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Fan Y, Gao Y, Wang X, Fan B, Chen Z, Yu Q, Xue M, Wang X, Huang Z, Yang D, Lin Z, Pan Y, Zhao J, Yu J, Chen Z, Xie S, Yuan H, Que K, Pan S, Huang X, Luo J, Meng X, Zhang J, Du Y, Zhang L, Li H, Chen W, Wu J, Xu X, Zou J, Li J, Huang D, Cheng L, Wang T, Hou B, Zhou X. Expert consensus on management of instrument separation in root canal therapy. Int J Oral Sci 2025; 17:46. [PMID: 40484859 DOI: 10.1038/s41368-025-00372-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 03/28/2025] [Accepted: 04/16/2025] [Indexed: 06/11/2025] Open
Abstract
Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
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Affiliation(s)
- Yi Fan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuan Gao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiangzhu Wang
- Department of Endodontics, Xiangya Stomatological Hospital, Central South University, Changsha, China
| | - Bing Fan
- Department of Cariology and Endodontics, Wuhan University & State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhi Chen
- Department of Cariology and Endodontics, Wuhan University & State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qing Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Ming Xue
- Department of Conservative Dentistry and Endodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Zhengwei Huang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, National Clinical Research Center for Oral Diseases, National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Deqin Yang
- Department of Conservative Dentistry and Endodontics, Shanghai Stomatological Hospital & School of Stomatology, Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Zhengmei Lin
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yihuai Pan
- Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Jin Zhao
- Department of Endodontics, The First Affiliated Hospital of Xinjiang Medical University, College of Stomatology of Xinjiang Medical University, Urumqi, China
| | - Jinhua Yu
- Institute of Stomatology, Nanjing Medical University & Department of Endodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Zhuo Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, China
| | - Sijing Xie
- Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - He Yuan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Kehua Que
- Department of Endodontics, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China
| | - Shuang Pan
- Department of Endodontics, The First Affiliated Hospital of Harbin Medical University & Department of Endodontics, School of Stomatology, Harbin Medical University, Harbin, China
| | - Xiaojing Huang
- Fujian Key Laboratory of Oral Disease & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Jun Luo
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xiuping Meng
- Department of Endodontics, School and Hospital of Stomatology, Jilin University, Changchun, China
| | - Jin Zhang
- Department of Endodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China
| | - Yi Du
- Jinan Stomatological Hospital, Jinan, China
| | - Lei Zhang
- Hohhot Stomatology Hospital, Inner Mongolia, China
| | - Hong Li
- Department of Endodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Wenxia Chen
- College & Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Jiayuan Wu
- Department of Endodontics, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jing Zou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Dingming Huang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tiemei Wang
- Department of Oral Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
| | - Benxiang Hou
- Department of Endodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China.
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Keskin C, Keleş A, Pirimoğlu B, Toplu D. Endoscope-assisted retrieval of separated instruments: An ex vivo comparative study of Masserann, microsonic, and loop techniques. Proc Inst Mech Eng H 2025; 239:381-387. [PMID: 40219933 DOI: 10.1177/09544119251331711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2025]
Abstract
Instrument separation during root canal treatment can hinder effective cleaning and shaping, making reliable retrieval techniques essential. Endoscopic visualization might aid in instrument removal procedures offering direct magnification of root canal anatomy. This ex vivo study evaluated the success rate and procedure time of three instrument retrieval techniques - Masserann, microsonic, and loop techniques - under the visualization of dental operation microscope (DOM) assisted by an endoscope. Sixty extracted human mandibular single-rooted teeth with simulated fractures were assigned to the Masserann, microsonic, or ultrasonic with loop techniques (n = 20/group), each performed under endoscopic visualization alongside DOM. The success rate of instrument removal and procedure time were recorded. Complications, such as root perforation, apical extrusion and secondary fracture, were recorded. Statistical analysis was conducted using Pearson χ2 and Kruskal-Wallis tests with 5% significance threshold. Success rates for the microsonic, Masserann, and ultrasonic with loop techniques were 80%, 70%, and 80%, respectively (p > 0.05). The average procedure times were 13.02 min for the microsonic technique, 17.25 min for the Masserann technique, and 17 min for the ultrasonic with loop technique (p > 0.05). The Masserann technique demonstrated a higher complication rate, with two cases each of perforation and apical extrusion, whereas no secondary fractures occurred in any group. Conclusively, the microsonic technique showed the highest success rate with the shortest retrieval time, indicating its efficiency and suitability for instrument removal from root canals, particularly when combined with enhanced visualization through endoscopy.
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Affiliation(s)
- Cangül Keskin
- Department of Endodontics, Ondokuz Mayıs University, Samsun, Türkiye
| | - Ali Keleş
- Department of Endodontics, Ondokuz Mayıs University, Samsun, Türkiye
- Department of Endodontics, Bolu Abant İzzet Baysal University, Bolu, Türkiye
| | - Burcu Pirimoğlu
- Department of Endodontics, Ondokuz Mayıs University, Samsun, Türkiye
| | - Defne Toplu
- Department of Endodontics, Ondokuz Mayıs University, Samsun, Türkiye
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Natanasabapathy V, Varghese A, Karthikeyan PKA, Narasimhan S. Pattern of endodontic instrument separation and factors affecting its retrieval: a 10-year retrospective observational study in a postgraduate institute. Restor Dent Endod 2025; 50:e7. [PMID: 39979228 PMCID: PMC11921455 DOI: 10.5395/rde.2025.50.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 11/22/2024] [Indexed: 02/22/2025] Open
Abstract
Objectives This study aimed to assess the pattern of endodontic instrument separation, their retrievability, and factors affecting its retrieval, in a postgraduate institute. Methods Cases referred for the management of separated endodontic instruments (SEI) from 2013 to 2023 were considered for this study. Data related to demographics, tooth type, file type, and retrieval were documented in an Excel sheet. Eight prognostic factors assumed to influence the retrieval were analyzed in this study. The secondary aim was to compare the pattern of SEI and retrievability between conventional nickel-titanium files and newer generation heat-treated nickel-titanium files. Retrieval was attempted by a senior endodontist under the dental operating microscope. Various ultrasonic tips and a Broken Tool Removal loop system were used during retrieval. Simple descriptive statistics were performed. Binomial logistic regression was done to identify the effect of the eight prognostic factors on the retrieval outcome. Results A total of 190 SEI was reported. SEI occurred more often in posterior teeth than anterior teeth, mandibular arch than maxillary arch, and in larger files than smaller files. Separation occurred more often in the apical third compared to the other levels. Retrieval was attempted in 88 cases and successful in 70 cases (79.5%). The larger taper and apical position of the SEI negatively influenced the retrieval by 1.4 and 8.7 times, respectively. Conclusions Retrieval of SEI was successful in the majority of the cases. An increase in taper and apically placed SEI negatively impacted the retrieval. There was no difference in the pattern of separation nor retrievability between conventional nickel-titanium files and newer generation heat-treated nickel-titanium files.
