Management of Separated Instruments Using Ultrasonic Technique and a Novel Loop Device (Kamand): A Case Report
Abstract
Separation of endodontic instruments can compromise canal disinfection and long-term prognosis. Microscope-guided ultrasonics combined with a loop device may improve retrieval in anatomically demanding canals. Three molars with fractured instruments in challenging canals (maxillary MB2, maxillary distobuccal, mandibular mesiolingual) were managed under a dental operating microscope. A staging platform was created with a modified #2 Gates-Glidden bur, followed by conservative ultrasonic troughing (ED87 tip) to create space around the fragment. The Kamand loop system was then used to engage and retrieve the fragment. Devices were used according to manufacturers’ instructions; any variant use is reported in the Case Presentation. All fragments were retrieved and canals were subsequently cleaned/shaped to 25–30/.04 with warm vertical obturation using AH Plus sealer. Patients were asymptomatic at 6–12 months with radiographic findings consistent with periapical healing. A combined approach, precise ultrasonic troughing to create safe space, followed by loop capture, enabled conservative and predictable retrieval of separated instruments across different canal anatomies, facilitating definitive disinfection and obturation. Keywords: Dental equipment; Endodontics; Equipment failure; Root canal therapy; Ultrasonics.
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9. Shahabinejad H, Ghassemi A, Pishbin L, et al.: Success of ultrasonic technique in removing fractured rotary nickel-titanium endodontic instruments from root canals and its effect on the required force for root fracture. J Endod. 2013;39:824-28.
10. Garg H, Grewal M: Cone-beam computed tomography volumetric analysis and comparison of dentin structure loss after retrieval of separated instrument by using ultrasonic EMS and ProUltra tips. J Endod. 2016;42:1693-98.
11. Wohlgemuth P, Cuocolo D, Vandrangi P, et al.: Effectiveness of the GentleWave System in removing separated instruments. J Endod. 2015;41:1895-98.
12. Gerek M, Baser E, Kayahan M, et al.: Comparison of the force required to fracture roots vertically after ultrasonic and Masserann removal of broken instruments. Int Endod J. 2012;45:429-34.
13. Wang NN, Ge JY, Xie SJ, Chen G, Zhu M: Analysis of Mtwo rotary instrument separation during endodontic therapy: a retrospective clinical study. Cell Biochem Biophys. 2014;70:1091-95.
14. Fu M, Zhang Z, Hou B: Removal of broken files from root canals by using ultrasonic techniques combined with a dental microscope: a retrospective analysis. J Endod. 2011;37(5):619-22.
15. Madarati AA, Hunter MJ, Dummer PM: Management of intracanal separated instruments. J Endod. 2013;39:569-81.
16. Haridas H, Abraham CS, Mishra SA, et al.: Cyclic fatigue and fracture resistance in contemporary rotary file systems: an evidence-based review. BioScan. 2024;19:702-06.
17. Terauchi Y, Ali WT, Abielhassan MM: Present status and future directions: removal of fractured instruments. Int Endod J. 2022;55(Suppl 3):685-709.
2. McGuigan MB, Louca C, Duncan HF: Endodontic instrument fracture: causes and prevention. Br Dent J. 2013;214(7):341-48.
3. Tzanetakis GN, Kontakiotis EG, Maurikou DV, Marzelou MP: Prevalence and management of instrument fracture in the postgraduate endodontic program at the Dental School of Athens: a five-year retrospective clinical study. J Endod. 2008;34:675-78.
4. Sattapan B, Nervo GJ, Palamara JE, Messer HH: Defects in rotary nickel-titanium files after clinical use. J Endod. 2000;26:161-65.
5. Ankrum MT, Hartwell GR, Truitt JE: K3 Endo, ProTaper, and ProFile systems: breakage and distortion in severely curved roots of molars. J Endod. 2004;30:234-37.
6. Eskibağlar M, Özata MY, Ocak MS, Öztekin F: Investigation of fracture prevalence of instruments used in root canal treatments at a faculty of dentistry: a prospective study. Restor Dent Endod. 2023;48:e38.
7. Shaik I, Qadri F, Deshmukh R, et al.: Comparing techniques for removal of separated endodontic instruments: systematic review and meta-analysis. Int J Health Sci (Qassim). 2022;6:13792-13805.
8. Souter N, Messer H: Complications associated with fractured file removal using an ultrasonic technique. J Endod. 2005;31:450-52.
9. Shahabinejad H, Ghassemi A, Pishbin L, et al.: Success of ultrasonic technique in removing fractured rotary nickel-titanium endodontic instruments from root canals and its effect on the required force for root fracture. J Endod. 2013;39:824-28.
10. Garg H, Grewal M: Cone-beam computed tomography volumetric analysis and comparison of dentin structure loss after retrieval of separated instrument by using ultrasonic EMS and ProUltra tips. J Endod. 2016;42:1693-98.
11. Wohlgemuth P, Cuocolo D, Vandrangi P, et al.: Effectiveness of the GentleWave System in removing separated instruments. J Endod. 2015;41:1895-98.
12. Gerek M, Baser E, Kayahan M, et al.: Comparison of the force required to fracture roots vertically after ultrasonic and Masserann removal of broken instruments. Int Endod J. 2012;45:429-34.
13. Wang NN, Ge JY, Xie SJ, Chen G, Zhu M: Analysis of Mtwo rotary instrument separation during endodontic therapy: a retrospective clinical study. Cell Biochem Biophys. 2014;70:1091-95.
14. Fu M, Zhang Z, Hou B: Removal of broken files from root canals by using ultrasonic techniques combined with a dental microscope: a retrospective analysis. J Endod. 2011;37(5):619-22.
15. Madarati AA, Hunter MJ, Dummer PM: Management of intracanal separated instruments. J Endod. 2013;39:569-81.
16. Haridas H, Abraham CS, Mishra SA, et al.: Cyclic fatigue and fracture resistance in contemporary rotary file systems: an evidence-based review. BioScan. 2024;19:702-06.
17. Terauchi Y, Ali WT, Abielhassan MM: Present status and future directions: removal of fractured instruments. Int Endod J. 2022;55(Suppl 3):685-709.
| Files | ||
| Issue | Vol 12, No 3 (Summer 2025) | |
| Section | Case Report(s) | |
| Keywords | ||
| Dental equipment; Endodontics; Equipment failure; Root canal therapy; Ultrasonics. | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Panjtanian SA, Mirzaei A, Moushekhian S. Management of Separated Instruments Using Ultrasonic Technique and a Novel Loop Device (Kamand): A Case Report. J Craniomaxillofac Res. 2025;12(3):205-212.
