Broken Instrument

As Grossman famously stated in 1969, "Any clinician who hasn't broken an instrument simply hasn't performed enough endodontic treatments." Of course, it is not something desirable or pleasant when it happens, but it certainly does not constitute a condemning factor for the treatment itself. Nevertheless, there is considerable fear among both patients and fellow dentists regarding the "broken instrument." While it can't be compared to "forgetting a clamp in the patient's abdomen," negligence is also not justifiable when it occurs.

Can a broken instrument travel through the body and become lodged in distant organs, like the heart? Does it cause pain or rust? The answer to these questions is a definitive NO. Indeed, as the literature demonstrates, the fracture of a micro-instrument by itself does not significantly reduce the prognosis of an endodontically treated tooth, especially when there is no pre-existing infection in the root canal or if the instrument broke in the final stage of the chemomechanical preparation.

The endodontist is the most qualified specialist to manage this situation. In the majority of cases, the broken instrument can be removed or bypassed. In other cases, it may be decided to leave it in the root canal, complete the endodontic treatment up to the point of the fragment, and monitor the case. Sometimes, microsurgery is the most appropriate solution.

In any case, we must always remember that the goal of endodontic treatment is to preserve or restore the health of the periapical tissues. The removal of the broken instrument is never an end in itself if it jeopardizes the health of the dental tissues.

To clarify this serious issue, in the latest issue of Dental Step, the Greek Endodontic Society published its official position.

You can view the PDF on the HES website: https://www.endodontics.gr/wp-content/uploads/2020/09/%CE%95%CE%95%CE%95135.pdf