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Affiliation(s)
- Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER) University, Maduravoyal, Chennai, India
| | - Aswathi Varghese
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER) University, Maduravoyal, Chennai, India
| | - Paul Kevin Abishek Karthikeyan
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER) University, Maduravoyal, Chennai, India
| | - Srinivasan Narasimhan
- Specialist - Endodontics, Hamad Dental Center, Hamad Medical Corporation, Doha, Qatar
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Zahran SS. Impact of anatomical and clinical variables on the success of endodontic instrument fragment retrieval. J Oral Sci 2025; 67:5-9. [PMID: 39581584 DOI: 10.2334/josnusd.24-0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2024]
Abstract
PURPOSE Separation of instrument fragments can impede the progress of endodontic treatment, and effective management of this complication is crucial for treatment success. This study examined the factors that impact the success of retrieval of separated instrument fragments by postgraduate endodontic residents. METHODS A retrospective analysis was conducted on a total of 224 teeth associated with instrument fragment separation that were managed by postgraduate residents specializing in endodontics between January 2020 and March 2024. Data were extracted from patient records, periapical radiographs, and clinical notes. Chi-squared test and t-test were employed to identify factors significantly influencing retrieval success. Associations between successful retrieval and variables were assessed using binary logistic regression models. RESULTS Fragment retrieval was successful in 32% of the examined cases. Retrieval was more likely to be successful for anterior teeth than for premolars and molars (P = 0.003). Fragment separation in the coronal third of the canal had a higher retrieval success rate (P < 0.001). Longer separated fragments were also associated with increased retrieval success (t = 3.035, P = 0.003). CONCLUSION The study revealed that factors critically influencing the successful retrieval of separated instrument fragments included the tooth type, the level of separation within the canal, and the fragment length. These findings highlight the importance of careful case selection in order to optimize management outcomes.
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Affiliation(s)
- Shatha S Zahran
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University
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Hashemi N, Aminsobhani M, Kharazifard MJ, Hamidzadeh F, Sarraf P. Comparison of the pull-out force of different microtube-based methods in fractured endodontic instrument removal: An in-vitro study. BMC Oral Health 2025; 25:1. [PMID: 39748358 PMCID: PMC11694359 DOI: 10.1186/s12903-024-05370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Accepted: 12/19/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND The fracture of an endodontic instrument within the root canal system can occur during root canal therapy, complicating thorough cleaning and shaping. Consequently, managing the broken fragment becomes crucial. METHODS Eighty Nickel-titanium (NiTi) #20 K-files (Mani, Tochigi, Japan) were cut 8 mm from the tip, fixed into a corkboard, and classified into five groups (n = 14 each). The microtube-based methods included: microtube with cyanoacrylate glue (group 1), light-cured flowable composite resin (group 2), wire (group 3), internal shaft (group 4), and laser (group 5). Each method grasped the separated instrument's free end above the corkboard, and a pull-out test was performed using a universal testing machine(UTM). Additionally, 10 samples were separated in extracted canine root canals, and the temperature of the outer surface of the root was measured using the microtube and laser methods. RESULTS Groups 1 and 4 exhibited significantly greater pull-out force compared to the other groups (p < 0.001). Groups 2 and 5 demonstrated significantly lower pull-out forces (p < 0.001). In Group 5, the temperature increase was 11 °C on the tube surface and 3 °C on the root surface. CONCLUSION All microtube-based techniques are effective for fractured instrument removal, with cyanoacrylate glue and laser methods being particularly suitable for cases that require higher force.
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Affiliation(s)
- Nasim Hashemi
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Aminsobhani
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Endodontics, Faculty of Dentistry/Dental Research Center, AJA and Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Fatemeh Hamidzadeh
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Sarraf
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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Sira A, Nawar NN, Saber SM, Kim HC. The Effect of Different Separated File Retrieval Strategies on the Biomechanical Behavior of a Mandibular Molar: A Finite Element Analysis Study. J Endod 2025; 51:64-70. [PMID: 39481752 DOI: 10.1016/j.joen.2024.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 10/17/2024] [Accepted: 10/23/2024] [Indexed: 11/02/2024]
Abstract
INTRODUCTION This study evaluated the effects of retrieval strategies of separated nickel-titanium files on the biomechanical behavior of endodontically treated teeth by finite element analysis. METHODS Six FE models were created: intact tooth; simulated a scenario where the apical 3 mm of a nickel-titanium file is separated and retained; TD, simulated application of a trephine drill to expose 1 mm of the separated file; simulated troughing of 180° at the inner wall of root canal for an extra 1 mm of the separated file beyond the staging platform; simulated circumferential ultrasonic troughing done for an extra 1 mm after the TD; and PM, simulated iatrogenic perforation sealed using mineral trioxide aggregate. Occlusal loading followed the occlusal fingerprint of the tooth before maximum von Mises stresses, maximum principal stresses, safety factor, and number of cycles till failure were determined. The cervical region of the teeth and mid-root sections including the separated file was chosen as the areas of interest for further analysis. RESULTS Intact tooth recorded the highest number of cycles till failure and safety factor. Other models showed a narrow range of variation in all aspects with the PM recording the lowest number of cycles till failure. The highest von Mises stress was recorded at the mesiobuccal line angle of the PM near its cervical margin, while the lowest was found at the intact tooth. CONCLUSION Under the limitation of this study, various file retrieval strategies removing the surrounding root dentin within the amounts of general guidelines do not affect the biomechanical behavior of the tooth.
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Affiliation(s)
- Anas Sira
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Cairo, Egypt
| | - Nawar Naguib Nawar
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Cairo, Egypt
| | - Shehabeldin Mohamed Saber
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Cairo, Egypt; Center for Innovative Dental Sciences (CIDS), Faculty of Dentistry, The British University in Egypt, Cairo, Egypt.
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, Pusan National University School of Dentistry, Dental Research Institute, Dental and Life Science Institute, Yangsan, Korea.
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Jitesh S, Surendran S, Natanasabapathy V. Efficacy of two instrument retrieval techniques in removing separated rotary and reciprocating nickel-titanium files in mandibular molars - An in vitro study. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:1240-1245. [PMID: 39959011 PMCID: PMC11823577 DOI: 10.4103/jcde.jcde_646_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 10/08/2024] [Accepted: 10/11/2024] [Indexed: 02/18/2025]
Abstract
Context This in vitro study aimed to evaluate the efficacy of both the staging platform (SP) and burrow platform (BP) techniques in the retrieval of separated rotary and reciprocating files in mesiobuccal (MB) canals of mandibular molars. Materials and Methods Forty extracted human mandibular molars with moderate curvature were used in this study. Anatomically, size-matched samples were equally distributed into two different retrieval techniques: Group SP and Group BP. Each group was further subdivided into two subgroups based on their motion kinematics: rotary and reciprocating subgroups. Four millimeters of ProTaper F1 20/07 (rotary) and WaveOne Gold 20/07 (reciprocating) instruments was separated at the apical third region of the MB canal in mandibular molars. Both techniques' success in retrieving separated files was assessed and the canal volume loss was calculated using cone-beam computed tomography. The total time taken for retrieval was also analyzed. Results The overall success rate for retrieval of separated instruments (SIs) was 92.5% (37/40). There was no significant difference in retrieval success rates between SP (95%) and BP technique (90%). BP technique (2.32 mm3 and 103 min) resulted in significantly lesser canal volume loss and longer time for retrieval when compared to SP technique (3.75 mm3 and 90 min). Conclusion Within the limitations of the current study, in mandibular molars with moderate curvature, the BP technique showed a similar success rate to that of SP technique for retrieval of SI. The BP technique resulted in lesser canal volume loss but took more time for retrieval of SI when compared with SP technique.
