One of the most common mishaps that can occur during root canal therapy is when the root canal instrument (commonly known as a file) fractures (or “separates”) inside the root canal. This is an inherent risk, particularly in patients whose root canals are severely curved and calcified and/or hard to access.
The probability of an occurrence is linked to the difficulty of each case and to practitioner skill and experience.
Before treatment begins, the dental practitioner should fully explain this risk to any patient who could possibly be affected. If a file does fracture, prior knowledge of the risk will make the rectification process much simpler and less stressful for both the patient and the practitioner.
Should a file fracture during treatment by a general dentist, the following simple and sound protocol applies.
- Unless the practitioner is highly experienced in managing such incidents, has the necessary equipment, and can clearly see the fragment, they should not attempt to remove it, as removal is likely to result in further problems (more instrument fracture and possible perforation of the canal).
- You, as the patient, should be informed about what has occurred. Obviously, if a pre-warning of the possibility of instrument fracture has been given, this discussion is much easier. Any apology that the dentist makes is not an admission of fault but, rather, an acknowledgement of the concern and inconvenience the mishap may cause you.
- You should be advised to see a registered specialist endodontist to resolve the problem and complete the treatment.
- The dentist should phone the endodontist directly to discuss the matter and arrange an appointment, as well as sending a letter. This helps clarify for the endodontist exactly what has happened.
- Occasionally, as a gesture of goodwill, the general dentist may offer to pay the difference between his or her own proposed fee and that of the endodontist.
- Your specialist should endeavour to arrange an early appointment and resolution for the problem.
Only two high-level evidence studies relating to the effect of fractured instruments on prognosis have been published. They are based on specialist management, and ultimately the outcome in an individual’s particular circumstance cannot be related even to these studies. Your prognosis is best identified and discussed by the specialist managing your particular case.
The main take home messages are:
- A thorough pre-treatment assessment of you and your tooth by your dentist is paramount. This is what will inform any pre-warning of the risk of fractured instruments.
- If a mishap does occur, your understanding of it is important for proper further management.
- If you have a concern about this common inherent risk, ask for a referral to a specialist endodontist before starting treatment with a general dentist.
Should you experience a mishap of any kind in root canal therapy, please do not hesitate to call one of our endodontists, who will be able to offer assistance.