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Background:
Case Report

Case Study of a Broken Instrument in a Primary Tooth and Literature Review

by
Masashi Nakano
1,2,
Tatsuya Akitomo
1,*,
Masashi Ogawa
1,
Mariko Kametani
1,
Momoko Usuda
1,
Satoru Kusaka
3,
Chieko Mitsuhata
1 and
Ryota Nomura
1
1
Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
2
Oral Health Center of Saitama Dental Association, Saitama 330-0075, Japan
3
Department of Pediatric Dentistry, Hiroshima University Hospital, Hiroshima 734-8551, Japan
*
Author to whom correspondence should be addressed.
Children 2025, 12(2), 149; https://doi.org/10.3390/children12020149
Submission received: 24 December 2024 / Revised: 15 January 2025 / Accepted: 24 January 2025 / Published: 27 January 2025
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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Abstract

:
Background: Root canal treatment is an important element of dental treatment, and broken instruments are one cause of endodontic treatment failure. Broken instruments are rarely reported in primary teeth because of their inherently wider and relatively straighter root canals. We describe a case of a patient with a broken instrument in a primary tooth and reviewed the literature across three databases. Case presentation: A boy aged 7 years and 2 months was referred to our hospital because of pain persisting despite multiple dental treatments. Radiographic examination revealed a broken instrument in the maxillary right primary second molar. The patient experienced dental fear, so the treatment proceeded with the use of behavioral management and nitrous oxide, after which his pain disappeared. At the age of 9 years and 2 months, eruption of the successive permanent teeth was confirmed, and no pathological findings were observed except enamel hypoplasia. We undertook a literature review across three databases and found only two articles about broken instruments in primary teeth, neither of which described the eruption of the permanent teeth. All three cases involved primary molars. Conclusions: We removed a broken instrument from the root of a primary molar and performed root canal treatment, resulting in a good outcome for the primary molar until it was replaced with successive permanent teeth. Although rare, broken instruments in the roots of primary molars do occur, and care should be taken during root canal treatment of primary molars.

1. Introduction

Dental caries and periodontitis are the most common oral diseases caused by oral microbiota [1,2,3]. Recently, the prevalence of dental caries in many developed countries, including Japan, has decreased [4,5,6]. Additionally, oral health status in these countries has become more polarized and patients still present with severe caries [4,5,6]. Tertiary teaching institutions such as university hospitals treat patients with a variety of conditions, including dental abnormalities and dental trauma, as well as hospitalized patients [7,8,9,10,11,12]. However, dental caries remains the most common complaint among patients visiting the dental hospital in tertiary teaching institutions in Japan [8,13,14].
Nonsurgical root canal treatment is an important element of comprehensive dental healthcare [15,16,17]. Previous studies have reported success rates of >90% for nonsurgical root canal treatment [17,18,19]. However, the absence of an apical seal (i.e., apical leakage) is the most common cause of endodontic treatment failure [20]. Broken instruments result from procedural errors during root canal treatment, and despite the attempts of manufacturers to improve the design of the instruments, fracture remains a problem in endodontic treatment [17,20,21].
Although there are some case reports of fractured root canal instruments in permanent teeth, there have been few reports involving primary teeth [22,23,24]. We encountered a patient with a broken instrument in a primary tooth. We present the case report and a literature review regarding broken instruments in primary teeth.

2. Detailed Case Description

A boy aged 7 years and 2 months was referred to our hospital for detailed examination of the maxillary right primary molars. He had visited a private dental clinic complaining of pain in the maxillary right primary molars 5 months previously and received root canal treatment. However, he experienced pain when the temporary restoration was placed. He was taken to another private dental clinic 1 month later, but his pain always occurred after a dental procedure. He developed a fever, which led to visiting the emergency room where they removed the temporary restoration. Additionally, he became an uncooperative patient during dental treatment, resulting in a referral to our hospital. There was no relevant medical or family history.
At the first visit, intraoral photographs showed three erupted permanent central incisors and 17 primary teeth in the oral cavity (Figure 1A). The maxillary right primary molars were connected with composite resin, and there was no temporary restoration (Figure 1B). The discharge of pus from the gum was detected. Radiographic examination revealed bone resorption in the region of the maxillary right primary molars and a radiopacity was observed in the mesio-buccal canal of the second primary molar, suggesting the presence of a broken instrument (Figure 1C). Dental caries were also present in other primary molars.
We diagnosed apical periodontitis of the maxillary right primary molars, and a treatment plan was formulated. Due to dental fear, behavioral management was performed before the start of dental treatment. In brief, the patients touch and operate the dental instruments, which leads to a reduction in dental fear. In addition, the dental treatment was performed under nitrous oxide inhalation sedation to reduce the patient’s fear during dental treatment. The maxillary right primary first molar was unable to be saved; it was extracted after the inflammation was controlled. The broken instrument located in the mesio-buccal canal of the maxillary right primary second molar was removed using ultrasonic tips (Figure 2A). Radiographic examination confirmed that the instrument had been removed from the root canal (Figure 2B). The removed broken instrument was a reamer approximately 5 mm in length (Figure 2C). The root canal treatment was completed 1 month later, and the tooth was restored with glass-ionomer cement. Two months later, there was no pain, and no pathological findings could be seen on the periapical radiograph (Figure 3A). During the follow-up period, inflammatory absorption of the mesio-buccal canal was found at age 8 years and 10 months, and the tooth was extracted 2 months later (Figure 3B–D).
The maxillary right second premolar erupted at the age of 9 years and 2 months. Enamel hypoplasia was detected on the mesial surface, but no symptoms were reported. There were no pathological findings in the intraoral examination or radiographic examination at 10 years of age (Figure 4 and Figure 5).

