Management of Separated Endodontic Instruments using Ultrasonic Retrieval and Bypass Techniques under Dental Operating Microscope: A Case Series

Abstract Instrument separation during root canal treatment is a challenging problem in endodontics. A broken instrument can prevent thorough cleaning, shaping, and disinfection of the root canal, which may affect treatment outcomes. Using a Dental Operating Microscope (DOM) and ultrasonic retrieval systems has improved the management of separated instruments. This case series describes three clinical cases managed with ultrasonic retrieval and bypass techniques using magnification. Case Series: In Case 1, a separated nickel-titanium (NiTi) rotary instrument was removed from tooth 11 using Ultra X ultrasonics with a Golden Tip under a dental microscope. In Case 2, a fractured instrument was taken out from tooth 17 using Woodpecker ED6 and ED7 ultrasonic tips with microscope magnification. In Case 3, a separated instrument in the palatal canal of tooth 16 was bypassed, allowing the root canal treatment to be finished. Results: Complete retrieval was achieved in Cases 1 and 2, whereas successful bypassing was achieved in Case 3. All teeth were asymptomatic at follow-up and demonstrated satisfactory radiographic healing. Conclusion: The use of ultrasonics under DOM facilitates predictable management of separated instruments while preserving tooth structure. Bypass techniques remain a valuable alternative when retrieval poses excessive risk to radicular dentin.