Background: Endodontic instrumentation is challenging in primary teeth due to narrow and curved roots that are under the influence of the physiological resorption process. Instrument separation in primary tooth root canal can have an adverse effect on erupting succedaneous teeth due to the persistence of infection and the risk of getting embedded into bone following root resorption. Case description: This paper comprised of a series of four cases with endodontic instrument separation at coronal third, middle third, apical third, and beyond apex in the root canal of primary teeth. All the cases were managed successfully using different strategies that include instrument retrieval, obturation and close periodic follow-ups, and the extraction of the involved tooth. Conclusion: Several factors determine the fate of the primary tooth with a separated instrument. Different management strategies can be tried considering the benefit vs risk in preserving the tooth.
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