Clinical Challenges and Success Strategies in Bypassing separated Endodontic files: two case reports

Auteurs: Rania Slama, Marwa Bouhaha, Sana Bagga, Saida Sahtout .

Abstract:

Introduction:

Broken instruments within the root canal system is a frequent and challenging complication in endodontic treatment, which can compromise the continuation of therapy and potentially affecting the prognosis of the tooth. The bypass technique offers a conservative approach that aims to preserve the root structure while allowing effective canal debridement.

This article presents two clinical cases highlighting the challenges encountered during the bypass of separated endodontic files, as well as the key strategies and precautions required to optimize treatment success. We will discuss also the selection of appropriate instruments, and meticulous technique to negotiate broken fragments without compromising canal integrity.

Observation:

Each case report details a unique clinical scenario, including the location and characteristics of the separated file, root canal anatomy, and the instruments and methods used to achieve the bypass. In all cases, the bypass technique successfully allowed the clinician to negotiate around the fractured instrument, facilitating adequate canal cleaning and optimal obturation.

Discussion:

When an instrument is broken in the root canal system a decision has to be made whether to leave, bypass, remove the file or even performing an apicoectomy. Our choice is based on an assessment of the potential benefit of removal compared with the risk of complication. The patient’s preferences is an important factor in this decision, as they may choose to have the tooth extracted for reasons such as anxiety, time and finance. Evidence shows that deeper fragments are associated with significantly greater dentin removal during retrieval attempts, which consequently reduces the fracture resistance of the root.

Given the risks of retrieval, bypassing a separated instrument represents a conservative strategy that maintains dentin and canal integrity. This technique uses the slight gap between the fragment and the inner wall of the canal to negotiate a pathway with small precurved files, preserving tooth structure and enabling effective cleaning and obturation when patency is reestablished.

Conclusion:

Ultrasonic retrieval can be useful but includes significant risks such as dentin loss, thermal damage, and reduced root strength. Studies indicate that the bypass technique is a conservative approach, not demanding in terms of equipment yet able to ensure therapeutic success.

Keywords: broken file, separated instrument, by-pass, retrieval, tooth structure preservation, prevention.

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