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Broken endodontic instruments and the importance of radiographs

10 March 2015
Radiographs are vital tools to determine what is happening in a patient’s mouth. Without this knowledge, problems can arise...

During his care of a patient over a three-year period, a practitioner took no radiographs. He root-filled a lower molar tooth and fitted it with a gold inlay. Subsequently the patient returned with pain but saw another practitioner in the practice. A radiograph was taken which showed a retained fractured file and the patient was referred to a specialist for advice and remedial treatment. 

During treatment the condition of a patient can change and this could lead to a change in diagnosis. In this case, had the original practitioner been aware of the fracture of an instrument by measuring each instrument before and after use, and taking x-rays during and after treatment he would have realised a piece of instrument was retained during instrumentation of one of the canals.

A radiograph (further investigation) could have been taken which would have confirmed the new diagnosis of ‘retained fractured instrument in mesial canal of non-vital lower molar’. The patient could then have been advised about the situation and the appropriate remedial action taken.

Learning points:

It is recognised that endodontic instruments do occasionally break, so the dentist must be responsible for checking for that possibility each time they are withdrawn from the canal; offering an appropriate response in such an eventuality. The possibility of this outcome ought to be discussed with the patient during the consent process.

2 comments
  • By fawzi on 12 July 2015 12:02 In theory a pt can always complain about everything and nothing !
  • By farshid on 25 June 2015 03:31

    does the pt have a right to  complain if he was advised of the probability of such a mishap during consent?

    if pt should be referred to endodontist, is the referring dentist liable to pay the extra cost of tx?

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