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Affiliation(s)
- S. Jitesh
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
| | - Smita Surendran
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
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Portigliatti R, Consoli Lizzi EP, Rodríguez PA. Predictive factors in the retrieval of endodontic instruments: the relationship between the fragment length and location. Restor Dent Endod 2024; 49:e35. [PMID: 39649534 PMCID: PMC11621310 DOI: 10.5395/rde.2024.49.e35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/23/2024] [Accepted: 06/27/2024] [Indexed: 12/11/2024] Open
Abstract
Objectives This study aimed to relate the file fragment length and location in the root canal to the retrieval chances, the clinical time required and the occurrence of secondary fractures. Materials and Methods Sixty clinical cases of fractured instruments were included in this study. They were classified according to the instrument length and the location of the root canal. In each group, the success rate in the instrument retrieval, the clinical time required and the occurrence of secondary fractures were evaluated. The collected data were analyzed using the Kruskal-Wallis test on the basis of a 0.05 significance level. Results The fragment length showed no significant influence on the assessed variables (p > 0.05). The root third where the instrument was located resulted in an increased clinical time, with statistically significant differences (p < 0.05). However, the procedure success rate and the occurrence of secondary fractures showed no association with these variables. Conclusions In accordance with the findings of this study, the fractured fragment length did not influence any of the variables assessed, but it is suggested to focus on the fragment location inside the root canal to decide the retrieval of a fractured instrument.
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Affiliation(s)
- Ricardo Portigliatti
- Department of Endodontic, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
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Dioguardi M, Dello Russo C, Scarano F, Esperouz F, Ballini A, Sovereto D, Alovisi M, Martella A, Lo Muzio L. Analysis of Endodontic Successes and Failures in the Removal of Fractured Endodontic Instruments during Retreatment: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis. Healthcare (Basel) 2024; 12:1390. [PMID: 39057533 PMCID: PMC11276083 DOI: 10.3390/healthcare12141390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
This study presents a systematic review with meta-analysis to evaluate the success rates of endodontic retreatments in teeth where separated instruments are located within the roots. The search and selection of studies were conducted across two databases, SCOPUS and PubMed, as well as the Cochrane Library registry, yielding a total of 1620 records. Following the selection process, 11 studies were included in the systematic review. Overall, out of 1133 retreated teeth, there were 172 failures in instrument removal and 55 perforations. The meta-analysis results indicate that failures are more frequent when instruments are located in the apical third, with a failure rate of 21%, compared to an 8.8% failure rate in the middle/coronal third. The anatomy of the root canals, particularly the location of the separated instruments, significantly influences the success rates.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Corrado Dello Russo
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Filippo Scarano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Fariba Esperouz
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Andrea Ballini
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Diego Sovereto
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
| | - Mario Alovisi
- Department of Surgical Sciences, Dental School, University of Turin, 10127 Turin, Italy;
| | - Angelo Martella
- DataLab, Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy;
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (C.D.R.); (F.S.); (F.E.); (A.B.); (D.S.); (L.L.M.)
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Aminsobhani M, Hashemi N, Hamidzadeh F, Sarraf P. Broken Instrument Removal Methods with a Minireview of the Literature. Case Rep Dent 2024; 2024:9665987. [PMID: 38919975 PMCID: PMC11196850 DOI: 10.1155/2024/9665987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/24/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
Instrument fracture in the root canal system is an unpleasant incident that may occur during root canal treatment. Comprehensive cleaning of the root canal system is often impossible in the presence of a broken instrument. Therefore, it is often imperative to remove the broken fragment from the root canal system. To date, various methods have been proposed for the removal of broken instruments from the root canal system. However, no consensus has been reached on a safe technique with a high success rate for broken instrument removal. This case series reports six cases of successful removal of broken instruments using different methods including the ultrasonic, tube-and-glue, tube-and-wire, tube-and-internal shaft, and the forceps techniques and also provides a brief review of the relevant literature.
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Affiliation(s)
- Mohsen Aminsobhani
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
- School of DentistryAJA University of Medical Sciences, Tehran, Iran
| | - Nasim Hashemi
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hamidzadeh
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
| | - Pegah Sarraf
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
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Rathod P, Patel A, Ikhar A, Chandak M, Mahapatra J, Suryawanshi T, Patil J, Mahale P. Management of an Intracanal Separated Instrument in the Lower Right First Molar: A Case Report. Cureus 2024; 16:e63418. [PMID: 39077284 PMCID: PMC11285720 DOI: 10.7759/cureus.63418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 06/28/2024] [Indexed: 07/31/2024] Open
Abstract
Separating an endodontic instrument is one of the most frequent errors during a root canal treatment. If endodontic instruments get separated, it could hinder disinfection and prevent access to the apical portion of the root. It compromises the success of the treatment by impeding the proper debris removal from the canal. But now that techniques and tools have advanced, it is feasible to remove a separated instrument from the root canal successfully. This case report presents the management of a separated instrument, demonstrating the successful removal of the separated instrument.
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Affiliation(s)
- Pratik Rathod
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aditya Patel
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anuja Ikhar
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manoj Chandak
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Joyeeta Mahapatra
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejas Suryawanshi
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jay Patil
- Department of Orthodontics and Dentofacial Orthopaedics, Annasaheb Chudaman Patil Memorial Dental College and Hospital, Maharashtra University of Health Sciences, Dhule, IND
| | - Priti Mahale
- Department of Conservative Dentistry and Endodontics, Shri. Yashwantrao Chavan Memorial Medical and Rural Development Foundation's Dental College and Hospital, Maharashtra University of Health Sciences, Ahmednagar, IND
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12
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Zanza A, Reda R, Testarelli L. Endodontic Orthograde Retreatments: Challenges and Solutions. Clin Cosmet Investig Dent 2023; 15:245-265. [PMID: 37899987 PMCID: PMC10612510 DOI: 10.2147/ccide.s397835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023] Open
Abstract
Endodontic orthograde retreatments are considered one of the possible treatment options in case of post-treatment diseases considering the promising results present in the literature. Despite this, a plethora of articles have been published on this topic, and drawing conclusions could be challenging. For this reason, this review aims to summarize the crucial points on each aspect of non-surgical endodontic retreatments, discussing and comparing the current protocols, techniques, materials, and indications. Taking into consideration data from the literature, in terms of diagnosis, CBCT should be considered the first choice, since it can thoroughly affect the diagnosis and treatment plan. Regarding the procedural phases, some conclusions can be drawn: when present, coronal restoration materials such as crowns, partial prostheses, post, and core should be removed; the use of magnification devices, ultrasonic instruments, and an in-depth interpretation of radiographic images with both 2D and 3D images are strongly recommended during the orifice location; additional protocols such as irrigants activation, ultrasonic cleaning, and rotary or reciprocating instrumentation of treated canals are strongly recommended for filling materials removal and to achieve a high-quality chemo-mechanical disinfection; perforations should be treated as soon as possible, and the material of choice to treat them is the MTA or other calcium-silicate-based repair materials; the presence of ledges does not intrinsically reduce the success rate of RCRts if properly managed; in case of instrument fragments, their removal should be considered as the first treatment option, however many variables should be considered to select the proper technique or consider the option of bypassing.
