PMC9200180_01
(a) Preoperative clinical picture (b) Preoperative intraoral periapical radiograph irt 36 showing under-obturated canals with separated instrument at the apical third; (c) Displaced broken file extending 3 mm beyond apex; (d) CBCT depicting fractured file fragment in the coronal section; (e) Fractured fragment 2.14 mm beyond apex; (f) Broken file fragment back within the root canal
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F1
Intraoral periapical (IOPA) radiograph revealed under-obturated both canals [Figure 1a and b]. It was observed that GP was removed but the separated instrument was displaced further, around 3 mm beyond the apex [Figure 1c]. Fractured fragment measured 2.14 mm in length in the sagittal view of CBCT [Figure 1d and e]. To our surprise, separated instrument's radio-opacity was observed within the confines of the canal in the middle third [Figure 1f].
(a) Displacement of the file again into the periapical region; (b) Broken file back inside the canal again; (c) Retrieved instrument; (d) Confirmatory IOPA after file retrieval; (e) Post-obturation IOPA; (f) Follow up IOPA at 2 years
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F2
Further attempt led to the displacement of the file back into the periapical region [Figure 2a]. IOPA revealed the surprising movement of the file fragment back up to the middle third of root canal [Figure 2b]. Periapical radiograph was taken postoperatively for confirmation of file retrieval [Figure 2c and d]. In the subsequent visit, obturation was done with GP and AH plus sealer (Dentsply Maiellefer, Tulsa, Oklahoma, USA) using cold lateral compaction technique [Figure 2e]. Radiograph shows complete periapical healing is seen in relation to both the roots [Figure 2f].