Fragmento separado de lima endodóntica en el tercio apical: Reporte de caso con 13 años de control

Abstract

The primary objective of endodontic treatment is to eliminate or prevent infection within the root canal system by removing pulp tissue, bacteria, and their byproducts, while preserving the original canal anatomy, thus enabling effective three-dimensional sealing in the obturation. This is particularly crucial in cases with significant infection. This case report details the management of a previously initiated therapy with an acute apical abscess in tooth 46, complicated by a separated instrument in the mesio-buccal root at the apical portion, which could not be removed and was therefore left incorporated within the obturation. The canal was instrumented using the K3 XF system, with files 25.10, 25.06, and 25.04 for the mesial canals, and 30.04 for the distal canals. Irrigation was performed with 5.25% sodium hypochlorite, 17% EDTA, and saline, which were activated by ultrasonics. Intracanal medication with calcium hydroxide was applied for 21 days, with two changes at 7 and 15 days. The root canal was then obturated using the continuous wave technique. Success can be shown with follow-up after 13 years. This report emphasizes the protocol to follow when retrieval or bypassing a separated instrument is not feasible. The success of the treatment was attributed to thorough decontamination achieved, in this case by ultrasonic irrigation, the use of calcium hydroxide to reduce the microbial load, and the appropriate obturation technique. Finally, the definitive restoration of the tooth ensured its long-term preservation.