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Affiliation(s)
- Alessio Zanza
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Rodolfo Reda
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Testarelli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
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13
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Galván-Pacheco J, Méndez-González V, González-Amaro A, Bujanda-Wong H, Pozos-Guillén A, Garrocho-Rangel A. Efficacy of the HBW Ultrasonic Ring for retrieval of fragmented manual or rotatory instruments. J Oral Sci 2023; 65:278-280. [PMID: 37558435 DOI: 10.2334/josnusd.23-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
A study was conducted to evaluate the success rates of bypassing or removing fragments of instruments that had fractured within the roots of mandibular molars using a HBW Ultrasonic Ring. Forty extracted first permanent mandibular molars with root canal curvature were included. The teeth were distributed randomly into four groups according to the type of instrument and the root canal third where they had fractured. The success rate for removal of instrument fragments was 100% for both of two stainless steel groups, 90% for a nitinol middle third group, and 80% for a nitinol apical third group. The mean time required for instrument removal was around 40 min. The HBW Ultrasonic Ring showed acceptable experimental results for retrieval of broken instrument fragments.
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Affiliation(s)
- Jennifer Galván-Pacheco
- Postgraduated Department of Endodontics, Faculty of Dentistry, Autonomous University of San Luis Potosí
| | - Verónica Méndez-González
- Postgraduated Department of Endodontics, Faculty of Dentistry, Autonomous University of San Luis Potosí
| | - Ana González-Amaro
- Postgraduated Department of Endodontics, Faculty of Dentistry, Autonomous University of San Luis Potosí
| | | | - Amaury Pozos-Guillén
- Postgraduated Department of Pediatric Dentistry, Faculty of Dentistry, Autonomous University of San Luis Potosí
| | - Arturo Garrocho-Rangel
- Postgraduated Department of Pediatric Dentistry, Faculty of Dentistry, Autonomous University of San Luis Potosí
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14
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Karim MH, Faraj BM. Comparative Evaluation of a Dynamic Navigation System versus a Three-dimensional Microscope in Retrieving Separated Endodontic Files: An In Vitro Study. J Endod 2023; 49:1191-1198. [PMID: 37393950 DOI: 10.1016/j.joen.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION This study aimed to compare the effectiveness of a dynamic navigation system and a three-dimensional microscope in retrieving broken rotary Nickel-Titanium files when using trepan burs and the extractor system. MATERIALS AND METHODS Thirty maxillary first bicuspids with 60 separate roots were split into 2 comparable groups based on a comprehensive cone beam computed tomography analysis of the root length and curvature. After standardized access opening, glide paths, and patency attainment with the K file (sizes 10 and 15), the teeth were arranged on 3D models (three per quadrant, six per model). Subsequently, controlled-memory heat-treated Nickel-Titanium rotary files (#25/0.04) were notched 4 mm from the tips and fractured at the apical third of the roots. The C-FR1 Endo file removal system was employed under both guidance to retrieve the fragments, and the success rate, canal aberration, treatment time, and volumetric changes were measured. The statistical analysis was performed using IBM SPSS software at a significance level of 0.05. RESULTS The microscope-guided group had a higher success rate than the dynamic navigation system guidance, but the difference was insignificant (P > .05). In addition, the microscope-guided drills resulted in a substantially lower proportion of canal aberration, shorter time to retrieve the fragments and less change in the root canal volume (P < .05). CONCLUSION Although dynamically guided trephining with the extractor can retrieve separated instruments, it is inferior to three-dimensional microscope guidance regarding treatment time, procedural errors, and volume change.
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Affiliation(s)
- Mohammed H Karim
- Conservative Department, University of Sulaimani, College of Dentistry, Iraq.
| | - Bestoon M Faraj
- Conservative Department, University of Sulaimani, College of Dentistry, Iraq
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15
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Umre U, Sedani S, Nikhade PP, Mishra A, Bansod A. The Good Old Masserann Technique for the Retrieval of a Separated Instrument: An Endodontic Challenge. Cureus 2023; 15:e45811. [PMID: 37876388 PMCID: PMC10591272 DOI: 10.7759/cureus.45811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
Instrument separation is one of the most upsetting endodontic errors, and it can occur at any time during root canal surgery. A broken file causes a metallic restriction in the root canal and makes it difficult to clean and shape the instrument effectively, thereby making the prognosis questionable. Hence, such a fragment should be properly retrieved when it becomes difficult to bypass it. A variety of techniques and tools are utilized for instrument recovery; however, most of them are expensive, difficult to master, and technique-sensitive. One such tool for orthograde removal of intracanal metallic obstacles is the Masserann kit. We discuss a case involving file removal from the maxillary premolar by using the Masserann technique.
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Affiliation(s)
- Utkarsh Umre
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shweta Sedani
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pradnya P Nikhade
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abeer Mishra
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akansha Bansod
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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16
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Coaguila-Llerena H, Lazo-Quezada G, Teves A, Zevallos-Chávez M, Faria G. Removal of separated instruments from unfavourable locations: Case reports using the HBW ultrasonic ring or a surgical approach. AUST ENDOD J 2023; 49:358-364. [PMID: 35932460 DOI: 10.1111/aej.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/05/2023]
Abstract
Two patients were admitted to the dental clinic to evaluate two right mandibular first molars (both FDI no. 46). In Case 1, there was an accidental instrument separation, which was thought to have been bypassed; however, the instrument was located beyond the apical foramen, in the alveolar bone. The 1-week follow-up revealed that the fragment was close to the inferior alveolar nerve, thus allowing surgical removal to be performed. In Case 2, two separated instruments located in the apical third of the mesiobuccal and mesiolingual canals were removed using the HBW ultrasonic ring coupled to ISO 10 and 15 hand instruments. The 3-month and 1-year follow-ups (Case 1), and the 2-year and 3-year follow-ups (Case 2) showed a favourable evolution in both cases. It can be concluded that both the surgical approach and the HBW ultrasonic ring are viable options for the removal of separated instruments in unfavourable locations.
