Mitigating the Iatrogenic: Endodontic Management of Separated Instruments – A Consecutive Case Series
Keywords:
Instrument separation, Root canal treatment, Endodontic mishaps, File retrieval, Bypass technique, Ultrasonics in endodontics, Fractured endodontic instrument, File braiding technique
Abstract
Abstract: Instrument separation is a common procedural complication in endodontic treatment that can impede thorough cleaning and shaping of the root canal system. If not properly managed, it may compromise treatment success by restricting access to the apical third of the canal. The decision to retrieve, bypass, or leave the fragment in situ depends on several clinical factors, including the location and type of the separated instrument, canal anatomy, and the tools available. With recent advancements in magnification and ultrasonic technologies, conservative management techniques have become increasingly effective and less invasive. Approaches such as ultrasonic activation and file braiding enable clinicians to remove or bypass fractured instruments while preserving tooth structure. The success of such procedures largely depends on the operator’s skill, visibility of the fragment, and the ability to maintain canal patency throughout the treatment. In this case series, separated instruments were successfully managed using both retrieval and bypass techniques, highlighting the importance of a strategic and minimally invasive approach in endodontic practice.
References
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33. Dioguardi, M., Dello Russo, C., Scarano, F., Esperouz, F., Ballini, A., Sovereto, D., Alovisi, M., & Lo Muzio, L. (2024). Analysis of endodontic successes and failures in the removal of fractured endodontic instruments during retreatment: A systematic review and meta-analysis. Healthcare (Basel), 12(14), 1390. https://doi.org/10.3390/healthcare12141390
34. Fan, Y., Gao, Y., Wang, X., Wang, R., & Zhang, S. (2025). Expert consensus on management of instrument separation in root canal therapy. International Journal of Oral Science, 17, 46.
2. Alapati, S. B., Brantley, W. A., Svec, T. A., Powers, J. M., & Mitchell, J. C. (2005). SEM observations of nickel–titanium rotary endodontic instruments that fractured during clinical use. Journal of Endodontics, 31(1), 40–43.
3. Knowles, K. I., Hammond, N. B., Biggs, S. G., & Ibarrola, J. L. (2006). Incidence of instrument separation using LightSpeed rotary instruments. Journal of Endodontics, 32(1), 14–16.
4. Iqbal, M. K., Kohli, M. R., & Kim, J. S. (2006). A retrospective clinical study of incidence of root canal instrument separation in an endodontics graduate program: A PennEndo database study. Journal of Endodontics, 32(11), 1048–1052.
5. Tzanetakis, G. N., Kontakiotis, E. G., Maurikou, D. V., & Marzelou, M. P. (2008). Prevalence and management of instrument fracture in the postgraduate endodontic program at the Dental School of Athens: A five-year retrospective clinical study. Journal of Endodontics, 34(6), 675–678.
6. Madarati, A. A., Watts, D. C., & Qualtrough, A. J. (2008). Factors contributing to the separation of endodontic files. British Dental Journal, 204(5), 241–245.
7. Alomairy, K. H. (2009). Evaluating two techniques on removal of fractured rotary NiTi endodontic instruments from root canals: An in vitro study. Journal of Endodontics, 35(4), 559–562.
8. Plottedino, G., Grande, N. M., Cordaro, M., Testarelli, L., & Gambarini, G. (2009). A review of cyclic fatigue testing of nickel–titanium rotary instruments. Journal of Endodontics, 35(11), 1469–1476.
9. Shen, Y., Coil, J. M., McLean, A. G., Hemerling, D. L., & Haapasalo, M. (2009). Defects in nickel–titanium instruments after clinical use. Part 5: Single use from endodontic specialty practices. Journal of Endodontics, 35(10), 1363–1367.
10. Wu, J., Lei, G., Yan, M., Yu, Y., & Yu, J. (2011). Instrument separation analysis of multi-used ProTaper Universal rotary system during root canal therapy. Journal of Endodontics, 37(6), 758–763.
11. Madarati, A. A., Hunter, M. J., & Dummer, P. M. H. (2013). Management of intracanal separated instruments. Journal of Endodontics, 39(5), 569–581.
12. Shen, Y., Zhou, H. M., Zheng, Y. F., Peng, B., & Haapasalo, M. (2013). Current challenges and concepts of the thermomechanical treatment of nickel–titanium instruments. Journal of Endodontics, 39(2), 163–172.
13. McGuigan, M. B., Louca, C., & Duncan, H. F. (2013). The impact of fractured endodontic instruments on treatment outcome. British Dental Journal, 214(6), 285–289.
14. Choksi, D., Idnani, B., Kalaria, D., & Patel, R. N. (2013). Management of an intracanal separated instrument: A case report. Iranian Endodontic Journal, 8(4), 205–207.
15. Ungerechts, C., Bårdsen, A., & Fristad, I. (2014). Instrument fracture in root canals—Where, why, when and what? A study from a student clinic. International Endodontic Journal, 47(3), 183–190.
