#case_endo Custom extractor fully explained Referred cas | طب وجراحة الفم والأسنان _ جامعة تعز🦷

#case_endo
Custom extractor fully explained

Referred case from a colleague for management of a separated file in the MB canal of lower 1st molar .

At first I attempted bypass as the fragment was 16 mm away from the reference point ( apical part ) , separated file was new so most probably it was separated due to torsional fatigue or faulty file , so high engagement was suspected.

I decided to bypass using rotary files to ramp up the process but this was a big mistake to attempt that without full manual bypassing first , the first file was Hyflex EDM 10/.05 was placed in the space ( catch area ) to immediately separate , So I stopped that to attempt retrieval.

Circumferential prep around the file was created using Ultrasonic VAT-3 device silver tip .

A wired loop was tightened around the file 2 times but it was torn twice due to the strong binding of the file to the canal wall .

Another retrieval strategy was attempted using multiple custom tube like intramuscular injection tips with different lengths & diameters , flowable composite tips , a bend was made on the hub & a hole was made at the top of the tip & the bottom also for more engagement ( x-rays shows multiple trials with the custom tubes )
I kept trying till one was fitted ( x-ray confirmed )

I noticed that secondary fracture is about to occur ( x-ray detected ) so I stopped using ultrasonic & used the trephination bur to create more space to accommodate both the tube , spreader & SF to engage the fragment.

Both files 10/.05 & 20/.04 was retrieved

Bassi Logic for Shaping

Well-Root ST bc sealer for obturation to reveal large lateral (furcal ) canal related to the furcal radi olucency in a buccal direction .

Details under each photo
Thanks
#MMENDOMANIA
https://t.me/TDoDL2