3. Methods

3.1. Search Strategy

The review protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and previous reports [25,26]. A literature review of three databases (Web of Science, Scopus, and PubMed) was conducted by one of the authors on 6 December 2024. The articles were searched for manually using the terms “broken instrument” and “primary tooth”.

3.2. Inclusion Criteria

The inclusion criteria for this study included the following:
-
Articles that could be viewed in their entirety.
-
Articles with their full text in English.
-
Case reports about broken instruments in primary teeth.

3.3. Exclusion Criteria

The exclusion criteria for this study included the following:
-
Articles that were not suitable for the objective of this review.
-
Articles that used the wrong study design.
-
Not being a case report, such as review.

3.4. Study Selection

According to the inclusion and exclusion criteria, one dentist performed the literature analysis and selected articles for this review.

3.5. Data Extraction

Data were extracted from the articles about tooth number, root canal, type of instrument, X-ray follow-up, and influence on successive teeth.

4. Results

Our literature search uncovered 25 articles in three databases (Web of Science: 9, Scopus: 7, PubMed: 9). Duplicates were removed and 16 articles remained. Of the 16 articles, two fulfilled the selection criteria. Detailed information about the articles is shown in Table 1 [27,28]. Thus, including the present case, we reviewed a total of three cases of broken instruments in primary teeth.
All three cases occurred in a primary molar, and few cases were reported in primary incisors. All cases were on the right side, with no predilection for maxilla over mandible, nor for particular root canals. Various types of instruments were involved. Both previous cases were followed up with X-ray examinations; however, no information was provided about the successive permanent teeth.

