Bypassing Technique for Managing Separated Instrument - A Case Report

Abstract

Fracture of endodontic instruments in the canal is an unfortunate occurrence that may hinder the root canal procedure and negatively impact the treatment outcome. This fragmented instrument present inside the root canal can prevent proper preparation of the root canal space. Overall endodontic prognosis following instrument separation depends on the stage and degree of canal preparation and disinfection at the time of the instrument fracture. Instrument fracture caused by iatrogenic error can occur due to repeated use of instruments, improper technique, lack of lubrication, insufficient knowledge and skills, and use of inappropriate instruments. Management of instrument fracture includes techniques such as bypass or retrieval. This case report describes endodontic bypassing with a separated instrument in a curved canal.

Endodontic treatment aims to clean, shape, and obturate the root canal system to prevent or treat apical periodontitis.^[1] However, procedural errors such as instrument separation can occur, complicating the treatment process and potentially jeopardizing the outcome. The separation of endodontic instruments within the root canal is a common and challenging problem that can hinder adequate canal cleaning and shaping, leading to potential treatment failure.^[2,3]

Instrument separation is frequently attributed to factors such as repeated usage, improper technique, insufficient lubrication, and the intrinsic material characteristics of the instruments themselves. The incidence of separated instruments varies depending on the type of instrument and the clinician’s experience. NiTi (Nickel-titanium) rotary instruments, while highly flexible and efficient, are more prone to fracture compared to stainless steel instruments due to their unique mechanical properties.^[4,5]

When an instrument fractures inside a root canal, it can block access to the apical portion of the canal, preventing thorough cleaning and disinfection. This can lead to persistent infection and failure of the endodontic treatment. The management of separated instruments includes techniques such as bypassing or retrieval. Bypassing involves negotiating a small instrument around the separated fragment to achieve patency and continue with the root canal preparation, whereas retrieval focuses on removing the fragment from the canal entirely.^[6-8]

This case report describes the successful management of a separated endodontic instrument in a curved canal of a maxillary molar using a bypassing technique. The case highlights the importance of clinical skill, appropriate technique, and the use of advanced tools to overcome the challenges posed by instrument separation. Through this report, we aim to provide insights into the practical application of bypassing techniques in endodontic practice and emphasize the need for continuous training and knowledge enhancement among endodontists.^[9]