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Endodontics · single question

An endodontic file separates in the canal during treatment. What is the MOST appropriate course of action?

  1. Inform the patient about the incident and refer to an endodontist if retrieval or bypass is beyond your ability
  2. Extract the tooth to avoid future complications
  3. Document it in the chart but do not tell the patient unless symptoms develop
  4. Complete the obturation and do not mention it, since the prognosis may still be good
Show answer and explanation

Correct answer: A. Inform the patient about the incident and refer to an endodontist if retrieval or bypass is beyond your ability

  • A. CORRECT. This is a matter of VERACITY and informed consent. The patient must be told what happened, what it means for the prognosis, and what the options are (bypass, retrieval, obturate to the fragment and monitor, surgical intervention, or extraction). Document the conversation. If the fragment is beyond your skill or armamentarium, refer. A separated instrument is not malpractice in itself — CONCEALING it is.
  • B. Extraction is a drastic overreaction. Many teeth with separated instruments have excellent long-term prognosis, especially when the fragment is in the apical third of an already-cleaned canal.
  • C. Withholding a known material fact from the patient still violates veracity and informed consent, regardless of charting.
  • D. Concealment is an ethical violation and, if discovered later, is far more damaging legally than the original incident.

Note: Prognosis after separation depends mostly on whether the canal was already disinfected and whether infection is present — not on the presence of metal.

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