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Medical Forum / General / Dentistry / January 2007URGENT: Question about mistake during root canal
We made the mistake (?) of letting my wife's sister in Mexico do a root canal on her. She was visiting and it needed done, so her sister wanted to do it. (Yes, her sister is a dentist and I understand she went to a very good dental school. But she has not been practicing very long at all and I felt very insecure about having her do a root canal and crowns... but it was hard to get out of letting her sister do it.) She broke off one of those little attachments inside my wife. Not sure what it is exactly, but one of those little dealies they use to clean the root I guess, something like that. She (her sister, the dentist) tried to say "Don't worry about it, we'll take care of it when you come back in June..." (My wife's plane was due to leave to come back home on Monday.) I said "No way! Get that thing out of there! Go to a really good oral surgeon or endodontist or whatever it takes and get it out of there!" Did I do the right thing? Aren't I right, that she shouldn't just leave it in there for awhile? My other question is: How much would it normally cost, in your area, to do the surgery required to get that thing out of there? Now I"m thinking, if she didn't get it done today, maybe I'll just have it done up here - IF it doesn't cost an arm and a leg... Thanks for your feedback! Without seeing her, it sounds like your sister-in-law broke off a file in the tooth during treatment. Does this happen, yes. It is a risk that can occur when having any root canal done. If it happened to me (and it has, as it has to every dentist who has done enough root canals), you stop, inform the patient what has happened. I would have the patient see an endodontist in such a situation. I think waiting until June is a bit long since it sounds like the root canal has been partially done. Perhaps you should get the full story before having her see one so that you can convey all the relevant information to the specialist (ie. in which canal did the file separate, what size file, etc) As for cost, an endodontist maybe able to remove or just bypass the broken file, so cost would be the same as for a root canal for that tooth (although slightly higher given the greater difficulty of this technique as well as the generally higher fee that a specialist charges). Alternatively she may need some sort of root end surgery. Can't say without seeing or knowing exactly what happened. I'm sure the endodontist will provide you with an estimate. Any estimate we give you may be totally off given we don't exactly know what needs to be done. J Suljak DDS > Without seeing her, it sounds like your sister-in-law broke off a file in > the tooth during treatment. Does this happen, yes. It is a risk that can [quoted text clipped - 6 lines] > relevant information to the specialist (ie. in which canal did the file > separate, what size file, etc) I love that word "separate". > As for cost, an endodontist maybe able to remove or just bypass the broken > file, so cost would be the same as for a root canal for that tooth (although > slightly higher given the greater difficulty of this technique as well as > the generally higher fee that a specialist charges). I think the patient should be prepared for an extra fee, esp. if something like the Maserin kit has to be used. Alternatively she may > need some sort of root end surgery. Can't say without seeing or knowing > exactly what happened. I'm sure the endodontist will provide you with an > estimate. Any estimate we give you may be totally off given we don't > exactly know what needs to be done. I have heard even endodontists recommend that if the canal has been pretty thoroughly cleaned out and the file fragment is in the apical 1/3 that the likelihood of success is fairly high. If this is the case and the tooth is otherwise assymptomatic it may be worthwhile to do some kind of provisional restoration and wait a while. I personally am afraid of things like the Maserin kit, and have almost never been successful removing broken fragments with ultrasonics. I have sometimes been able to bypass broken files, but the danger is always creating a new canal. Yes, if in doubt, I refer. Steve > J Suljak DDS  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > I have heard even endodontists recommend that if the canal has been pretty > thoroughly cleaned out and the file fragment is in the apical 1/3 that the > likelihood of success is fairly high. I have seen this done. Generall, success will be higher if the tooth was asymptomatic and pulp was not necrotic, lower if the opposite was true. > If this is the case and the tooth is otherwise assymptomatic it may be > worthwhile to do some kind of provisional restoration and wait a while. Agreed. > I personally am afraid of things like the Maserin kit, and have almost > never been successful removing broken fragments with ultrasonics. I have > sometimes been able to bypass broken files, but the danger is always > creating a new canal. Yes, if in doubt, I refer. > in which canal did the file >> separate, what size file, etc) > > I love that word "separate". It is the correct terminology. > I have heard even endodontists recommend that if the canal has been >pretty thoroughly cleaned out and the file fragment is in the apical 1/3 >that the likelihood of success is fairly high. If this is the case and >the tooth is otherwise assymptomatic it may be worthwhile to do some >kind of provisional restoration and wait a while. Generally this is true, and with NiTi there is no corrosion. > I personally am afraid of things like the Maserin kit, and have almost >never been successful removing broken fragments with ultrasonics. I >have sometimes been able to bypass broken files, but the