Breakage and displacement of the high-speed hand-piece bur during impacted mandibular third molar extraction: three cases

Abstract

Background The high-speed hand-piece bur is one of the methods to perform tooth sectioning during the minimally traumatic extraction of impacted mandibular third molars. During tooth sectioning, the breakage of the bur might take place when it is improperly used. Three cases of the breakage and displacement of a high-speed hand-piece bur during extraction are reported, aiming to remind dental surgeons of this complication. Case presentation The bur fragment in case 1 was embedded in the mandibular bone under the previously removed crown of tooth 48 and distal to tooth 47. The bur fragment in case 2 was embedded in the lingual edge of the socket and partly beneath the mucosa on the lingual side. The position of the bur fragment in case 3 was similar to that of case 1 but was completely embedded in the spongious bone. The three cases were performed by first-year residents, and all of the bur fragments were successfully removed by attending doctors after accurately locating them by radiological examination. Conclusions In order to avoid breakage of the high-speed hand-piece bur, the number of uses of the bur should be monitored and the integrity and state of the bur should be carefully checked. Moreover, light pressure with little lateral force should be used during tooth sectioning. If bur breakage and displacement occur, the retrieval protocol should be determined based on the imaging findings and conducted as soon as possible to avoid serious consequences.

Instrument fracture in periodontal therapy: ethical disclosure and clinical management - a case report

“…Timely removal of the fragment is essential to prevent migration into adjacent spaces; for instance, a fragment fractured on the lingual side of the mandible can migrate to the submandibular or parapharyngeal space. This may potentially cause catastrophic complications, such as laceration of the maxillary artery or jugular vein [ 22 , 23 ]. Delayed removal increases the risk of infection and tissue destruction due to inflammation, thrombosis, erosion into the carotid artery or its branches, and nerve interference [ 24 ].…”

Efficient removal technique of foreign body in the mandible with optimization of 3D simulation

“…Iatrogenic foreign bodies are usually associated with inadequate technique or the erroneous selection of an instrument 9 . There are case reports about iatrogenic foreign bodies of dental elevators, surgical knives, and bur breakages of high‐speed dental hand‐piece burs 10–17 . Cases that have shown sufficient clinical data and clinical information (i.e., age, sex, and broken tools) are listed in Table 1.…”

“…9 There are case reports about iatrogenic foreign bodies of dental elevators, surgical knives, and bur breakages of high-speed dental hand-piece burs. [10][11][12][13][14][15][16][17] Cases that have shown sufficient clinical data and clinical information (i.e., age, sex, and broken tools) are listed in Table 1. In our case, the breakage bur was made of steel with tungsten carbide, echoing previous reports, 16 suggesting that the application of force during cutting has a greater effect on breakage than the original physical characteristics of the burs.…”

Foreign body in the mandible: a case report

“…Dental Bur ( 6), ( 7) (8) Dental Needle (9) Endodontic Spreader (10) Dental Elevator (11) (12) Endodontic Files (13) Periodontal Probe ( 14) Amalgam (15) Composite Resin (16) Calcium Hydroxide (17) It was not possible to request a CT scan for a more accurate diagnosis, because, locally, no dental clinic has equipment to perform CT scans. Differential diagnosis must be made with giant cell granuloma [20] and mental nerves dysaesthesia (neurapraxia) [15] associated with amalgam material and osteosarcoma [20].…”