Fractured endodontic instrument: clinical decision making, and its influence on success rate of endodontic treatment

The fracture of an endodontic instrument is a recognized complication in endodontics.The immediate response to a fractured instrument is frequently regarded as the treatment failure. Several factors must be taken into account to evaluate the prognosis of the tooth. Although integration of modern technique into endodontic practice has improved the clinician’s ability to remove fractured files, removal may not always be possible or even desirable. Analysis of the literature shows that the presence of a fractured instrument need not reduce the prognosis if the case is well-treated and there is no evidence of apical disease. Given the variants of anatomy that Mother Nature may have placed in the canals, roots and /or jaw of that particular patient, we now have added an iatrogenic factor. In a quest to develop better instruments and techniques to improve our quality of care, we have developed a double-edged sword, an instrument that can cut and shape the dentin wall efficiently, and in the blink of an eye, cut into the peace of the mind of the operator when it separates. The aim of the paper is an attempt to place fractured instrument in context, and to manage the situation both clinically and medico-legally.