of clinical practice through education and peer-to-peer communication. No dentist should have a particular tolerance for broken instruments; however, it is important to know how to prevent and treat these incidents and how to explain the situation to the patient.
The broken instruments impede the mechanical instrumentation of the infected root canal apical to the instrument (Fig.1), and that is the primary cause of treatment failure (1).
5): One of the paradigm shifts occurring in endodontics today is the concept of doing the apical preparation last instead of first. In general, if one third of the overall length of an obstruction can be exposed, it can usually be removed. More challenging are separated instruments that lie partially around canal curvatures, but these can often be removed if straight-line access can be established to their most coronal extents.
Coronal access is the first step in the removal of broken instruments, where straight-line access to all canal orifices should be created, and special attention should be directed toward flaring the axial wall that approximates the canal holding the broken instrument. Hand files are used serially small to large, coronal to the obstruction, to create sufficient space to safely introduce GG drills (8). Prior to performing any radicular removal techniques, it is wise to place cotton pellets over other exposed orifices, if present, to prevent the nuisance re-entry of the fragment into another canal system.
In this case, the canal is cleaned and shaped, and the segment is incorporated into the obturation (10) (Fig.7). The tip of this ultrasonically selected instrument is placed in intimate contact against the obstruction and typically activated within the lower power settings.


If the bulk of the canal space has been soaking in full strength sodium hypochlorite, and the critical concentration of bacterial contaminants within the canal are sufficiently reduced, the body may heal around this root as well (14).
Adhering to proven concepts, integrating best strategies, and utilizing safe techniques during root canal preparation procedures will virtually eliminate the broken instrument procedural accident. Final rinse with 17% EDTA, 2.5% NaOCl, canals dried, obturated with warm vertical condensation of gutta percha and thermaseal. A  vertical root fracture was detected in the mesial root and a resection of the root was performed up to the upper level of the fracture. By creating shape from coronal to apical direction, the canal is predictably and safely prepared.
If the broken instrument segment is apical to the curvature of the canal and safe access cannot be accomplished, then removal is usually not possible. In combination with lubricants, a precurved no.10 stainless file is used to bypass the fractured instrument.
The selected instrument is moved lightly in a counter clockwise direction around the obstruction. If this is successful, Hedstr?m files are used to try to grasp and remove the segment (Fig.6).
This ultrasonic action trephines, sands away dentin, and exposes the coronal few millimetres of the obstruction. Typically, during ultrasonic use the obstruction begins to loosen, unwind, and then spin (12,13).



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