5. Discussion

It has been reported that the prevalence of fracture of stainless-steel hand files is 2–6%, while that of NiTi rotary files is 1.04–13.54% [29,30,31,32,33,34]. However, the separation of a file during pulpectomy rarely occurs in primary teeth because of the inherently wider and relatively straighter root canals [27]. Additionally, primary teeth eventually fall out, so there are few cases of broken instruments that require treatment. We encountered a patient with a broken instrument in a primary tooth. We also undertook a literature review. To our knowledge, this is the first report of a patient with a broken instrument in a primary tooth who was followed up until permanent tooth eruption.
Instrument fracture during root canal therapy is a troublesome incident that can interfere with efficient cleaning and shaping of the root canal and can act as an irritant to the periapical tissues, especially when the separated fragment overextends from the root apex [35,36,37,38]. In the present case, multiple root canal treatments in private dental clinics could not resolve the patient’s symptoms. As a consequence, the patient gradually developed dental phobia and was unable to cooperate with dental treatment, resulting in a referral to our hospital. At his first visit, the patient reported feeling pain, and discharge of pus from the gum was detected. Negative dental experiences, especially those resulting from dental pain, can lead to the development of fear and anxiety, which in turn can lead to the avoidance of further dental treatment [39,40,41,42]. The incidence of pediatric dental fear is higher than that of adult dental fear and, if left unchecked, can persist for a lifetime and adversely impact the patient’s physical and psychological health [43,44,45]. We chose behavioral management administrated before dental treatment, which led to a reduction in his dental fear. In addition, inhalation sedation with nitrous oxide is a form of light conscious sedation widely used in apprehensive children to help them relax and accept dental treatment [46]. Our patient was able to receive dental treatment without physical restraint by using behavioral management and nitrous oxide. Appropriate treatment and management improved not only the patient’s dental condition, but also his dental fear.
A literature search was conducted for three databases, and only two previous reports were located. The prevalence of dental caries has been decreasing in developed countries [4,5,6]. As mentioned above, the anatomical characteristic of primary teeth makes it unlikely for broken instrument [27]. In addition, broken instruments are rarely an issue because primary teeth eventually fall out. This background may be why so few articles met the criteria. We reviewed three cases including the present case, and all occurred in primary molars. Terauchi et al. (2022) reported that instruments are fractured more commonly in molars than in anterior teeth because of factors including canal accessibility, root canal diameter, and root canal curvature [47]. The same tendency may also pertain to primary teeth. Pedir et al. (2016) reported that 94% of fractured instruments occurred in molars, with 66% in the mesio-buccal canal, followed by 24% in the mesio-lingual canal [48]. In two out of the three cases, the instrument was broken in the root canal of a primary molar, suggesting that these root canals are at high risk of instrument fracture in primary teeth. Reciprocating file systems have a lower incidence of instrument fracture than rotary file systems [47,49,50,51]. However, the types of instruments used in these three cases were different. Although the sample size was small, factors such as the operating method and metal fatigue of the instruments may be more important than the type of instrument. Future investigations including other case reports may lead to the identification of factors influencing broken instruments in primary teeth.
Premature loss of the primary teeth may lead to a lack of space, malocclusion, and midline discrepancies in the permanent dentition [52,53,54]. Additionally, premature loss of primary molars impacts the oral health-related quality of life of children [55]. At the patient’s first visit, the first molar had not erupted, and we decided to preserve the primary molars until space maintenance was possible. The technique of using ultrasonic tips under a dental operating microscope is considered to be the optimal strategy for the successful removal of broken instruments [56,57,58,59]. In the two previous cases, the instruments were also removed in this way [27,28]. In the present case, the broken instrument was clearly visible, permitting removal using only ultrasonic tips. These cases demonstrate the usefulness of ultrasonic tips for the removal of broken instruments in primary teeth.
At the age of 8 years and 10 months, radiographic examination revealed inflammatory resorption of the mesio-buccal canal, necessitating extraction. Additionally, enamel hypoplasia was detected on the mesial surface of the maxillary right second premolar, which was located in the region of the broken instrument. Dental abnormalities can occur in healthy children; therefore, the effect of the broken instrument on the inflammatory root resorption or enamel hypoplasia is unclear [60,61,62]. However, no other abnormal findings and no malocclusion such as a space deficit were detected. Long-term oral management resulted in a minimal impact on the permanent teeth. Regular dental checkups are important for the early detection of disease, and long-term oral management also leads to improvement in patients’ quality of life [63,64,65]. This report highlights the importance of long-term follow-up.
This study has some limitations. First, it was unclear when the instrument was broken. Second, the patient felt pain every time a temporary restoration was placed at the private dental clinics, and the association between the pain and the broken instrument was unclear. A retained broken instrument does not have a significant adverse effect on the quality of the root canal seal by filling materials, and the success of endodontic treatment mainly depends on the coronal seal and effective cleaning of the middle and coronal thirds of the root [20,66]. The pain was likely caused by inflammation, because it disappeared after the abscess was incised. Third, the sample size was small even though the literature search spanned three databases. This report brings together previous reports at once reflecting a gap in the existing literature, but the small sample size limits the generalizability of the findings. Breakage of instruments is inevitable during dental procedures. Dental professionals should be aware of such cases, even in primary teeth, where broken instruments are thought to be uncommon. In addition, if such a case is encountered, it is important to follow up and report the outcome until the permanent tooth eruption. Sharing information among dental professionals and increasing sample sizes leads to clarifying the effect of the broken instrument on the root canal of the primary tooth.

6. Conclusions

In this case, a broken instrument found in the root canal of a primary molar of a 7-year-old boy was removed using an ultrasonic tip. We then performed root canal treatment on the primary tooth, which saved the tooth and minimized any adverse effects on the successive permanent teeth. Our literature review found that the breakage of instruments in primary teeth is rare, but broken instruments may have adverse effects not only on the primary tooth but also on the successive permanent tooth. Therefore, we should take great care when performing root canal treatment in children.

Author Contributions

Conceptualization, M.N. and T.A.; attending dentists, M.N., T.A., M.O., M.K., M.U. and S.K.; intraoral photography, M.N., M.O., M.K., M.U. and S.K.; writing—original draft preparation, T.A.; writing—review and editing, R.N.; supervision, C.M. and R.N. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

This study was granted an exemption from requiring ethics approval by the “Ethical Guidelines for Medical and Biological Research Involving Human Subjects Guidance (https://www.mhlw.go.jp/content/001237478.pdf (accessed on 6 December 2024))” formulated by Ministry of Education, Culture, Sports, Science and Technology, Ministry of Health, Labour and Welfare, and Ministry of Economy, Trade, and Industry. In addition, written informed consent was obtained from the parents of the patients to publish this paper.