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Affiliation(s)
- Hernán Coaguila-Llerena
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University - UNESP, Araraquara, Brazil
| | | | - Abel Teves
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo - USP, Bauru, Brazil
| | - Marco Zevallos-Chávez
- Department of Endodontics, Catholic University of Santa Maria - UCSM, Arequipa, Peru
| | - Gisele Faria
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University - UNESP, Araraquara, Brazil
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17
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Malentacca A, Zaccheo F, Rupe C, Lajolo C. Endodontic Clinical Outcome after Separated Instrument Removal Using a Spinal Needle Technique: A Retrospective Study of Thirty Years of Clinical Experience. J Endod 2023; 49:980-989. [PMID: 37422250 DOI: 10.1016/j.joen.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Current methods for the removal of separated endodontic instruments (RSI) are not predictable. METHODS The primary outcome of this retrospective study was to assess the clinical and radiographic success (CRS) of teeth in case of RSI after a 5-year follow-up. Secondary outcomes were to evaluate (1) the effectiveness in RSI and (2) the risk of root fracture after RSI. The study protocol was registered at ClinicalTrials.gov (ID: NCT05128266). The patients were treated by the same endodontist between January 1991 and December 2019. The RSI was performed under the operative microscope as follows: first, the dentine surrounding the coronal part of the broken instrument was selectively removed by using a small ultrasonic tip to loosen the fragment; then, a modified spinal needle was used to catch and remove the instrument. The 1-, 3-, 5-, and >5-year CRS were recorded. Logistic regression analysis was performed to determine independent predictors of failure (ie, tooth number, type of root canal, shape of the root canal, type of broken instrument, apicocoronal level of the separated instrument, presence of periapical lesions, and root perforations). RESULTS A total of 158 teeth were included in this study. Finally, 131 instruments underwent RSI (82.9%). RSI was an independent predictor of CRS after 1-year of treatment (odds ratio: 58.3; 95% confidence interval: 27.42-95.73, P < .05). At the 5-year follow-up, only 10 of 131 teeth (7.6%) failed. All failures were caused by root fracture (10/10) (χ2 test, P < .05). Separated instruments located in the apical third of the root were more difficult to remove (13/49 cases, 26.5%; χ2 test, P < .05). CONCLUSIONS The proposed technique can achieve excellent effectiveness in RSI, can achieve a high CRS rate when a periapical lesion is present, is not associated to a significant increase in root fracture incidence, and should be performed with the help of an operative microscope.
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Affiliation(s)
| | | | - Cosimo Rupe
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli-IRCCS", Rome, Italy.
| | - Carlo Lajolo
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli-IRCCS", Rome, Italy
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18
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Grande NM, Castagnola R, Minciacchi I, Marigo L, Plotino G. A review of the latest developments in rotary NiTi technology and root canal preparation. Aust Dent J 2023; 68 Suppl 1:S24-S38. [PMID: 37960998 DOI: 10.1111/adj.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/15/2023]
Abstract
The introduction of nickel-titanium (NiTi) mechanical instruments dramatically changed clinical endodontics over the last few decades. Before NiTi, it was necessary to use more instruments to create an ideal root canal shape, and many approaches, sequences and techniques were developed over the years. Recently, NiTi endodontic instruments have undergone a series of changes brought about by modifications in design, surface treatments, and thermal treatments to improve their root canal preparation outcomes and reduce associated canal preparation risks during root canal treatment. Heat treatment is one of the most fundamental approaches to improving the fatigue resistance and flexibility of NiTi endodontic instruments. In addition, new kinematics have been developed to offer greater safety and efficiency. This narrative review describes the general properties and manufacturing of NiTi instruments, and the mechanical system evolution of NiTi instruments.
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Affiliation(s)
- N M Grande
- Dipartimento di Testa-Collo e organi di senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Castagnola
- Dipartimento di Testa-Collo e organi di senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - L Marigo
- Dipartimento di Testa-Collo e organi di senso, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Odontoiatria Generale e Ortodonzia, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo. Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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19
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Hindlekar A, Kaur G, Kashikar R, Kotadia P. Retrieval of Separated Intracanal Endodontic Instruments: A Series of Four Case Reports. Cureus 2023; 15:e35694. [PMID: 37012963 PMCID: PMC10066733 DOI: 10.7759/cureus.35694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
The separation of an endodontic instrument during a root canal procedure is one of the most common endodontic mishaps. Separation of endodontic instruments may block access to the apical portion of the root and hamper the disinfection process. It obstructs the appropriate debridement of the canal apical to the fragment, jeopardizing the treatment's outcome. However, due to the advancements in the methods and armamentarium, the effective retrieval of a separated instrument (SI) from the root canal has become possible. This paper includes a case series of management of separated instruments whereby SI was successfully removed in four cases. The instruments were separated intracanal at various levels in the middle and apical third of maxillary and mandibular molar teeth. The level of separation was located, staging performed, and SI was removed using an ultrasonic device under magnification. Removal of the SI was followed by obturation till the entire working length and subsequent post-endodontic restoration. Patient satisfaction with treatment outcomes in all cases was good. Case evaluation, good armamentarium, adequate knowledge along with good clinical skills and experience aid in the successful retrieval of separated instruments. Removal of the instrument without further damage to radicular dentin is important to maintain the integrity of the tooth.
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20
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Bhasin P, Vats V, Chauhan S, Tandon M, Kumar H, Chugh R. MAGNIFICATION, ULTRASONICS AND BIOCERAMICS - THE IDEAL TRIO FOR FILE
RETRIEVAL: A CASE REPORT. BULLETIN OF STOMATOLOGY AND MAXILLOFACIAL SURGERY 2023:9-13. [DOI: 10.58240/1829006x-2023.19.1-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2024]
Abstract
During routine endodontic therapy, a clinician may encounter many procedural errors which alter the course and outcome of the treatment. Instrument separation is one of the most common types of procedural error, resulting in metallic obstruction in the canal and impeding efficient cleaning and shaping of the root canal. The clinician has to evaluate the options of attempting retrieval, bypassing or leaving the fragment as it is. When an attempt such a fragment becomes difficult, it should be retrieved with the help of ultrasonics under magnification and the canals should with bioceramic sealer to improve the tooths prognosis.
