Endodontic file fracture. The following is a guide, based on the literature, for prevention.
The fracture of an endodontic instrument may have a negative impact on treatment prognosis, mainly by blocking or preventing access to the entire root canal, compromising its conformation and cleaning.
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Although this is a controversial issue, the literature review indicates that the prognosis associated with a file fracture may have a favorable success rate of 89%, both in cases of vital and necrotic pulps. Cases in which there is a previous periapical injury have a worse prognosis, with a decrease in the success rate of up to 47%.
The approach to clinical situations with fractured instruments can be done either surgically or conventionally by non-surgical endodontic treatment, attempting removal or bypassing of the instruments. The approach route is usually the most recommended. It is important to keep in mind that this is a difficult process that requires, besides the knowledge and experience of the professional, specific materials, namely microscopy, in order to adopt a procedure that is as safe as possible.
The evaluation of the case must be done rigorously and some factors that may influence the possibility of removing the instrument are known to be important to consider, namely (Prof. Carlos Morais and Miguel Stanley).
The endodontic instruments, whether manual files, rotatory or reciprocating files or lentils and irrigation instrument and degates or Largo burs, can fracture inside the root canal in any region, apical, medium and cervical. If the speed, torque and other parameters such as type and direction of rotation are not respected, besides the incorrect use, there will be risk of separation of the instrument, often difficult to remove.
In case of failure in any technique, it is then indicated the paraendodontic surgery for resolution via apex, removing the instrument and performing retropreparation and retroobturation.