Data Availability Statement

Data are contained within the article.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Frencken, J.E.; Sharma, P.; Stenhouse, L.; Green, D.; Laverty, D.; Dietrich, T. Global epidemiology of dental caries and severe periodontitis—A comprehensive review. J. Clin. Periodontol. 2017, 44 (Suppl. 18), S94–S105. [Google Scholar] [CrossRef] [PubMed]
  2. Usuda, M.; Kametani, M.; Hamada, M.; Suehiro, Y.; Matayoshi, S.; Okawa, R.; Naka, S.; Matsumoto-Nakano, M.; Akitomo, T.; Mitsuhata, C.; et al. Inhibitory Effect of Adsorption of Streptococcus mutans onto Scallop-Derived Hydroxyapatite. Int. J. Mol. Sci. 2023, 24, 11371. [Google Scholar] [CrossRef]
  3. Yasuda, J.; Yasuda, H.; Nomura, R.; Matayoshi, S.; Inaba, H.; Gongora, E.; Iwashita, N.; Shirahata, S.; Kaji, N.; Akitomo, T.; et al. Investigation of periodontal disease development and Porphyromonas gulae FimA genotype distribution in small dogs. Sci. Rep. 2024, 14, 5360. [Google Scholar] [CrossRef] [PubMed]
  4. Tinanoff, N. Dental caries risk assessment and prevention. Dent. Clin. N. Am. 1995, 39, 709–719. [Google Scholar] [CrossRef] [PubMed]
  5. Pessan, J.P.; Al-Ibrahim, N.S.; Buzalaf, M.A.; Toumba, K.J. Slow-release fluoride devices: A literature review. J. Appl. Oral Sci. 2008, 16, 238–246. [Google Scholar] [CrossRef] [PubMed]
  6. Bashir, N.Z. Trends in the prevalence of dental caries in the US pediatric population 2011–2020. J. Clin. Pediatr. Dent. 2022, 46, 51–57. [Google Scholar] [PubMed]
  7. Yawaka, Y.; Iwabuchi, H.; Ito, S.; Kaga, M. A Seven-year Survey at the Pediatric Dentistry Clinic of a University Hospital of Patients with Systemic Diseases. Jpn. J. Ped. Dent. 2007, 45, 623–631. (In Japanese) [Google Scholar]
  8. Tominaga, S.; Tanaka, A.; Nemoto, K.; Hamaguchi, S.; Tamura, R.; Tanase, T.; Sakurai, A.; Tsujino, K.; Shintani, S. A Survey of the Actual Condition of New Patients at the Pediatric Dentistry Department of College Hospitals and Dental Caries Status in Deciduous Dentition: A Comparison Study between Tokyo and Chiba. Jpn. J. Ped. Dent. 2020, 58, 49–54. (In Japanese) [Google Scholar]
  9. Ng, L.; Malandris, M.; Cheung, W.; Rossi-Fedele, G. Traumatic dental injuries presenting to a paediatric emergency department in a tertiary children’s hospital, Adelaide, Australia. Dent. Traumatol. 2020, 36, 360–370. [Google Scholar] [CrossRef] [PubMed]
  10. Akitomo, T.; Asao, Y.; Mitsuhata, C.; Kozai, K. A new supernumerary tooth occurring in the same region during follow-up after supernumerary tooth extraction: A case report. Pediatr. Dent. J. 2021, 31, 100–107. [Google Scholar] [CrossRef]
  11. Akitomo, T.; Kusaka, S.; Iwamoto, Y.; Usuda, M.; Kametani, M.; Asao, Y.; Nakano, M.; Tachikake, M.; Mitsuhata, C.; Nomura, R. Five-Year Follow-Up of a Child with Non-Syndromic Oligodontia from before the Primary Dentition Stage: A Case Report. Children 2023, 10, 717. [Google Scholar] [CrossRef]
  12. Akitomo, T.; Ogawa, M.; Kaneki, A.; Nishimura, T.; Usuda, M.; Kametani, M.; Kusaka, S.; Asao, Y.; Iwamoto, Y.; Tachikake, M.; et al. Dental Abnormalities in Pediatric Patients Receiving Chemotherapy. J. Clin. Med. 2024, 13, 2877. [Google Scholar] [CrossRef] [PubMed]
  13. Matumoto, H.; Kakuta, H.; Natsubori, H.; Harada, R.; Tanaka, M. A Survey on the Present Situation of the First Visit Patients in a University Pediatric Dental Clinic. Jpn. J. Ped. Dent. 2007, 45, 405–411. (In Japanese) [Google Scholar]
  14. Kaneko, K.; Tsubokura, A.; Tsujino, K.; Mochizuki, K.; Ohtawa, Y.; Yakushiji, M. An Investigation of the Actual Conditions During the Initial Visit of Patients Under 3 years of Age at the Pedodontics of Dental College Hospital. Jpn. J. Ped. Dent. 2008, 46, 342–346. (In Japanese) [Google Scholar]
  15. Barrieshi-Nusair, K.; Al-Omari, M.; Al-Hiyasat, A. Radiographic technical quality of root canal treatment performed by dental students at the Dental Teaching Center in Jordan. J. Dent. 2004, 1132, 301–306. [Google Scholar] [CrossRef] [PubMed]
  16. Er, O.; Sagsen, B.; Maden, M.; Cinar, S.; Kahraman, Y. Radiographic technical quality of root fillings performed by dental students in Turkey. Int. Endod. J. 2006, 39, 867–872. [Google Scholar] [CrossRef] [PubMed]
  17. AlRahabi, M.K. Evaluation of complications of root canal treatment performed by undergraduate dental students. Libyan J. Med. 2017, 12, 1345582. [Google Scholar] [CrossRef] [PubMed]
