Background and Objectives: Accidental aspiration or ingestion of small endodontic instruments, particularly hand files, constitutes a well-documented and potentially life-threatening complication in dental practice. Children undergoing pulpectomy procedures present an exceptionally high-risk population due to their limited cooperation, exaggerated gag reflex, and the inherent difficulty in achieving adequate patient control. This paper describes an innovative, simple preventive technique in which waxed dental floss is tied to the handle of hand files prior to use, creating a reliable safety tether that arrests instrument displacement should accidental drop or release occur.

Technique: A length of waxed dental floss (approximately 25–30 cm) is looped and secured with a surgeon's knot around the neck of the file handle before instrumentation commences. The free end is secured to the hair band placed on child’s head by the clinician or assistant throughout the procedure. The technique requires no additional armamentarium, adds minimal procedural time, and is applicable to all ISO-sized stainless steel hand files (K-files, H-files, reamers) used in primary tooth pulpectomy.

Discussion: Current guidelines recommend rubber dam isolation as the primary barrier against instrument aspiration, however, rubber dam placement in uncooperative pediatric patients is frequently impractical. The floss-tethering technique serves as an effective adjunct or substitute in such scenarios, providing a physical safety net without modifying the tactile feedback critical for canal instrumentation.

Conclusion: Dental floss tethering of endodontic hand files is a simple, inexpensive, and readily implementable innovation that may substantially reduce the risk of instrument aspiration and ingestion in pediatric endodontics. Wider adoption and formal prospective evaluation of this technique are recommended.