procedural incidents

Tools may break off (break) within the tooth’s root canal, meaning that part of the metal file used during the procedure remains inside the tooth. The remaining piece of dental file can be left if there is an acceptable level of cleaning and shaping, and attempting to remove the remaining piece may cause danger to the tooth. While potentially worrisome to the patient, the presence of metal inside teeth is a relatively common occurrence, eg containing metal wedges, amalgam fillings, gold crowns, and fused-to-metal crowns. The occurrence of file separation in the tooth is proportional to the narrowness, curvature, length, calcification and number of roots of the tooth being treated. Complications resulting from incomplete cleaning of the canals, due to blockage with a separated dental file, can be treated by surgical root canal treatment. The incidence of tool separation is well documented.[20] A sodium hypochlorite accident is an immediate reaction consisting of severe pain, followed by edema, hematoma and bruising as a result of fluid escaping from the border of the tooth and entering the periapical space.[21] The cause may be obscure due to ligation or excessive pressure on the irrigation syringe, or it may occur if the tooth has an unusually large apical foramen. [22] It is usually self-resolving and may take 2-5 weeks to cure completely.[22]