  18. Friedman, S.; Mor, C. The success of endodontic therapy—Healing and functionality. J. Calif. Dent. Assoc. 2004, 32, 493–503. [Google Scholar] [CrossRef]
  19. Imura, N.; Pinheiro, E.T.; Gomes, B.P.; Zaia, A.A.; Ferraz, C.C.; Souza-Filho, F.J. The outcome of endodontic treatment: A retrospective study of 2000 cases performed by a specialist. J. Endod. 2007, 33, 1278–1282. [Google Scholar] [CrossRef]
  20. Godiny, M.; Hatam, R.; Khavid, A.; Khanlari, S. Apical Microleakage in Root Canals Containing Broken Rotary Instruments. Iran. Endod. J. 2017, 12, 360–365. [Google Scholar] [PubMed]
  21. Shen, Y.; Zhou, H.-M.; Zheng, Y.-F.; Peng, B.; Haapasalo, M. Current Challenges and Concepts of the Thermomechanical Treatment of Nickel-Titanium Instruments. J. Endod. 2013, 39, 163–172. [Google Scholar] [CrossRef] [PubMed]
  22. Faramarzi, F.; Fakhri, H.; Javaheri, H.H. Endodontic treatment of a mandibular first molar with three mesial canals and broken instrument removal. Aust. Endod. J. 2010, 36, 39–41. [Google Scholar] [CrossRef] [PubMed]
  23. Sukegawa, S.; Kanno, T.; Shibata, A.; Matsumoto, K.; Sukegawa-Takahashi, Y.; Sakaida, K.; Furuki, Y. Use of an intraoperative navigation system for retrieving a broken dental instrument in the mandible: A case report. J. Med. Case Rep. 2017, 11, 14. [Google Scholar] [CrossRef]
  24. Meidyawati, R.; Suprastiwi, E.; Setiati, H.D. Broken File Retrieval in the Lower Right First Molar Using an Ultrasonic Instrument and Endodontic Micro Forceps. Case Rep. Dent. 2019, 2019, 7940126. [Google Scholar] [CrossRef]
  25. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef] [PubMed]
  26. Akitomo, T.; Kusaka, S.; Usuda, M.; Kametani, M.; Kaneki, A.; Nishimura, T.; Ogawa, M.; Mitsuhata, C.; Nomura, R. Fusion of a Tooth with a Supernumerary Tooth: A Case Report and Literature Review of 35 Cases. Children 2024, 11, 6. [Google Scholar] [CrossRef] [PubMed]
  27. Pk, M.; Sc, K.; As, S. Broken instrument retrieval with indirect ultrasonics in a primary molar. Eur. Arch. Paediatr. Dent. 2015, 17, 71–74. [Google Scholar] [CrossRef]
  28. Kaul, R.; Gupta, R.; Chhabra, S.; Koul, R. Dental Operating Microscope-guided Retrieval of Broken Instrument from a Deciduous Molar Using Ultrasonics. Int. J. Clin. Pediatr. Dent. 2022, 15 (Suppl. 1), S114–S118. [Google Scholar]
  29. Iqbal, M.K.; Kohli, M.R.; Kim, J.S. A retrospective clinical study of incidence of root canal instrument separation in an endodontics graduate program: A PennEndo database study. J. Endod. 2006, 32, 1048–1052. [Google Scholar] [CrossRef] [PubMed]
  30. Cheung, G.S.; Bian, Z.; Shen, Y.; Peng, B.; Darvell, B.W. Comparison of defects in ProTaper hand-operated and engine-driven instruments after clinical use. Int. Endod. J. 2007, 40, 169–178. [Google Scholar] [CrossRef] [PubMed]
  31. Tzanetakis, G.N.; Kontakiotis, E.G.; Maurikou, D.V.; Marzelou, M.P. Prevalence and management of instrument fracture in the postgraduate endodontic program at the Dental School of Athens: A five-year retrospective clinical study. J. Endod. 2008, 34, 675–678. [Google Scholar] [CrossRef] [PubMed]
  32. Abu-Tahun, I.; Al-Rabab’ah, M.A.; Hammad, M.; Khraisat, A. Technical quality of root canal treatment of posterior teeth after rotary or hand preparation by fifth year undergraduate students, The University of Jordan. Aust. Endod. J. 2014, 40, 123–130. [Google Scholar] [CrossRef] [PubMed]
  33. Yılmaz, A.; Gökyay, S.S.; Dağlaroğlu, R.; Küçükay, I.K. Evaluation of deformation and fracture rates for nickel-titanium rotary instruments according to the frequency of clinical use. Eur. Oral Res. 2018, 52, 89–93. [Google Scholar] [PubMed]
  34. Eskibağlar, M.; Özata, M.Y.; Ocak, M.S.; Öztekin, F. Investigation of fracture prevalence of instruments used in root canal treatments at a faculty of dentistry: A prospective study. Restor. Dent. Endod. 2023, 48, e38. [Google Scholar] [CrossRef] [PubMed]
  35. Kaufman, A.; Neuman, H. Iatrogenic damages caused by dental procedures. Foreign bodies in the oral cavity. Quintessence Int. 1983, 14, 361–366. [Google Scholar] [PubMed]
  36. Lin, L.M.; Rosenberg, P.A.; Lin, J. Do procedural errors cause endodontic treatment failure. J. Am. Dent. Assoc. 2005, 136, 187–193. [Google Scholar] [CrossRef]
  37. Madarati, A.A.; Watts, D.C.; Qualtrough, A.J. Factors contributing to the separation of endodontic files. Br. Dent. J. 2008, 204, 241–245. [Google Scholar] [CrossRef] [PubMed]