16. Monteiro, J. C., Kuga, M. C., Dantas, A. A., Jordão-Basso, K. C., Keine, K. C., Ruchaya, P. J., Faria, G., & Leonardo, R. T. (2014). A method for retrieving endodontic or atypical non-endodontic separated instruments from the root canal: A report of two cases. Journal of Contemporary Dental Practice, 15(6), 770–774.
17. Pk, M., Sc, K., & As, S. (2016). Broken instrument retrieval with indirect ultrasonics in a primary molar. European Archives of Paediatric Dentistry, 17(1), 71–74.
18. Capar, I. D., & Arslan, H. (2016). A review of instrumentation kinematics of engine-driven nickel–titanium instruments. International Endodontic Journal, 49(2), 119–135.
19. Saji, S., Geetha, P., Nair, R. K., & Kurup, N. (2019). Management of instrument separation: A case series. Conservative Dentistry and Endodontic Journal, 4, 39–43.
20. Hou, B. X. (2019). Complications occurred in root canal mechanical preparation: The reason, prevention and management. Zhonghua Kou Qiang Yi Xue Za Zhi, 54(9), 605–611.
21. Coelho, M. S., Rios, M. A., & Bueno, C. (2018). Separation of nickel–titanium rotary and reciprocating instruments: A mini-review of clinical studies. Open Dentistry Journal, 12, 864–872.
22. Sobotkiewicz, T., Lipski, M., Woźniak, K., & Nowicka, A. (2021). Effect of canal curvature location on the cyclic fatigue resistance of reciprocating files. Clinical Oral Investigations, 25(1), 169–177.
23. Zanza, A., Seracchiani, M., Reda, R., Di Nardo, D., Gambarini, G., & Testarelli, L. (2021). An update on nickel–titanium rotary instruments in endodontics: Mechanical characteristics, testing and future perspective—An overview. Bioengineering, 8(12), 218.
24. Terauchi, Y., Ali, W. T., & Abielhassan, M. M. (2022). Present status and future directions: Removal of fractured instruments. International Endodontic Journal, 55(6), 685–709.
25. El Abed, R., Nehme, W., Dib, A., El Hachem, R., & Khalil, I. (2022). Fracture resistance of heat-treated nickel–titanium rotary files after usage and autoclave sterilization: An in vitro study. Journal of Endodontics, 48(10), 1428–1433.
26. Kaul, R., Gupta, R., Chhabra, S., & Koul, R. (2022). Dental operating microscope-guided retrieval of broken instrument from a deciduous molar using ultrasonics. International Journal of Clinical Pediatric Dentistry, 15(S1), S114–S118.
27. Lakshmaiah, D., Raj Kumar, J., Sakthi, N., Karunakaran, J., & Vishwanath, S. (2023). The management of fractured dental instruments: A case series. Cureus, 15(11), e49132. https://doi.org/10.7759/cureus.49132
28. “Retrieval of Separated Intracanal Endodontic Instruments: A Series of Cases”. (2023). PMCID PMC10066733.
29. “Navigating Separated Instrument Retrieval: A Case Report”. (2023). PMCID PMC10787944.
30. Chai, R., Chen, X., Liu, Y., Duan, C., & Sun, L. (2024). Different strategies for treating intracanal fractured instruments in a single tooth: A case report. Experimental and Therapeutic Medicine, 28(2), 411.
31. Portigliatti, R., Consoli Lizzi, E. P., & Rodríguez, P. A. (2024). Predictive factors in the retrieval of endodontic instruments: The relationship between the fragment length and location. Restorative Dentistry & Endodontics. Advance online publication.
32. Aminsobhani, M., Sadeghi, S., Kharazifard, M. J., & Hamidi, A. (2024). Broken instrument removal methods: Six-case series plus literature mini-review. Journal of International Society of Preventive and Community Dentistry, 14(1), 14–20. https://doi.org/10.4103/jispcd.jispcd_366_23
33. Dioguardi, M., Dello Russo, C., Scarano, F., Esperouz, F., Ballini, A., Sovereto, D., Alovisi, M., & Lo Muzio, L. (2024). Analysis of endodontic successes and failures in the removal of fractured endodontic instruments during retreatment: A systematic review and meta-analysis. Healthcare (Basel), 12(14), 1390. https://doi.org/10.3390/healthcare12141390
34. Fan, Y., Gao, Y., Wang, X., Wang, R., & Zhang, S. (2025). Expert consensus on management of instrument separation in root canal therapy. International Journal of Oral Science, 17, 46.
Published
2025-09-30
How to Cite
Chauhan, D. D., Minocha, D. A., Sharma, D. V., & Saroj, D. S. (2025). Mitigating the Iatrogenic: Endodontic Management of Separated Instruments – A Consecutive Case Series. UNIVERSITY JOURNAL OF DENTAL SCIENCES, 11(3), 53-58. https://doi.org/10.21276/ujds.2025.v11.i3.11
Section
Case Reports
