Conservative Retrieval of a Separated Rotary Instrument from an Anterior Tooth Using an Ultrasonic Device and the Braiding Technique: A Clinical Case Report

Instrument separation during root canal treatment can compromise canal debridement and adversely affect prognosis. Conservative retrieval is critical, especially in anterior teeth with limited dentin thickness. This case is reported for its integration of ultrasonic retrieval with simultaneous K- and H-file braiding, a combination used in anterior teeth, providing a minimally invasive solution. A patient presented with pain and a history of incomplete root canal treatment in a maxillary anterior tooth. Clinical and radiographic evaluation revealed a separated rotary instrument within the canal, associated with symptomatic apical periodontitis. Considering the fragment location and need for dentin preservation, a conservative retrieval strategy was adopted. Ultrasonic tips were first used under magnification to achieve precise dentin removal and expose the fragment. Subsequently, K-files and H-files were introduced and braided to securely engage the fragment, enabling its retrieval. The procedure was completed without excessive dentin removal or procedural complications. Root canal treatment was then completed with cleaning, shaping, and obturation. At follow-up, the patient was asymptomatic with radiographic signs of periapical healing, indicating a successful outcome. This case demonstrates that combining ultrasonic and braiding techniques enhances retrieval efficiency while preserving tooth structure. The strategic integration of techniques can improve clinical outcomes, supporting its application as a predictable and minimally invasive approach in endodontic practice.