  38. Heydari, A.; Rahmani, M.; Heydari, M. Removal of a Broken Instrument from a Tooth with Apical Periodontitis Using a Novel Approach. Iran. Endod. J. 2016, 11, 237–240. [Google Scholar] [PubMed]
  39. Hosey, M. Managing anxious children: The use of conscious sedation in paediatric dentistry. Int. J. Paediatr. Dent. 2002, 12, 359–372. [Google Scholar] [CrossRef] [PubMed]
  40. Shetty, V.; Suresh, L.R.; Hegde, A.M. Effect of Virtual Reality Distraction on Pain and Anxiety During Dental Treatment in 5 to 8 Year Old Children. J. Clin. Pediatr. Dent. 2019, 43, 97–102. [Google Scholar] [CrossRef]
  41. Lin, C.S.; Lee, C.Y.; Chen, L.L.; Wu, L.T.; Yang, S.F.; Wang, T.F. Magnification of fear and intention of avoidance in non-experienced versus experienced dental treatment in adults. BMC Oral Health 2021, 21, 328. [Google Scholar] [CrossRef] [PubMed]
  42. Hoffmann, B.; Erwood, K.; Ncomanzi, S.; Fischer, V.; O’Brien, D.; Lee, A. Management strategies for adult patients with dental anxiety in the dental clinic: A systematic review. Aust. Dent. J. 2022, 67 (Suppl. 1), S3–S13. [Google Scholar] [CrossRef] [PubMed]
  43. Zhang, Y.; Zhu, L.; Mei, Y.; Cao, L.; Ma, H. Investigation of children’s dental fear. BJ Stomatol. 2007, 25, 225–227. [Google Scholar]
  44. Karst, M.; Winterhalter, M.; Münte, S.; Francki, B.; Hondronikos, A.; Eckardt, A.; Hoy, L.; Buhck, H.; Bernateck, M.; Fink, M. Auricular acupuncture for dental anxiety: A randomized controlled trial. Anesth. Analg. 2007, 104, 295–300. [Google Scholar] [CrossRef] [PubMed]
  45. Xia, Y.H.; Song, Y.R. Usage of a Reward System for Dealing with Pediatric Dental Fear. Chin. Med. J. 2016, 129, 1935–1938. [Google Scholar] [CrossRef] [PubMed]
  46. Bangash, M.; Mustafa, L.; Irshad, M.; Omer, Q.; Alam, M.K. Short Term Effects of Inhalation Sedation on Child Dental Fear and Anxiety. Curr. Pediatr. Rev. 2024, 20, 89–93. [Google Scholar] [CrossRef] [PubMed]
  47. Terauchi, Y.; Ali, W.T.; Abielhassan, M.M. Present status and future directions: Removal of fractured instruments. Int. Endod. J. 2022, 55 (Suppl. 3), 685–709. [Google Scholar] [CrossRef] [PubMed]
  48. Pedir, S.S.; Mahran, A.H.; Beshr, K.; Baroudi, K. Evaluation of the Factors and Treatment Options of Separated Endodontic Files Among Dentists and Undergraduate Students in Riyadh Area. J. Clin. Diagn. Res. 2016, 10, ZC18–ZC23. [Google Scholar] [CrossRef] [PubMed]
  49. Cunha, R.S.; Junaid, A.; Ensinas, P.; Nudera, W.; da Silveira Bueno, C.E. Assessment of the separation incidence of reciprocating WaveOne files: A prospective clinical study. J. Endod. 2014, 40, 922–924. [Google Scholar] [CrossRef] [PubMed]
  50. Ahn, S.Y.; Kim, H.C.; Kim, E. Kinematic effects of nickel-titanium instruments with reciprocating or continuous rotation motion: A systematic review of in vitro studies. J. Endod. 2016, 42, 1009–1017. [Google Scholar] [CrossRef]
  51. Bueno, C.S.P.; de Oliveira, D.P.; Pelegrine, R.A.; Fontana, C.E.; Rocha, D.G.P.; da Silveira Bueno, C.E. Fracture incidence of WaveOne and Reciproc Files during root canal preparation of up to 3 posterior teeth: A prospective clinical study. J. Endod. 2017, 43, 705–708. [Google Scholar] [CrossRef]
  52. Pedersen, J.; Stensgaard, K.; Melsen, B. Prevalence of malocclusion in relation to premature loss of primary teeth. Community Dent. Oral Epidemiol. 1978, 6, 204–209. [Google Scholar] [CrossRef] [PubMed]
  53. Ahamed, S.S.; Reddy, V.N.; Krishnakumar, R.; Mohan, M.G.; Sugumaran, D.K.; Rao, A.P. Prevalence of early loss of primary teeth in 5-10-year-old school children in Chidambaram town. Contemp. Clin. Dent. 2012, 3, 27–30. [Google Scholar] [CrossRef] [PubMed]
  54. Law, C.S. Management of premature primary tooth loss in the child patient. J. Calif. Dent. Assoc. 2013, 41, 612–618. [Google Scholar] [CrossRef] [PubMed]
  55. Monte-Santo, A.S.; Viana, S.V.C.; Moreira, K.M.S.; Imparato, J.C.P.; Mendes, F.M.; Bonini, G.A.V.C. Prevalence of early loss of primary molar and its impact in schoolchildren’s quality of life. Int. J. Paediatr. Dent. 2018, 28, 595–601. [Google Scholar] [CrossRef]
  56. Ward, J.R.; Parashos, P.; Messer, H.H. Evaluation of an ultrasonic technique to remove fractured rotary nickel-titanium endodontic instruments from root canals: Clinical cases. J. Endod. 2003, 29, 764–767. [Google Scholar] [CrossRef] [PubMed]