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Affiliation(s)
- Prashant Bhasin
- Professor & HOD, Department of Conservative Dentistry & Endodontics, Sudha Rustagi College of Dental Sciences & Research, Faridabad, India
| | - Vrinda Vats
- Post Graduate, Department of Conservative Dentistry & Endodontics, Sudha Rustagi College of Dental Sciences & Research, Faridabad, India
| | - Sachin Chauhan
- Post Graduate, Department of Conservative Dentistry & Endodontics, Sudha Rustagi College of Dental Sciences & Research, Faridabad, India
| | - Monika Tandon
- Professor, Department of Conservative Dentistry & Endodontics, Sudha Rustagi College of Dental Sciences & Research, Faridabad, India
| | - Hemanshi Kumar
- Professor, Department of Conservative Dentistry & Endodontics, Sudha Rustagi College of Dental Sciences & Research, Faridabad, India
| | - Rajiv Chugh
- Professor, President Elect Indian Dental Association, Director, Dr. Chugh’s Dental Centre, New Delhi, India
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21
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Terauchi Y, Ali WT, Abielhassan MM. Present status and future directions - Removal of fractured instruments. Int Endod J 2022; 55 Suppl 3:685-709. [PMID: 35377473 DOI: 10.1111/iej.13743] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
Success rate of fractured instrument retrieval varies because it is dependent mainly on several factors including the visibility of the fractured instrument, the length of the fractured instrument in relation to the curvature of the canal, and the techniques applied to each case. This review aims to update the present status on removal of fractured instruments to identify factors and variables that could affect the success of fractured instrument retrieval based on both the preparation techniques and the instrument retrieval techniques. On the other hand, future directions of fractured instrument retrieval should focus on management of non-visible fractured instruments since the removal of those instruments are deemed unpredictable with the current techniques, whereas the removal of visible fractured instruments are considered predictable now. Another possible direction of it is there might be no more instrument fracture due to possible significant changes in the root canal preparation technique which may dispense with the use of rotary instruments.
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Affiliation(s)
- Yoshi Terauchi
- CT & MicroEndodontic center, 3-3-1 Chuorinkan, Yamato-Shi, KANAGAWA, 242-0001, Japan.,Yoshitsugu Terauchi, 9-8-14 Chuorinkan, Yamato City, KANAGAWA, 2420007, Japan
| | - Wagih Tarek Ali
- Endodontic Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
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22
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The Effect of Cone-Beam Computed Tomography (CBCT) Evaluation on Treatment Planning after Endodontic Instrument Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074088. [PMID: 35409771 PMCID: PMC8998552 DOI: 10.3390/ijerph19074088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 02/01/2023]
Abstract
Intracanal instrument fracture is a procedural iatrogenic event during endodontic treatment that may affect treatment planning and eventually treatment outcome. Cone Beam Computed Tomography (CBCT) has offered several advantages, especially in endodontic cases in which information from conventional periapical radiograph may not be adequate to allow a precise treatment planning decision and a subsequent appropriate management of the cases. The present study was firstly conducted to assess the effect of CBCT evaluation on the decision-making process after instrument fracture; secondly, to introduce a new clinical approach in cases with fractured instruments located in the mesial roots of mandibular and maxillary molars. The study design was observational. The sample comprised all cases of mandibular and maxillary molars where an instrument fracture had occurred in the mesial roots. Two qualified (National and Kapodistrian University of Athens, Greece) and experienced (more than fifteen years of daily practicing) endodontists evaluated all the cases. The initial treatment plan made by evaluating periapical radiographs of each case was compared to the final plan set after CBCT evaluation. A marginal homogeneity test for paired data was conducted to test the concordance of treatment planning with periapical radiographs versus CBCT. Multivariable logistic regression was structured to identify predictors of modification in treatment planning following CBCT assessment, and to record estimators for decision to remove, bypass or retain the fragment. The level of statistical significance was pre-specified at p < 0.05. Of a total 52 cases evaluated, change in treatment planning with conventional periapical radiograph as a reference, following evaluation of CBCT, was observed in more than half of the teeth. The difference was statistically significant (p < 0.001). Apical location of the fragment was more likely to induce a perceived change in treatment planning after CBCT evaluation (p < 0.01). Canal merging induced 95% lower odds (p = 0.01) for taking a decision to remove or bypass, revealing that retaining the fragment was by far a more likely decision. A significant impact of CBCT preoperative evaluation on treatment planning for the management of such cases was demonstrated. Apical location of the fragment and canal merging seem to influence the decision-making process.
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23
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Kaul R, Gupta R, Chhabra S, Koul R. Dental Operating Microscope-guided Retrieval of Broken Instrument from a Deciduous Molar Using Ultrasonics. Int J Clin Pediatr Dent 2022; 15:S114-S118. [PMID: 35645502 PMCID: PMC9108828 DOI: 10.5005/jp-journals-10005-1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Endodontic procedures are associated with various mishaps, one of which is instrument breakage. It can act as an obstruction to mechanical and chemical cleaning of an infected root canal, thereby hampering the prognosis of treatment. Instrument retrieval must be performed with minimum damage to a tooth and surrounding tissues, minimal loss of radicular dentine and simultaneously maintaining the original canal shape as much as possible. This case report represents successful retrieval of a separated K file fragment from the distobuccal canal of the right mandibular primary second molar 85 with ultrasonic energy application under the dental operating microscope.
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Affiliation(s)
- Rahul Kaul
- Department of Paediatric Dentistry, Field Hospital, Manipur, India
- Rahul Kaul, Department of Paediatric Dentistry, Field Hospital, Manipur, India, Phone: +91 9469280800, e-mail:
| | - Rohan Gupta
- Department of Dentistry, Master of Dental Surgery (Conservative Dentistry and Endodontics), Rajouri, Jammu and Kashmir, India
| | - Sanjay Chhabra
- Department of Dentistry, Master of Dental Surgery (Conservative Dentistry and Endodontics), Dimapur, Nagaland, India
| | - Rishu Koul
- Department of Dentistry, MDC Gopalpur, Odisha, India
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Faus-Matoses V, Burgos Ibáñez E, Faus-Llácer V, Ruiz-Sánchez C, Zubizarreta-Macho Á, Faus-Matoses I. Comparative Analysis of Ease of Removal of Fractured NiTi Endodontic Rotary Files from the Root Canal System-An In Vitro Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020718. [PMID: 35055540 PMCID: PMC8775915 DOI: 10.3390/ijerph19020718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
This study aimed at analyzing and comparing the ease of removal of fractured nickel-titanium (NiTi) endodontic rotary files from the root canal system between the ultrasonic tips and the Endo Rescue appliance removal systems, as well as comparing the volume of dentin removed between ultrasonic tips and the Endo Rescue appliance using a micro-computed tomography (micro-CT) scan. MATERIAL AND METHODS Forty NiTi endodontic rotary files were intentionally fractured in 40 root canal systems of 20 lower first molar teeth and distributed into the following study groups: A: Ultrasonic tips (n = 20) (US) and B: Endo Rescue device (n = 20) (ER). Preoperative and postoperative micro-CT scans were uploaded into image processing software to analyze the volumetric variations of dentin using an algorithm that enables progressive differentiation between neighboring pixels after defining and segmenting the fractured NiTi endodontic rotary files and the root canal systems in both micro-CT scans. A non-parametric Mann-Whitney-Wilcoxon test or t-test for independent samples was used to analyze the results. RESULTS The US and ES study groups saw 8 (1 mesiobuccal and 7 distal root canal system) and 3 (distal root canal system) fractured NiTi endodontic rotary files removed, respectively. No statistically significant differences were found in the amount of dentin removed between the US and ER study groups at the mesiobuccal (p = 0.9109) and distal root canal system (p = 0.8669). CONCLUSIONS Ultrasonic tips enable greater ease of removal of NiTi endodontic rotary files from the root canal system, with similar amounts of dentin removal between the two methods.
