NON-SURGICAL REMOVAL UNDER MICROSCOPIC GUIDANCE OF A BROKEN FILE PROTRUDING INTO THE MAXILLARY SINUS

Abstract

We report a case in which a piece of a file that had broken inside the root canal as a result of inappropriate device manipulation by a dentist and was protruding through the apical foramen into the maxillary sinus was removed non-surgically under microscopic guidance via the root canal, and a good treatment outcome was achieved.

The patient was a 36-year-old woman. A dental X-ray showed an opacity caused by a broken instrument projecting from the apical foramen of the maxillary left second premolar. Computed tomography (CT) showed that most of the broken piece was located in the left maxillary sinus, and that the mucosae of this sinus were hypertrophic around the apical foramen of the maxillary left second premolar. As only a small part of the broken piece remained within the root canal, we began root canal treatment after explaining to the patient that there was a possibility that the broken piece might come free in the maxillary sinus and that if this happened then surgery under general anesthesia would be required, and obtaining her consent. A MICROFILE Type-H fitted with an ENDOHOLDER was used under microscopic guidance to remove the broken piece by rotating it anticlockwise (as the microscope generated a mirror image, the rotation appeared to be clockwise) to loosen it. An ultrasound tip was not used out of concern that it might cause the broken piece to come free in the maxillary sinus. After the broken piece had been removed, the damaged apical foramen was plugged with calcium hydroxide–distilled water paste, and the root canal was filled after the apex had become calcified.

In this case, CT simulation before the procedure and manipulation under microscopically guided visual observation enabled the broken piece to be removed non-surgically via the root canal, and a good treatment outcome was achieved.