The Importance of Irrigation
Every separated file removal case is different and how it should be removed is also different, although the principle of separated file removal is always the same. You have to take CBCT on every case as it will show you where the separated file is, the length of the separated file, and the curvature of the canal to estimate the separated file removal time. Without CBCT, nothing would be predictable. In this case, everything went as planned. I didn’t use the Micro-Trephine Bur #5 or TFRK-S Tip because the canal curvature was greater than 15 degrees and the separated file was loosened just with TFRK-12 tip alone. The separated file was 2 mm, which is considered retrievable with ultrasonics alone, and the separated file was found in the MB canal curved mesiopalatal on the coronal and sagittal views. A thin space on the inside canal wall (mesiopalatal wall) was created with a precurved TFRK-12 tip and the separated file was immediately loosened with ultrasonics. EDTA was filled in the canal to enhance separated file removal. The same precurved TFRK-12 tip was placed in the space created and ultrasonically activated for 5 seconds. The file didn’t come out; I thought the ultrasonic tip itself must have blocked the space for the separated file to go through. If this is the case, you should either irrigate the canal or sharpen the ultrasonic tip and get back into the canal to take it out. As soon as I irrigated the canal, the separated file came out. There was another separated file in the DB canal. The separated file removal time was 4.5 minutes. The radiograph taken after the separated file was removed shows the dentin sacrifice was very little.