Management of Separated Endodontic Instruments Using Ultrasonics and BTR-Pen® System: A two-case report

Auteurs: RIM TOUNSI, MARWENNE BOUATAY, FARAH JELALIA, SANA BAGGA, SAIDA SAHTOUT.

Abstract:
Introduction:
Separation of endodontic instruments is a common procedural complication that can compromise canal disinfection and affect treatment prognosis. While ultrasonic techniques are widely used for fragment retrieval, deeply engaged or difficult-to-access fragments may require adjunctive mechanical systems, such as the BTR-Pen®.
Case Presentation:
This article presents two clinical cases of separated endodontic instruments in molars with complex canal anatomy. In both cases, ultrasonic tips under dental operating microscope guidance were initially employed to mobilize the fragments. When ultrasonic retrieval alone was insufficient, the BTR-Pen® loop system, available in three different loop sizes, was used to securely engage and remove the fragments without excessive dentin removal.
Discussion:
The combination of ultrasonics and loop-based retrieval allowed successful fragment removal while preserving radicular dentinal structure. This approach highlights the importance of careful canal and fragment assessment, proper preparation, and selection of retrieval technique according to fragment position, length, and canal curvature.
Conclusion:
Ultrasonic and loop-based retrieval systems are complementary techniques that provide a predictable and minimally invasive approach for managing separated endodontic instruments. Their combined use can enhance clinical outcomes and maintain tooth integrity in challenging endodontic cases.

Keywords: Endodontic instrument fracture; Ultrasonic retrieval; Loop system; BTR-Pen®; Case report

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