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Periodontitis treatment with medical leeches
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Author’s view on the problem of broken tools

This article presents the author’s view of Dr. M. Solomonov on the problem of broken instruments from a biological point of view. The author created a clinical decision making scheme based on the following factors:

1. Tooth vital or infected
2. The initial or final stage of cleaning channels
3. The tool is broken before or after bending.        Based on this design, doctors may decide not to remove the tool, try to bypass it, or try to remove the broken tool.

Key words: broken endodontic instrument, clinical tactics, By pass technique.

A broken instrument in the canal is, unfortunately, a complication of endodontic practice. Studies show that breaking of steel tools occurs from 1 to 6% of cases.

With the advent of nickel-titanium rotating tools, a marketing myth arose about their resistance to breakage due to their flexibility. However, the practical activities of endodontists around the world, unfortunately, have refuted this statement. Even with experienced endodontists, the breaking of nickel-titanium instruments ranges from 0.5% to 5% of cases.
Moreover, if the problem of breaking off steel tools can be solved by observing the signs of metal fatigue and the removal of such tools from use, then when working with nickel-titanium tools, doctors faced a situation in which the tool could break without signs of metal fatigue.

This occurs either due to breaking off due to fatigue of the metal to bend, or due to a metallurgical defect. Therefore, even a single use of NT tools does not completely prevent breaks. The only solution to prevent tool fracture is to stop clinical work. All tools break ….
In the process of clinical activity, doctors are faced with a situation where they can detect a broken instrument in the canal from previous treatments, or they themselves break the instrument in the canal.

Today, under the influence of marketing pressure and in the presence of certain instruments and equipment, doctors automatically begin an attempt to remove a broken instrument.

We will analyze this problem from various points of view:

1. Broken instrument and failure of endotherapy

The cause of periapical processes is an infection of the root canals [8]. A broken instrument in itself, of course, does not cause an inflammatory process.
Studies have shown that SI is the reason for the failure of endodontic treatment in only 0.96% of cases [9]. Often we see old endotherapy with broken instruments without any signs of periapical inflammation (Fig. 5,6).

The impact of a broken instrument on the forecast will depend on several parameters:
Vital or infected tooth
At what stage of the instrumentation and cleaning of the channel the instrument broke.

2. Procedure for removing a broken tool

The procedure involves the creation of direct access to the instrument using modified gates of glideden and the use of ultrasonic nozzles.
Some technicians recommend the additional use of grabbing tools like IRS, Masserannkit, STN, etc.
This procedure is associated with the loss of root dentin, and therefore can lead to complications such as perforation and vertical root fracture due to weakening of the root wall due to loss of dentin.

It is dentin that provides tooth strength and its loss increases the deformation of the root. Vertical root fracture is responsible for 11% of endodontic treatment failures.

3. The instrument broke in the apical part of the canal after bending
In such a situation, no technique is usually effective [.

4. Bypass technique
The procedure for passing next to a broken tool.

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