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Affiliation(s)
- Vicente Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-M.); (E.B.I.); (V.F.-L.); (C.R.-S.); (I.F.-M.)
| | - Eva Burgos Ibáñez
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-M.); (E.B.I.); (V.F.-L.); (C.R.-S.); (I.F.-M.)
| | - Vicente Faus-Llácer
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-M.); (E.B.I.); (V.F.-L.); (C.R.-S.); (I.F.-M.)
| | - Celia Ruiz-Sánchez
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-M.); (E.B.I.); (V.F.-L.); (C.R.-S.); (I.F.-M.)
| | - Álvaro Zubizarreta-Macho
- Department of Endodontics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain
- Correspondence:
| | - Ignacio Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-M.); (E.B.I.); (V.F.-L.); (C.R.-S.); (I.F.-M.)
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Portela NN, Rech JP, Marchionatti AME, Barasuol JC. Techniques to address fractured instruments in the middle or apical third of the root canal in human permanent teeth: a systematic review of the in vitro studies. Clin Oral Investig 2021; 26:131-139. [PMID: 34698940 DOI: 10.1007/s00784-021-04235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study is to investigate techniques for approaching fractured instruments in the root canal and to present possible outcomes in relation to dentin thickness, fracture resistance, technique success, and clinical time. MATERIALS AND METHODS The bibliographic research was carried out in PubMed, Cochrane, Lilacs, Web of Science, Scopus, grey literature, and manual search. Following the inclusion and exclusion criteria, the titles and abstracts of 506 articles were read. Of these, 60 articles were selected and read in full. Fourteen articles were included in this systematic review. RESULTS The most studied technique was the ultrasonic technique and obtained good general results. The more apically the instrument is located, the more difficult it is to remove, the more dentin is removed, and the lower the fracture resistance of the tooth. When removal is not possible, the bypass technique can be performed (bypassing), and on weakened teeth or with little dental remnants, the GentleWave System technique can be used. CONCLUSION This systematic review shows the evidence from laboratory studies that the curvature and the root third in which the fracture of instruments occurred is relevant to fracture resistance and success. The ultrasonic technique got the best results. Well-conducted clinical studies should be performed for clinical practice. CLINICAL RELEVANCE The approach of fractured instruments in the root canal is efficient with the use of ultrasound, bypass technique, and Gentle Wave System.
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Affiliation(s)
- Nathalia Nadalon Portela
- Faculdade CNEC, R. Prof. Dr. João Augusto Rodrigues, 471 - Harmonia, Santo Ângelo, RS, 98801-015, Brazil
| | - Júlia Petry Rech
- Faculdade CNEC, R. Prof. Dr. João Augusto Rodrigues, 471 - Harmonia, Santo Ângelo, RS, 98801-015, Brazil
| | | | - Jéssica Copetti Barasuol
- Faculdade CNEC, R. Prof. Dr. João Augusto Rodrigues, 471 - Harmonia, Santo Ângelo, RS, 98801-015, Brazil.
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A Modified Partial Platform Technique to Retrieve Instrument Fragments from Curved and Narrow Canals: A Report of 2 Cases. J Endod 2021; 47:1657-1663. [PMID: 34298031 DOI: 10.1016/j.joen.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/02/2021] [Accepted: 07/11/2021] [Indexed: 11/22/2022]
Abstract
Two cases are reported to present the "Burrow platform" (BP) technique. The BP technique uses a partial platform for retrieving instrument fragments, thereby reducing the loss of radicular dentin.The BP technique is a microscope-aided approach implementing coated ultrasonic tips to create an access to instrument fragments in the middle and apical thirds of the root canal. The technique consists of 4 steps: (1) coronal access, (2) radicular access, (3) partial platform, and (4) exposure of the fragment and retrieval. A precise, angulated access pathway is specific to the BP technique. In the coronal half, the radicular access pathway extends toward the outer wall of the curvature. In the apical half, the radicular access pathway is oriented toward the inside of the curvature. One and 4 instrument fragments were successfully retrieved in the respective cases. At follow-up, all teeth were asymptomatic and had responded favorably to the treatment.The BP technique may present a suitable alternative to fragment removal from curved canals and slender roots to avoid ledge formation, transportation, and perforation. Instrument retrieval using the BP technique can be performed using commonly available armamentarium.
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Management of Intracanal Separated File Fragment in a Four-Rooted Mandibular Third Molar. Case Rep Dent 2021; 2021:5547062. [PMID: 34306768 PMCID: PMC8266475 DOI: 10.1155/2021/5547062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
The success of endodontic therapy is attributed to complete arbitration of the bound entities concealed within the complexity and absolute disinfection of the root canal system, thus, deeming it mandatory to effectively negotiate and overcome the challenges posed by obstruction, either iatrogenic or anatomic. To achieve this, considerable depth of knowledge and expertise with reference to variations in root canal morphology and clinical mishap management is substantially as important as developing fine observation skills in conjunction with an appropriate armamentarium and a keen sense of determination, thereby enhancing one's clinical acumen by several folds. In the present case, following rubber dam isolation, the temporary restoration was removed, and the remaining carious dentin was excavated. Endodontic access cavity was refined and explored with a DG-16 probe, following which three separate canal orifices were identified in the pulp chamber floor (mesiobuccal, mesiolingual, and distal). On further observation under a surgical operating microscope and continuous exploration with the DG-16 probe, a fourth canal was found in the mesial aspect of the tooth (middle mesial). With instrumentation, it was confirmed that a fractured object was indeed present at the apical third of the mesiolingual root of tooth 38. Bypassing of the fractured fragment was initiated with a size 10 SS K-file coupled with copious irrigation with 3% sodium hypochlorite. In the present case report, four distinct canals comprising 3 mesial and 1 distal canal were recognized, and the fractured instrument in one of the canals was bypassed successfully.
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Terauchi Y, Sexton C, Bakland LK, Bogen G. Factors Affecting the Removal Time of Separated Instruments. J Endod 2021; 47:1245-1252. [PMID: 34000326 DOI: 10.1016/j.joen.2021.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Separated endodontic instruments may adversely affect the outcome of endodontic treatment. The combination of ultrasonic techniques and dental operating microscopes appears to be effective in the removal of separated instruments compared with more randomized techniques. This study evaluated the roles of root canal curvature and separated instrument length on the time needed to loosen and retrieve the instrument fragments. METHODS The retrieval procedures of 128 separated instruments referred to a private endodontic practice for retreatment by general practitioners were evaluated in patients who were monitored for a minimum of 6 months. Preoperative cone-beam computed tomographic images were used to measure separated instrument lengths in relation to the degrees of canal curvatures. Ultrasonic instruments were used in the initial phase to remove the tooth structure and to loosen the fractured instrument. In the second phase, ultrasonic instruments, wire loops, or XP Shapers (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) were used for fragment removal. The time periods for all procedures were recorded. Statistical analysis was completed applying log-normal regression, structural equation modeling, and linear regression using Stata Version 14.2 software (StataCorp LLC, College Station, TX). RESULTS All separated instruments were successfully retrieved. Using the protocol in this study, 89.8% of the instruments were removed using ultrasonic instruments alone with a mean time of 221 seconds. The instrument removal time was dependent on both the instrument length and the root canal curvature. Additionally, preparation times were proportionately longer with increasing separated instrument lengths when the loop device was required. CONCLUSIONS The preparation phase appears to have an important role in the retrieval of separated instruments. Preparation times for both non-loop and loop groups demonstrate that length and curvature are independent predictors of the log-transformed time. Generally, procedure times were extended with increasing file lengths and higher degrees of canal curvature.
