From the Research
A broken dental file should not be left in a tooth root after extraction, as it can lead to complications such as infection, inflammation, foreign body reaction, or delayed healing. When a tooth is extracted, the entire tooth including its roots should be completely removed from the socket, along with any foreign objects such as broken files or instruments. If a dental file breaks during a root canal procedure and the tooth is subsequently extracted, the extraction process should include removal of the broken file fragment. Leaving a broken file in the extraction site could lead to complications, and the metal from the file could potentially migrate to surrounding tissues over time.
Some studies suggest that the presence of a fractured instrument need not reduce the prognosis if the case is well treated and there is no evidence of apical disease 1. However, in cases where apical disease is present, file fracture significantly reduces prognosis, indicating a greater need to attempt file removal or bypass. The use of ultrasonic instruments and endodontic micro forceps has been shown to be effective in removing broken files from the root canal 2.
It is essential to note that the decision to retrieve or leave a broken file in place should be made on a case-by-case basis, taking into account the location of the file, the stage of cleaning and shaping, and the overall health of the patient. A prudent approach may decrease complications from unnecessary dentin removal, while respecting the biological aspects of cleaning the canals 3, 4.
During extraction, dentists typically examine the removed tooth to ensure it's complete and will use imaging such as X-rays if there's any concern about retained fragments. If a broken file is discovered after extraction, the dentist should immediately retrieve it from the socket before wound closure to prevent these complications. The patient should also be informed of the situation and the potential risks associated with a retained broken file.
In summary, the most recent and highest quality study on this topic is not directly applicable, as the provided studies focus on root canal treatment rather than tooth extraction. However, the principles of removing foreign objects and preventing complications can be applied to the extraction scenario. Therefore, it is recommended to remove the broken dental file from the tooth root after extraction to prevent potential complications and ensure the best possible outcome for the patient.