Pt referred for management of separated file in the apical third of the MB root. Management of separated file cases are among the most difficult clinical problems encountered in endodontics. The following case series demonstrate successful orthograde management of several cases. The decision on whether to bypass or remove said file fragments is determined on a case by case basis. Bypassing the file and incorporating it into the filling material in many cases is an excellent method of managing these situations. I hope this case series will influence dentists to rethink the conventional wisdom that these cases can only be dealt with via apical surgery or extraction. Rather, referral to a skilled endodontist should be your first call.
In this particular case the separated file was bypassed successfully and incorporated into the fill. The primary objectives of RCT are canal debridement and sealing of all portals of exit. Bypassing a file fragment allows fulfillment of both these objectives and therefore the prognosis for this case is no different than that of any other root canal treated tooth. Note the puff of sealer at the end of the DB root confirming a proper apical seal has been achieved. (may need to click on picture ot magnify.)
