Management of Endodontic Instrument Fracture in the Apical Third of the Root Canal Using Cold Ceramic: A Case Report

Abstract

Introduction: Fracture of an endodontic instrument within a root canal constitutes a major challenge to accomplishing adequate cleaning and proper three-dimensional obturation. This case report aimed to present a clinical case and evaluate the role of cold ceramic in managing fractured endodontic instruments. A 20-year-old patient presented with pain in the maxillary second premolar, where a fractured file was detected in the apical third of the canal. Following canal debridement, attempts to remove the fragment were unsuccessful. In order to avoid perforation, an apical barrier made of cold ceramic was placed in both canals, and obturation was subsequently completed using gutta-percha and sealer. The patient’s symptoms resolved within 14 days. At the three-month follow-up visit, the patient remained asymptomatic, and radiographic examination showed complete healing and bone regeneration.

The removal of fractured instruments located in the apical third carries considerable risk. Cold ceramic, with high sealing ability and biocompatibility, represents a valuable option in such cases.