Management of Separated Instruments Using Ultrasonic Technique and a Novel Loop Device (Kamand): A Case Report

Abstract

Separation of endodontic instruments can compromise canal disinfection and long-term prognosis. Microscope-guided ultrasonics combined with a loop device may improve retrieval in anatomically demanding canals. Three molars with fractured instruments in challenging canals (maxillary MB2, maxillary distobuccal, mandibular mesiolingual) were managed under a dental operating microscope. A staging platform was created with a modified #2 Gates-Glidden bur, followed by conservative ultrasonic troughing (ED87 tip) to create space around the fragment. The Kamand loop system was then used to engage and retrieve the fragment. Devices were used according to manufacturers’ instructions; any variant use is reported in the Case Presentation. All fragments were retrieved and canals were subsequently cleaned/shaped to 25–30/.04 with warm vertical obturation using AH Plus sealer. Patients were asymptomatic at 6–12 months with radiographic findings consistent with periapical healing. A combined approach, precise ultrasonic troughing to create safe space, followed by loop capture, enabled conservative and predictable retrieval of separated instruments across different canal anatomies, facilitating definitive disinfection and obturation.