发生于根尖区的器械分离，尤其是当器械超出根尖孔，临床处置往往面临较大挑战。传统取出方法常需切除过多的根部牙本质，这不仅可能造成根管的穿孔和牙根折断等并发症，还可能影响患牙的长期预后。然而，对于在高质量根管治疗末期发生的此类器械分离病例，在严格评估适应证的前提下，保留分离器械可能是更为合理的临床决策。本文报道1例术前存在根尖周病变的患牙，治疗过程中发生超出根尖孔的器械分离，经过综合评估后采用保留处置方案。通过9年随访观察，该患牙仍具有良好的功能状态，为该处置方法的临床有效性和长期性提供了验证。

Instrument separation in the apical region, particularly when the fragment extends beyond the apical foramen, often presents significant clinical challenges. Conventional retrieval techniques typically require excessive removal of radicular dentin, which may not only lead to complications such as root perforation or fracture, but also compromise the long-term prognosis of the affected tooth. However, for cases occurring during the final stages of high-quality root canal treatment, retaining the separated instrument may represent a more rational clinical approach when strict indications are met. This article reports a tooth with preoperative periapical pathology that experienced instrument separation extending beyond the apical foramen during treatment. Following comprehensive evaluation, a retention protocol was adopted. Nine years of follow-up observations confirmed the tooth's maintained functional integrity, validating the clinical efficacy and long-term sustainability of this management approach.