  57. Suter, B.; Lussi, A.; Sequeira, P. Probability of removing fractured instruments from root canals. Int. Endod. J. 2005, 38, 112–123. [Google Scholar] [CrossRef] [PubMed]
  58. Gencoglu, N.; Helvacioglu, D. Comparison of the different techniques to remove fractured endodontic instruments from root canal systems. Eur. J. Dent. 2009, 3, 90–95. [Google Scholar] [CrossRef] [PubMed]
  59. Terauchi, Y.; Sexton, C.; Bakland, L.K.; Bogen, G. Factors Affecting the Removal Time of Separated Instruments. J. Endod. 2021, 47, 1245–1252. [Google Scholar] [CrossRef] [PubMed]
  60. Bittencourt, S.P.; Cesario, F.E. Association Between Molar-Incisor Hypomineralization and Enamel Hypoplasia. J. Clin. Pediatr. Dent. 2022, 46, 143–147. [Google Scholar] [CrossRef] [PubMed]
  61. Akitomo, T.; Asao, Y.; Iwamoto, Y.; Kusaka, S.; Usuda, M.; Kametani, M.; Ando, T.; Sakamoto, S.; Mitsuhata, C.; Kajiya, M.; et al. A Third Supernumerary Tooth Occurring in the Same Region: A Case Report. Dent. J. 2023, 11, 49. [Google Scholar] [CrossRef]
  62. Akitomo, T.; Tsuge, Y.; Mitsuhata, C.; Nomura, R. A Narrative Review of the Association between Dental Abnormalities and Chemotherapy. J. Clin. Med. 2024, 13, 4942. [Google Scholar] [CrossRef] [PubMed]
  63. Kebede, B.; Tare, D.; Bogale, B.; Alemseged, F. Odontogenic tumors in Ethiopia: Eight years retrospective study. BMC Oral Health 2017, 17, 54. [Google Scholar] [CrossRef]
  64. Usuda, M.; Akitomo, T.; Kametani, M.; Kusaka, S.; Mitsuhata, C.; Nomura, R. Dens invaginatus of fourteen teeth in a pediatric patient. Pediatr. Dent. J. 2023, 33, 240–245. [Google Scholar] [CrossRef]
  65. Kametani, M.; Akitomo, T.; Usuda, M.; Kusaka, S.; Asao, Y.; Nakano, M.; Iwamoto, Y.; Tachikake, M.; Ogawa, M.; Kaneki, A.; et al. Evaluation of Periodontal Status and Oral Health Habits with Continual Dental Support for Young Patients with Hemophilia. Appl. Sci. 2024, 14, 1349. [Google Scholar] [CrossRef]
  66. Saunders, J.L.; Eleazer, P.D.; Zhang, P.; Michalek, S. Effect of a Separated Instrument on Bacterial Penetration of Obturated Root Canals. J. Endod. 2004, 30, 177–179. [Google Scholar] [CrossRef]
Children 12 00149 g001
Figure 1. First examination at age 7 years and 2 months. Intraoral photographs (A,B). Radiographic examination showing a suspected broken instrument (arrow) in the mesio-buccal canal of the maxillary right second primary molar (C).
Figure 1. First examination at age 7 years and 2 months. Intraoral photographs (A,B). Radiographic examination showing a suspected broken instrument (arrow) in the mesio-buccal canal of the maxillary right second primary molar (C).
Children 12 00149 g001
Children 12 00149 g002
Figure 2. Images at age 7 years and 4 months. Intraoral photograph during dental treatment showing broken instrument (arrow) (A). Radiograph confirming removal of the instrument (B). Photograph of the removed broken instrument (C).
Figure 2. Images at age 7 years and 4 months. Intraoral photograph during dental treatment showing broken instrument (arrow) (A). Radiograph confirming removal of the instrument (B). Photograph of the removed broken instrument (C).
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Children 12 00149 g003
Figure 3. Radiographs of the maxillary right primary second molar: 7 years and 7 months (A), 7 years and 10 months (B), 8 years (C), and 8 years and 10 months (D).
Figure 3. Radiographs of the maxillary right primary second molar: 7 years and 7 months (A), 7 years and 10 months (B), 8 years (C), and 8 years and 10 months (D).
Children 12 00149 g003
Children 12 00149 g004
Figure 4. Intraoral photographs at age 10 years.
Figure 4. Intraoral photographs at age 10 years.
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Children 12 00149 g005
Figure 5. Radiographs at age 10 years: panoramic photograph (A), and periapical photograph (B).
Figure 5. Radiographs at age 10 years: panoramic photograph (A), and periapical photograph (B).
Children 12 00149 g005
Table 1. Cases of broken instruments in primary teeth reported in the literature.
Table 1. Cases of broken instruments in primary teeth reported in the literature.
AuthorToothRoot CanalType of InstrumentX-Ray Follow-UpInfluence on Successive Teeth
Pk M, 2016 [27]#84Mesio-lingual canalH file15 monthsNot listed
Kaul R, 2022 [28]#85Disto-buccal canalK file6 monthsNot listed
Present case#55Mesio-buccal canalReamer17 monthsEnamel hypoplasia
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MDPI and ACS Style

