Instrument Fractures: Treatment

When instrument fracture occurs in the apical canal in the treatment of the vital pulp (e.g. pulpitis), the prognosis is not necessarily reduced if adequate aseptic measures have been employed both before and after fracture. However, in necrotic, infected root canals the prognosis is definitively worsened.
Primarily, the aim is to remove the fractured instrument from the root canal. This is best done with the use of ultrasound and specially designed tips. Other possibilities include the use of engine-driven trephines (e.g. the Masseran system).
If the fractured piece cannot be removed, the following strategies should be followed:
Vital teeth: long-term calcium hydroxide treatment (up to 3 months) followed by filling with gutta-percha and sealer.
Infected teeth: long-term placement of calcium hydroxide until the lesion heals. In some teeth, passing the fractured instrument (e.g. ribbon shaped canals) resolves the problem. However, in many cases, endodontic surgery and removal of the fractured instruments surgically is required for long-term success.