How to bypass a broken file: Friday Questions

[Allen Ali Nasseh]

In this video, Dr. Nasseh discusses some strategies for bypassing broken or separated NiTi files in the root canal.
[See the full post at: How to bypass a broken file: Friday Questions]

[nano]

Dr, Nasseh,

I am a 41 year old female who had a broken file in my canal tooth 30 from about 20 years ago when I did the first root canal. See the first picture showing the broken file in my root. Apparently, I have had an infection in this tooth since then but it never hurt me so I never did anything about it. Last week I had a re treatment on this root canal as they kept telling me I needed it and I had an infection. The endo told me the file could not be removed because it would be very difficult to remove. He told me he would try to bypass the broken file and finish the root canal i.e. re treatment of the root canal.

After about 1 hour of doing the re treatment he said he was done. He showed me the x-ray attached which shows the before picture showing the broken file in the root of the tooth and the after picture and it seems like the file has been pushed down into the apex. I don’t know if this will cause me pain going forward as it”s only been about 1 week and I have not used the tooth yet. The doctor said to monitor it with x-rays going forward and maybe surgery would be needed to remove the broken file in the apex if I feel pain or the infection does not go away.

When you try to bypass a broken file in a re treatment is it normal for the file to go past the apex or is this not normal a potential problem for me? Should he have tried to bypass the file or just told me to remove the tooth because pushing the file past the apex is actually worse than removing the tooth?

I understand that I needed a re treatment of the root canal and removing the broken file from years before was not possible but now I”m wondering if just removing the tooth would have been better than having the broken file pushed down into the apex.

What should I do going forward now with this broken file in my apex?

• This reply was modified 3 years, 11 months ago by nano.

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[Allen Ali Nasseh]

Let’s focus on the problem rather than finding fault. I agree with the assessment to wait and monitor. Yes, there’s a chance that apicoectomy is needed if the lesion expands or if symptoms develop down the line. But retreatment was still the best first step. Now the question is if apicoectomy is also needed at some point or not. You should restore the tooth right away with a definitive filling. You can wait for the crown if needed; but do not wait with a provisional for an extended period “to see what happens” as it can get cause a separate problem. It’s not as bad as situation as you may think. The overextension of the material/file is not necessarily a problem; and if a problem comes up (pain/swelling) apicoectomy by an experienced surgeon/endodontist will have a good prognosis. Good luck.

[Zaman Shihab]

How to bypass this apical broken file plz give me guidelines

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