In addition, I also refer you to my Ruddle on Retreatment DVD "Removal of Posts and Broken Instruments" to exactly explain this precise clinical technique. More information on the File Removal System is posted to the Inventions page of this site. With the broken instrument strongly engaged, it can generally be readily removed. Rotating the screw wedge handle counterclockwise (CCW) tightens, wedges, and oftentimes, displaces the head of the file through the microtube’s side window. The screw wedge is then placed through the open end of the microtube and passed down its internal lumen until it contacts the broken instrument. The microtube is inserted into the canal and, in the instances of canal curvature, the long part of its beveled end is oriented to the outer wall of the canal to "scoop-up" the head of the broken instrument and guide it into its lumen. The microtube has a small handle to enhance vision and its distal end is constructed with a 45° beveled end and side window. The File Removal System is composed of variously sized microtubes and screw wedges. When ultrasonic techniques fail, the fall-back option is to use the File Removal System (Dentsply Tulsa Dental) which provides a breakthrough in the retrieval of broken instruments lodged within the root canal space. Oftentimes, the broken instrument will "jump out" of the canal.Īre there any other techniques for removing broken instruments when ultrasonics, alone, does not work? The idea is to transfer ultrasonic energy to the broken instrument so that it will loosen, unwind and then spin. Once the head of the broken instrument is readily visible then specially designed contra-angled, parallel-walled and abrasively-coated ultrasonic instruments (ProUltra ENDO Tips #3, 4, 5, Dentsply Tulsa Dental) are selected to sand away dentin and trephine circumferentially around the obstruction. The microscope, in conjunction with ultrasonic techniques, has led to precise microsonic techniques. GG’s are used like "brushes" and each larger GG is stepped out of the canal to create a smooth flowing funnel which is largest coronally and tapers down to the head of the broken file. If radicular access is limited, then hand files are used serially small to large, coronal to the obstruction, to create sufficient space to safely introduce gates glidden (GG) drills.
Before establishing radicular access, attention is directed towards pre-operative radiographs and working films to better appreciate the root bulk, thickness of the dentinal walls, and if present, the depth of an external concavity.
The techniques required to remove a broken instrument first begin with establishing complete coronal access.
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