Breakage of Instruments

Amy Beth Dukoff, D.M.D.
Breakage of Instruments

Amy Dukoff

reakage of instruments is a common problem for all practitioners. Breakage can occur for a multitude of reasons. The operator can be as careful as possible and still an instrument may separate. The challenge then becomes how to turn this into a positive and successful situation. Handling the occurrence with confidence gives the patient the comfort of knowing that all will be well.
Fractures can occur with K-files, Hedstroms, reamers, NiTi, and rotary instruments. Generally, instruments should be discarded if one of the following occurs:

There are unwound flutes on the instrument.
The instrument has seen excessive use.
The operator had to place excessive bending or precurving.
You see corrosion on the instrument.

Instruments may separate for any of several reasons. They can break due to the operator’s overworking the file. One cannot force an instrument to the desired length. Instruments may also break due to advancing from a smaller to a larger instrument, skipping steps in the progressive sequence. Some instruments, especially the NiTi and rotary instruments, separate more easily than stainless steel. One can check NiTi instruments by bending them in one’s hand before use. Rotary instruments may break without warning during use.
Once an instrument is separated, the operator must inform the patient of the occurrence. Speaking to and informing the patient is usually the most difficult task. We want to transform the reaction of the patient from fear to comfort. Many times, a matter-of-fact approach is best, simply stating that an instrument separated because of the metal’s weakness. Speaking with confidence, demonstrating that you are in control of the situation, instills a feeling of comfort in the patient.
One clinical example is the following. I was referred a patient with a separated file in the MB1 canal. The other canals were calcified. (See Figure 1.) The patient was asymptomatic and aware of the occurrence. The patient was referred to me to complete the case. Upon accessing the case, I found an MB2 that bypassed the instrument and had a common apex. Also, I found the DB canal. (See Figure 2.) The patient remained asymptomatic throughout the treatment. In the final post-operative radiograph , the separated instrument could not be noted. The result was a success. (See Figure 3.)

FIGURE 1: A separated file in the MB1 canal.

FIGURE 2: An MB2 was found that bypassed the broken instrument and had a common apex.

FIGURE 3: In the post-operative radiograph, the instrument is not visible.

Breakage or separation of instruments are problems that all practitioners experience. No matter how hard one tries to avoid this occurrence, it usually will occur at some point. Sometimes the instrument is simply used as part of the obturation system. At other times the instrument is bypassed, or, during further instrumentation, the separated file is removed using one of a variety of techniques. Managing the situation will provide the patient with added confidence and trust in you.

May-June 2002

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