Management of Separated Endodontic Instrument in Young Permanent First Molars - A Case Series

AbstractBackground: Separation of endodontic instruments during root canal treatment is a challenging procedural complication that may compromise canal disinfection and adversely affect treatment outcomes. The management of fractured instruments depends on several factors, including the location of the fragment, root canal anatomy, periapical status, and overall prognosis of the involved tooth.Case Presentation: This case series describes three permanent first molars with separated endodontic instruments managed using different treatment approaches. The first case involved a maxillary right first molar with a fractured instrument beyond the apical third of the mesiobuccal root, which was successfully managed by apicoectomy and retrograde mineral trioxide aggregate (MTA) filling. The second case involved a mandibular first molar with radix entomolaris and a fractured instrument in the distolingual root, where extraction was performed because of severe structural compromise and favorable development of the second molar. The third case involved intentional reimplantation of a mandibular first molar following retrieval of the fractured instrument, retrograde MTA filling, and immediate reimplantation.Results: All three treatment approaches resulted in satisfactory clinical outcomes. Apicoectomy facilitated preservation of the maxillary first molar, extraction promoted favorable eruption guidance of the second molar, and intentional reimplantation successfully maintained the natural tooth with satisfactory healing during follow-up.Conclusion: Management of separated endodontic instruments requires careful evaluation of root canal anatomy, location of the fractured instrument, periapical status, and long-term prognosis of the tooth. Apicoectomy, extraction, and intentional reimplantation represent valuable treatment options when selected appropriately. Individualized treatment planning is essential for achieving favorable clinical outcomes in permanent molars with separated instruments.