Removal of fractured endodontic NiTi file in the apical third of the root canal using an alternative approach. A case report

This case report presents an alternative approach for the removal of a fractured endodontic instrument from the apical third of the root canal. A 52-years-old female patient was referred for specialized endodontic treatment of the maxillary left first molar due to the presence of a periapical lesion and root canal calcification. After clinical and radiographic examination, the calcification was confirmed. During biomechanical preparation, the fracture of a size 25/.06 NiTi reciprocating file (ProDesign R) occurred in the apical third of the palatine canal. The patient was informed about the complication and agreed with the attempt to remove the fragment. Firstly, a slight wear of the dentinal walls around the fragment was made using ultrasonic inserts under magnification. Then, a customized extractor was made using a hypodermic needle and a handling file whose mechanism is similar to the removal method previously described by Masserann. For this, the hypodermic needle was inserted in the root canal and the handling file was adapted in the needle lumen, with the function of fixing the fragment and removing it from the canal through the opposite movement performed by the fractured file. After associating the technique with a hypodermic needle and using ultrasound and an operating microscope to perform the procedure, the fragment was successfully removed. The association of techniques to remove fragments using only items already present in the endodontic arsenal can eliminate the need for surgical treatment and improve the prognosis of endodontic treatment through a safe, simple and cost-effective method that can be performed in the endodontic clinical routine.