Nakano, M.; Akitomo, T.; Ogawa, M.; Kametani, M.; Usuda, M.; Kusaka, S.; Mitsuhata, C.; Nomura, R. Case Study of a Broken Instrument in a Primary Tooth and Literature Review. Children 2025, 12, 149. https://doi.org/10.3390/children12020149

AMA Style

Nakano M, Akitomo T, Ogawa M, Kametani M, Usuda M, Kusaka S, Mitsuhata C, Nomura R. Case Study of a Broken Instrument in a Primary Tooth and Literature Review. Children. 2025; 12(2):149. https://doi.org/10.3390/children12020149

Chicago/Turabian Style

Nakano, Masashi, Tatsuya Akitomo, Masashi Ogawa, Mariko Kametani, Momoko Usuda, Satoru Kusaka, Chieko Mitsuhata, and Ryota Nomura. 2025. "Case Study of a Broken Instrument in a Primary Tooth and Literature Review" Children 12, no. 2: 149. https://doi.org/10.3390/children12020149

APA Style

Nakano, M., Akitomo, T., Ogawa, M., Kametani, M., Usuda, M., Kusaka, S., Mitsuhata, C., & Nomura, R. (2025). Case Study of a Broken Instrument in a Primary Tooth and Literature Review. Children, 12(2), 149. https://doi.org/10.3390/children12020149

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