Two broken fragments removal (by Ilya Mer)

It is well known that shit happens if dentist needs any treatment. This patient is a dentist came to my practice in order to complete the RCT and remove broken Protaper in distal canal. I ‘m told that fragment is several millimeters out of root. I do two X-ray with different horizontal angle in order to understand the relationship with mandibular canal and find TWO fragments! Both are partially outside. The first fragment was removed very calmly. I have to remove some dentin along the file with ultrasonic and the Protaper tip moved out, it took me no more than 15 minutes. The second fragment made me sweat. The whole instrument was out of sight around the buccal curve. After removing the minor curve I could see the upper side of the fragment. The idae was to spin the fragment against clockwise. But it simple to say but very difficult to do, especially if the fragment had only 1.5mm inside the root and the rest was outside. I had to irrigate after all ultrasonic shot because of bleeding from periapex. Miracle happened after almost 40 minutes. But look at the fly in the ointment… The tip of fragment remained in the bone. I have doubts that I could break it because I influenced only on the upper part of the fragment. At the second visit after calcium hydroxide removing MTA apical plaug was performed in the distal and obturation by squirt technique in mesials.

Two fragments seen in different angulation
The first fragment is taken out
The second fragment is still on its place, in order to see it I have to remove a minor curve of distal canal
The second fragment is taken out but the tip remains in the periapex
MTA apical plug in distal
Final X-rays

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