Wedging Tube Technique For Removing Over-Apex Instrument In Incisor

Instrument separation beyond the apical foramen is a rare but challenging complication in root canal treatment. This case presents the successful removal of an over-apex separated instrument using a custom-made wedging tube technique. A 51-year-old male presented with pain in the left maxillary lateral incisor after unsuccessful root canal treatment at an external clinic, where an endodontic instrument fractured and extended 7mm beyond the apical foramen. Under a dental operating microscope, a self-fabricated tube was utilized to grasp and remove the separated instrument. The root canal was then thoroughly cleaned, shaped, and sealed with an apical barrier technique using iRoot BP plus and warm gutta-percha. Various techniques exist for managing separated instruments, but those extending beyond the apex pose additional risks of periapical inflammation and treatment failure. The wedging tube technique allows controlled engagement and removal of fractured instruments with minimal damage to the root canal walls. In this case, precise instrument retrieval and subsequent apical barrier placement ensured a successful outcome. The custom-made wedging tube technique is a viable, minimally invasive approach for retrieving over-apex separated instruments. This method preserves tooth structure and supports optimal endodontic treatment outcomes.