This document discusses strategies for managing dental files that break off during root canal procedures. It describes common causes of file separation and provides guidelines for attempting to retrieve or bypass broken files based on their location within the root canal. For files broken in the apical or middle portions, the document recommends bypassing or obturating the canal up to the file fragment. For coronal fractures, removal is suggested when possible with minimal dentin removal. It also provides options for cases where initial retrieval or bypass attempts fail, such as using calcium hydroxide medication or periapical surgery. The document stresses considering microbial and biomechanical factors when making clinical decisions.

1. Retrieve, bypass or entomb for an endodontic separated file
By Dr Nay Aung, BDS PhD
Common causes of instrument fractures
1. Using the instrument many times
2. Working in severely curved areas
3. Not using a lubricant or irrigant
4. Not using the rotary system in sequential order
Retrieval of a broken file

2. Bypass Procedure
1. Analyze the position of the fracture by Xray.
2. Use Glyde lubricant and NaOCl irrigation.
3. Widen the area coronal to the separation by GG burs.
4. Use ISO size 8 or 10 to negotiate the area of the fracture.
5. Use watch-winding motion.
6. Always start buccally or lingually to the separated instrument
7. Never use ‘FORCE’.

3. Using Broken Tool Removal (BTR) pen
The use of Ca(OH)2 dressing for 2-4 weeks can be recommended for the following cases:
- bypass technique failed
- attempts to remove fractured instrument from root canals took more than 60 min and are
not successful
- instrument fractured beyond the curvature and attempt to its retrieval is dangerous with
relation to root weakening and perforation
After this procedure, root canal obturation and follow-up after 6 and 12 months are
recommended.
If the periapical lesion increases, periapical surgery or extraction should be considered.
Decision Making
Vital Pulp (Not a heavily infected canal). Location of fragment can influence our decisions-
a. Instrument fractured in the apical part of the canal-
Removal of the fractured file fragment should not be attempted. One should change working
length, prepare canal up to the fragment, use some type of NaOCl agitation and obturate the
canal in the same visit.

4. b. Instrument fractured in the middle part of the canal-
One should try to bypass the broken instrument. If bypass is impossible, my recommendation is
to obturate the canal up to the instrument; Follow-up is obligatory, and in case of post-treatment
endodontic disease, apical surgery should be considered.
c. Instrument fractured in coronal part of canal-
Removal of a fractured instrument should be attempted with minimal dentin removal, different
types of grasping equipment can be used
Non Vital Pulp (An Infected Case)
The stage of shaping and cleaning at the moment of file breakage influences our decisions-
a. Instrument fractured after major cleaning and shaping- canal is prepared to at least size
#30. Recommendations are the same as in vital pulp cases:
1. Apical third of the canal: removal of the fractured file fragment should not be routinely
attempted. Obturation up to the fragment is recommended.
2. Middle part of the canal: one should try to bypass the broken instrument. If bypass is
impossible, obturate canal up to instrument and follow up, apical surgery should be
considered.
3. Coronal part of the canal: removal of fractured instrument should be attempted with
minimal dentin removal.
b. Separation of instrument before significant instrumentation and irrigation have been
performed
1. Bypass is highly recommended. Canal cross-section influences this procedure: Long oval
and flattened canals and isthmuses enables this procedure, while round canal can impede
it. If bypass was successful completion of shaping of the canal by hand files up to size
#30 is recommended. Removal of the fragment is not necessary.
2. If bypass was unsuccessful, inter-appointment medication with Ca(OH)2 for two – four
weeks combined with NaOCl agitation is recommended for disinfection. After final
obturation, follow-up is obligatory, and in case of post-treatment endodontic disease,
apical surgery should be considered.
Successful removal of fractured instruments may risk the long-term outcome of the tooth by
sacrificing sound peri-cervical dentin, which may lead to perforations and predispose the tooth to
vertical root fracture. The clinician should consider the micro-biological and biomechanical
aspects during clinical decision making.

5. Bypassing a broken file
References
1. Broken instruments – Clinical decision-making algorithm (by Dr Michael Solomonov)
2. A modified partial platform technique to retrieve instrument fragments from curved and
narrow canals: A report of 2 cases (by Bharadwaj Narasimhan, et. al.)
3. Bypassing a broken instruments (Clinical Cases) (by Elka Radeva)