Case 26 Separated instrument - surgical approach

Pre-operative x-ray #13

Separated lentulo-type paste filler in apical third of root.
Periapical lesion present and the tooth is symptomatic to occlusal pressure.

Photo of removed instrument with bur for scale

Post-operative x-ray #13

Separated instruments pose two problems: should they try to be removed or should the tooth holding the separated file be surgically retreated? My philosophy is any separated file in the top one-third of the canal system has a good chance of being removed. I also believe any separated instrument in the last half of the canal system is usually non-retrievable. If a surgical approach is done, all attempts should be made to retrieve the separated instruments apically. Any kind of apical filling seals best when a metal instrument has been removed. It is difficult to make an adequate apical preparation against a metal instrument. Indecently, plastic thermal files are relatively easy to prep against.