Push and Pull Your Way to Success!
is case appeared difficult- the coronal portion of the separated file was beyond the curve of the canal and barely visible under the microscope. In addition, there was a perforation on the lingual wall, as you can see on the coronal view of the CBCT. A clinician should always take a CBCT to assess the degree of the curvature and the direction of the curve. This is necessary to guide the ultrasonic tip into the space between the inner curve and the broken instrument. The TFRK-S ultrasonic tip is pre-curved by the clinician to meet the canal curvature of the distolingual root. During ultrasonic activation, the separated file segment shifted upwards and the coronal portion became completely visible. The canal was filled with EDTA and the ultrasonic tip was activated in the thin space. A couple of short push-pull motions with the ultrasonic tip caused the separated file to pop out in just five seconds.
Next, the ledge was addressed to establish apical patency for the distolingual canal. I used a #15 .04 VortexBlue file to bypass the ledge. This file is a flexible martensitic instrument with a biconical tip. The VortexBlue file was precurved to access the original canal without entering the perforation. The key to success in managing the ledge is to use a push-pull motion with a biconical tip file- never rotate the file. Apical patency was successfully established, as demonstrated on the radiograph. A significant quantity of pus issued from both the distobuccal and distolingual canals once canal terminus was reached with the file.