FragRemover

Advantages of the FragRemover in comparison to other fragment removing methods

 

There are a number of methods used in order to remove fractured pieces of root canal instruments available; however most of the tools used for the procedure have a very limited indication range.

The most well known fragment removal methods are the Braiding technique, Tube techniques (Masserann-Kit, IRS, Tube/glue technique), ultrasonic procedures and fragment removal with specialised tweezers.

The so called “Braiding technique” involves small instruments which are placed either side of the fragment and then twisted out to remove the loose fragment. This technique is only functional if there is sufficient room between the fragment and the canals. Besides this, the force which is exerted on the tooth through the twisting motion can lead to fracturing of the “braided files”.

Removing instrument fragments with speciality tweezers (Stieglitz root forceps) is also not ideal. This is because unless tooth hardness weakening has occurred it is only possible to remove fragments that are no deeper than the pulp cavity itself.

All tube techniques are associated with a significant substance loss due to the necessity of at least a 3mm circular opening for the cannula in order for safe fragment retention. Another downside of tube techniques is that the view of the top of the fragment is obstructed by the tools used during the process. This lack of a reliable control increases the risk of perforations and fragment extrusions. Often, only very long, high-retentive fragments in the upper coronal third with straight roots and sufficient wall thickness can be treated with tube techniques. Deeper fragments can only be removed with a great loss in root dentin which then increases the likelihood of a vertical fracture.

Nowadays, ultrasonic procedures are regarded as the most effective fragment removal method. The loss of substance is comparatively low and also allows for an excellent view of the fragment during the procedure. For very short fragments (<2mm) ultrasonic is always the method of choice. However, difficulties start to arise while trying to remove longer fragments (>2.5mm). Using the ultrasound method means that one has to operate on the surrounding tooth dentin until the fragment is freed up so that it can be removed with a damp paper tip. Long fragments often lie in the area of curvature (mesial roots of lower molars) and have a relatively high retention due to the restoring effect of NiTi. This causes problems when using the ultrasound technique as the length of the fragment is so, that operating on the surrounding area causes a considerable loss of substance in the internal curvature. This becomes dangerous as soon as the area of the lower molars is affected. This area has a particularly thin wall and there is a high risk of perforation. Furthermore, long fragments which are exposed to ultrasonic wavelengths for tend to lead to secondary fractures due to the stress they are under. Thereafter a complete removal is made much more difficult or even impossible. Lastly, due to the mostly dry preparation, heat damage to the periodontium is also a possibility.

Because of the problems mentioned with the aforementioned techniques it is evident that a method which is quick, has marginal substance loss and good visualization for longer, retentive fragments would be highly desirable. This set of criteria is aptly met by the FragRemover through the use of the wire loop technique.

Micro invasive procedures are made possible by the use of ultrafine cannulae and wires. The fragment head is left uncovered through the use of U-Files (ISO 15-20) and is released through a perforation of just 0.5mm in diameter. This is done by using an adjustable wire loop which is placed around the fragment. Once the wire is tightened around the fragment it can be removed by pulling. Further exposure is only necessary for highly retentive fragments, and even if this is the case, less preparation is needed than what would be used for an ultrasound equivalent. Even fragments that are located in the periapex can be safely captured without risk of further extrusion.

The following bullet points briefly summarise the advantages of the FragRemover and the wire loop technique in comparison with traditional fracture removal methods.

  1. Maximum protection of the root dentin
  2. Straightforward removal of long fragments from areas of curvature
  3. Clear visual control
  4. Low risk of secondary fractures
  5. Safe removal of fragments
  6. Minimal thermal effect on the periodontium
  7. Efficient and fast compared to other methods

Click on “Cases” to hear from people who have experienced the efficiency of the FragRemover device. All fragments shown were removed with a prototype of the FragRemover.

Design and function of the FragRemover

Demo video about the preparation, assembly and function of FragRemover:

Benefits:

  • One can use any cannula with a Luer fitting or purchase cannulas directly from us at any time.
  • By turning the adjusting ring, wire loops can easily be controlled in a very precise manner.
  • A one-handed operation is guaranteed through the use of a comfortable grip
  • Changing cannulas and wires is simple and can be completed by an assistant in under a minute

Wire is supplied in the following diameters:

  • 0.075 mm
  • 0.1 mm
  • 0.15 mm