CASE REPORT Broken instrument retrieval with indirect ultrasonics in a primary molar Musale PK 1 • Kataria SC 1 • Soni AS 1 Received: 30 March 2015 / Accepted: 28 August 2015 Ó European Academy of Paediatric Dentistry 2015 Abstract Background The separation of a file during pulpectomy is a rare incident in primary teeth due to inherently wider and relatively straighter root canals. A broken instrument hin- ders the clinician from optimal preparation and obturation of the root canal system invariably leading to failure, although in such teeth, an extraction followed by suit- able space maintenance is considered as the treatment of choice. This case report demonstrates successful nonsur- gical retrieval of a separated H file fragment in 84. Case report A 7-year-old girl was referred to the Department of Paedodontics and Preventive Dentistry for endodontic management of a primary tooth 84 with a dento-alveolar abscess. Her medical history was noncon- tributory. After diagnosing a broken H file in the mesio- lingual canal, the tooth was endodontically treated in two appointments. At the first session, a broken file was suc- cessfully retrieved after using low intensity ultrasonic vibrations through a DG 16 endodontic explorer viewed under an operating microscope. After abscess resolution, Vitapex root canal obturation with a preformed metal crown cementation was completed at a second session. Follow-up The patient was recalled at 3, 6, 12 and 15 month interval and reported to be clinically asymp- tomatic and radiographically with complete furcal healing. Conclusion Integration of microscopes and ultrasonics in paediatric dental practice has made it possible to save such teeth with a successful outcome. Favourable location of the separated file, relatively straighter root canal system and patient cooperation resulted in successful nonsurgical management in this case. Keywords Primary teeth Á Pulpectomy Á Instrument separation Á Separated instrument retrieval Á Indirect ultrasonics Background During any endodontic procedure on primary or permanent teeth, the risk of instrument breakage or fracture exists. Most stainless steel instruments appear to fail with exces- sive torque and multiple usage of files by an operator (Cheung 2009). The separated instrument leads to mechanical obstruction in the root canal which impedes further cleaning and shaping thereby compromising the successful clinical outcome (McGuigan et al. 2013). Clinically, every attempt should be made to bypass or retrieve the separated instrument. The feasibility of these treatment options is influenced by pulp vitality status, the root canal anatomy, the position and type of separated instrument and the amount of damage that would be caused to the remaining tooth structure during retrieval (Gencoglu and Helvacioglu 2009). In permanent teeth, successful instrument retrievals are carried out using ultrasonics, operating microscopes or microtube delivery methods by endodontists (Terauchi et al. 2006). Most of these techniques require preparation of a staging platform which leads to excessive removal of radicular dentine. Ideally, the instrument retrieval must be performed with minimum damage to a tooth and sur- rounding tissues while maintaining the original canal shape as much as possible (Fors and Berg 1983). In primary teeth, & Musale PK pedoprass@gmail.com 1 Department of Paedodontics and Preventive Dentistry, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India 123 Eur Arch Paediatr Dent DOI 10.1007/s40368-015-0203-y