Broken endodontic instruments and the importance of radiographs
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.
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do occasionally break, so the dentist must be responsible for checking for that possibility each time they are withdrawn from the canal; offering an appropriate response in such an eventuality.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.
These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits Dental Protection members enjoy as part of their subscription.
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