Tretments of the separated instrument in the root canal.

Lom instrumenta pogreška je koja nastaje pretjeranom uporabom sile prilikom instrumentacije u zavojitim ili nedovoljno obrađenim kanalima tijekom njihova izvlačenja, no može nastati i zbog pogreške u materijalu. Čimbenici koji utječu na lom dijele se na: 1. one vezane uz terapeuta, 2. anatomske uzroke, 3. čimbenike vezane uz instrument i 4. čimbenike vezane uz tehniku instrumentacije.Instrumenti mogu biti od ugljičnog čelika, nehrđajućeg čelika i nikal-titanskih (NiTi) legura, a u današnje vrijeme najviše se koriste strojno upravljani NiTi instrumenti. Kada se lom dogodi, potrebno je uzeti u obzir čimbenike kao što su vrsta denticije, položaj zuba u zubnom luku, morfologiju zuba i korijena, stanje periapikalnog i parodontnog tkiva te fazu instrumentacije u kojoj se lom dogodio. Na temelju tih čimbenika terapeut odlučuje o daljnjem postupku. Moguće su odluke, a shodno tome i plan terapije:1.ne uklanjanje slomljenog fragmenta, 2. njegovo konzervativno ili kirurško uklanjanje i 3. ekstrakcija zuba. Ako se odluči ostaviti fragment u kanalu, kanal se instrumentira i puni do koronarnog dijela fragmenta. Druga je mogućnost „zaobilaženje“ instrumenta i punjenje uz obuhvaćanje fragmenta. Tehnike uklanjanja instrumenta razne su, mogu biti jednostavne i uključivati instrumente koje svaki doktor dentalne medicine ima u ambulanti, ali i biti kompleksnije i uključivati specijalne instrumente i sustave za uklanjanje. Najčešće korištene tehnike uključuju ultrazvuk i njegove vibracije u kombinaciji s posebnim nastavcima, tehnike obuhvaćanja kao što su Masserannova tehnika i Feldmanova tehnika i tehnike tube. Kada dio fragmenta izvire u pulpnu komoricu, može se ukloniti specijaliziranim kliještima kao što su Stieglitzova kliješta.Instrument breakage is an error caused by excessive use of force during instrumentation in twisted or insufficiently instrumented canals during their retrieval. Factors affecting fracture are divided into: (1) operator related, (2) anatomy related, (3) instrument related and (4) technique related. Instruments can be made of carbon steel, stainless steel and NiTi alloys (Nickel-Titanium), and nowadays electric motor-controlled NiTi instruments are used most commonly. When a fracture occurs, factors such as the type of dentition, the position of the tooth in the dental arch, the morphology of the tooth and the root, the condition of the periapical, and periodontal tissue, as well asthe stage of instrumentation in which the fracture occurred must be taken into account.Based on these factors, the therapist decides on the further procedure.Possible outcomes include: (1)no intervention, (2) non-surgical (orthograde, conservative)or surgical management,or (3) tooth extraction.If it is decided to leave the fragment in the canal, then the canal is instrumented and filled to the coronary part of the fragment. Another possibility is to “bypass” the instrument and fill with the fragment. Instrument removal techniques vary, they can be simple with the instruments that every dentist has in their clinic, but they can also be more complex and requirespecial instruments and removal systems. The most used techniques are ultrasound and its vibrations in combination with special tips, holding techniques such as Masserann’s technique and Feldman’s technique and tube techniques.When part of the fragment springs into the pulp chamber, it can be removed with specialized forceps such as Stieglitz forceps