danger is >always creating a new canal. Yes, if in doubt, I refer. > >Steve OK I give, what's a Maserin Kit ? Are you using an endodontic ultrasonic ? If so, which one ? Bypassing an possibly removing separated instruments are largely a function of the type of instrument that has separated and the location. Have been able to remove some, but it is very time consuming. If you can bypass it, you can still get good obturation and may be able to remove the fragment. This is a good reason to toss endo files frequently, perhaps after one or two cases. And yes, I mean *both* rotary and hand files. IMO you can't detect metal fatigue until it's too late. >>in which canal did the file >> [quoted text clipped - 3 lines] >> > It is the correct terminology. Me too. The wiseguys in Brooklyn have taken to saying "I'm gonna separate your face". >> I have heard even endodontists recommend that if the canal has been >>pretty thoroughly cleaned out and the file fragment is in the apical 1/3 [quoted text clipped - 3 lines] > > Generally this is true, and with NiTi there is no corrosion. There probably isn't much with stainless steel either. But with NiTi it's of course less likely you're zipping an apex, so in a curved canal I think it's likely it would break less. I'm also guessing you don't break many NiTi instruments because you ain't cheap. >> I personally am afraid of things like the Maserin kit, and have almost >>never been successful removing broken fragments with ultrasonics. I [quoted text clipped - 4 lines] > > OK I give, what's a Maserin Kit ? Sorry, I misspelled it. Here is a brief description: http://www.micro-mega.com/anglais/produits/masseran/index.php > Are you using an endodontic ultrasonic ? No I'm not, and I use perio ultrasonic largely for fractured posts or peeso/gates gliddens. I'm no apex boy. I leave that to the specialists. If so, which one ? > Bypassing an possibly removing separated instruments are largely > a function of the type of instrument that has separated and the location. [quoted text clipped - 6 lines] > or two cases. And yes, I mean *both* rotary and hand files. > IMO you can't detect metal fatigue until it's too late. I agree 100%. Happy New Year! Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >>>in which canal did the file >>> [quoted text clipped - 20 lines] > I'm also guessing you don't break many NiTi instruments because you >ain't cheap. I look at it this way, what is cheaper, new endodontic instruments or the cost of a potential RCT failure due to separation ? It's a no brainer. I routinely go through several 6, 8 files in some molar cases. For NiTi, if it gets torqued it gets tossed. Especially in closed bi's and almost all molars one case is more than plenty. Suspect that most toss carbide or diamond burs after only a few uses, same applies to files. Toss 'em ! Frequently ! I say !!! When in doubt, throw it out. <not to be confused with Ted Nugent's philosophy> ;-) >>> I personally am afraid of things like the Maserin kit, and have almost >>>never been successful removing broken fragments with ultrasonics. I [quoted text clipped - 8 lines] > >http://www.micro-mega.com/anglais/produits/masseran/index.php Kewl, am gonna consult with Dr. Endo about this before I buy one. >> Are you using an endodontic ultrasonic ? > > No I'm not, and I use perio ultrasonic largely for fractured posts or >peeso/gates gliddens. I'm no apex boy. I leave that to the specialists. Alas, perio ultrasonics are just not designed for this application. > If so, which one ? >> [quoted text clipped - 14 lines] > >Steve Same to ya ! >>>>in which canal did the file >>>> [quoted text clipped - 31 lines] > When in doubt, throw it out. > <not to be confused with Ted Nugent's philosophy> ;-) All I remember is "make believe your face is a Maserati..." Steve >>>> I personally am afraid of things like the Maserin kit, and have almost >>>>never been successful removing broken fragments with ultrasonics. I [quoted text clipped - 38 lines] >> > Same to ya ! SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Using a different id through google groups, at work... but this is JimSocal: Thanks for all the feedback. Apparently the file broke off after the root canal treatment was done, that is the root canal does not need to be finished. I could not get the size of the file from my wife, but she has an appt. with an endodontist on Friday. So what you are saying is that sometimes it IS alright to leave the file inside? Thanks to all for the help. > Using a different id through google groups, at work... but this is > JimSocal: > Thanks for all the feedback. > > Apparently the file broke off after the root canal treatment was done, > that is the root canal does not need to be finished. I don't understand what you're saying here. Instrumentation was completed? I could not get > the size of the file from my wife, but she has an appt. with an > endodontist on Friday. > > So what you are saying is that sometimes it IS alright to leave the > file inside? Yes. Steve > Thanks to all for the help. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Using a different id through google groups, at work... but this is >> JimSocal: [quoted text clipped - 4 lines] > > I don't understand what you're saying here. Instrumentation was completed? Not sure what I mean. As I understand it, the root canal procedure was finished when the file broke off. I don't see how that could be true, because if it was finished, then why would the dentist still be using the file? All I know is what my wife told me and that's how she said it, that the rct was finished. In any case she's going to an endo on Friday so hopefully the endo knows his/her stuff and will do whatever is necessary to protect my wife's health and tooth. Thanks for everyone's comments. |
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