A quick cure for separation anxiety

Retrieve a broken file in a matter of minutes with materials you already have

Mike Zerivitz, DDS
Deltona, FL

Friday ... last patient of the week. As soon as you complete this upper molar endo, you’re off on a long, well-earned weekend. You’ve just ... about ... refined the curved mesio/buccal canal ... when you hear a faint “click.” Your heart sinks.

NiTi instruments have revolutionized endo for the typical GP. But they may also have increased the incidence of file breakage.

The first time an instrument separates, it’s terrifying. With time, it loses its terror, but it remains a major annoyance.

Among the solutions suggested for removing file fragments are:

• trying to rattle it loose using
  ultrasonics
• trying to grab it with Steiglitz forceps
• trying to work around it using a thin file - praying you don’t add a “perforation” to your “separation”
• automatically referring the case to the endodontist

Here’s a file-removal technique I’ve used for a number of years. It’s my personal variation of a trick I learned at a seminar given by endodontist, Dr. John Schoeffel.

It doesn’t always work, but if you can see 2-3mm of the file fragment in the canal, this approach is so fast and so reliable, it’s a great first thing to try.

When Parkell asked me to write this little article they asked if I could take a few photos to illustrate it. Obviously, file breakage isn’t something you plan, and I’ve been enjoying an extended break-free period lately. (Now that I’ve written that, I’ll probably have a file separation next week.) That’s why the photos are of an extracted tooth.

1.) Using a bur, blade or scissors, cut the fuzzy tip off an Ultradent plastic or metal Infuser tip or one of their mini-brush tips (figure 2). Examine the tip to be certain the hole is open. If the cutting process has pinched it shut, open it with the tip of an explorer.

2) Try fitting the tip over the end of the broken file to assure that the modified tip is long enough to cover the entire exposed shank. Do this several times to be certain you can do it repeatedly. (In this particular case the file was jammed firmly against the side of the access chamber. Getting the tip over it was a little tricky - but as you’ll see, doable.)

3.) Express some Absolute Dentin core resin through its mixing tip directly into any Luer Lock syringe (figure 3). (To assure proper mixing, you should always bleed a bit of Absolute Dentin onto a pad both before and after affixing the mixing tip.)

4.) Twist the modified tip onto the Luer Lock syringe, and insert the plunger.

5.) Press the plunger and express a small amount of Absolute Dentin from the tip (figure 4). You’re doing this to be certain the tip is full of resin.

6.) Place the modified tip in the chamber, and push it as far down over the file as possible (figure 5).

7.) Hold the tip and syringe motionless for 3 minutes while the Absolute Dentin sets.

8.) Slowly rotate the syringe counter-clockwise, and the file fragment will “unscrew” from the root (figures 6 &7).

Does it have to be an Ultradent tip? Probably not. A Centrix needle tip might do it. But I prefer the taper of the plastic or metal Ultradent tip. It virtually assures there will be sufficient resin to grab the file flutes. Remember, the orifice has to be wide enough to slide over the shank and still allow a little room for the resin to surround the file.

About the author: Michael A. Zerivitz, DDS is a 1977 graduate of the University of Maryland School of Dentistry. A former Naval Dental Officer, he operates a general practice in the Deltona, Florida. He can be contacted at his office: 386-574-5201.

For more information about Absolute Dentin click here.