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Affiliation(s)
| | - Christopher Sexton
- University of Queensland, School of Dentistry, Brisbane, Queensland, Australia
| | - Leif K Bakland
- Loma Linda University, School of Dentistry, Loma Linda, California
| | - George Bogen
- Department of Endodontics, University of Queensland, School of Dentistry, Brisbane, Queensland, Australia.
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PradeepKumar A, Kumar B, Krishnamoorthy S, Shanmugam S. The time taken for retrieval of separated instrument and the change in root canal volume after two different techniques using CBCT: An in-vitro study. Indian J Dent Res 2021; 32:489-494. [DOI: 10.4103/ijdr.ijdr_403_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Türker SA, Uzunoğlu-Özyürek E, Kaşikçi S, Öndeş M, Geneci F, Çelik HH. Filling quality of several obturation techniques in the presence of apically separated instruments: A Micro-CT study. Microsc Res Tech 2020; 84:1265-1271. [PMID: 33378798 DOI: 10.1002/jemt.23685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/09/2020] [Accepted: 12/15/2020] [Indexed: 11/05/2022]
Abstract
Separated root canal instruments may affect the quality of root canal obturation and hence the survival of endodontically treated teeth. Obturation techniques may influence filling-quality. The aim was to evaluate the obturation quality of teeth filled with different obturation techniques in the presence of apically separated instruments using micro-computed tomography (μ-CT). Notched ProTaper F2 rotary-files were separated in the apical third of 36-human mandibular incisors with single root/canal and mature apex. Samples were filled by an endodontist according to one of the following obturation techniques (n = 12): cold lateral-compaction (CLC), single-cone (SC) and thermoplastic injection (TI). Samples were scanned by the Skyscan 1,274® μ-CT device after 1-week at 37°C in 100% humidity. Images of the sections were evaluated with CTan software in terms of total-volume and volume percentage of the filling materials and voids between coronal end of the separated instrument and gutta-percha/sealer filled void-free sections. Data was analyzed using Kruskal-Wallis and Mann Whitney-U tests with a significance level of 5%. Kruskal-Wallis revealed differences among groups (p < 0.05).Pairwise comparisons revealed that less volume of voids were measured in SC (0.02 ± 0.03 mm3 ) compared to CLC (0.15 ± 0.16 mm3 ) and TI (0.18 ± 0.24 mm3 ) (p < 0.05); while TI was statistically similar with CLC (p > 0.05). Percentages of volumes of voids and filling materials were as follows for SC, CLC and TI, respectively: 8.88 ± 18.52% and 24.45 ± 38.40%, 46.92 ± 33.53% and 53.07 ± 33.53%, 40.54 ± 33.85% and 42.79 ± 34.45%. The obturation technique may have a significant impact on the volume of voids in the presence of a separated file. No obturation technique produced a void-free root canal filling.
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Affiliation(s)
- Sevinç Aktemur Türker
- Faculty of Dentistry, Department of Endodontics, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Emel Uzunoğlu-Özyürek
- Faculty of Dentistry, Department of Endodontics, Hacettepe University, Ankara, Turkey
| | - Sena Kaşikçi
- Faculty of Dentistry, Department of Endodontics, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Melike Öndeş
- Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ferhat Geneci
- Faculty of Medicine,Department of Anatomy, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hakan Hamdi Çelik
- Faculty of Medicine, Department of Anatomy, Hacettepe University, Ankara, Turkey
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Eymirli A, Uzunoğlu Özyürek E, Serper A. Sealer penetration: effect of separated file's cross-section, taper and motion characteristics. Clin Oral Investig 2020; 25:1077-1084. [PMID: 32562075 DOI: 10.1007/s00784-020-03404-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 06/10/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The separated root canal instruments may affect the quality of root canal filling, hence the success of endodontic treatment. The aim of this study was to evaluate the effects of separated file fragments of nickel-titanium rotary systems with different cross-section, taper and motion characteristics on the apical sealer penetration in oval-shaped root canals via confocal laser scanning microscope (CLSM). MATERIALS AND METHODS Distal roots of 60 mandibular molars with oval-shaped root canals were randomly divided into 4 groups as follows: group 1, FlexMaster Nickel Titanium Rotary File System (NTRFS) (separated instrument: 30/.06); group 2, ProTaper Next NTRFS (X3); group 3, ProTaper Universal NTRFS (F3); group 4, Revo-S NTRFS (AS30/.06). Root canals were filled with gutta-percha and AH plus labelled with 0.1% rhodamine B using a warm vertical compaction technique. Each specimen was horizontally sectioned at 1st, 3rd and 5th mm from apical foramen. Amount of maximum and average penetration depths, penetration percentage and sealer penetrated area were measured and analysed with one-way repeated measures of ANOVA and the Bonferroni post hoc tests. p < 0.05 was considered significant. RESULTS The penetration depth, percentage and penetrated area of the sealer increased from apical to coronal in all systems. The maximum and average penetration depths and penetration areas were higher in FlexMaster and Revo-S groups at the 3rd mm (p < 0.05). At the 5th mm, the Revo-S group had a higher penetration percentage, when compared with ProTaper Next and ProTaper Universal groups (p < 0.05). CONCLUSIONS In the 1st mm, separated fragments of any system did not allow the penetration of the sealer, while it was observed that the files with constant taper showed more positive results in terms of sealer penetration at apical 3rd and 5th mm. CLINICAL RELEVANCE In the presence of a separated file, the taper of the file might significantly affect the amount of penetrated sealer into the dentinal tubules as compared with the cross-section and motion characteristics of the file.
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Affiliation(s)
- Ayhan Eymirli
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - Emel Uzunoğlu Özyürek
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
| | - Ahmet Serper
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
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Microcomputed tomographic investigation of the trepan bur/microtube technique for the removal of fractured instruments from root canals without a dental operating microscope. Clin Oral Investig 2019; 24:1717-1725. [PMID: 31346785 DOI: 10.1007/s00784-019-03032-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/16/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the removal of fractured instruments in mandibular incisor canals by using the trepan bur/microtube technique without a dental operating microscope (DOM). MATERIALS AND METHODS Thirty-four mandibular incisors were selected, and 5-mm apical segments of #25/.06 taper K3 NiTi instruments were fractured in the apical portion of each canal. Coronal enlargement was performed, and a staging platform was prepared at the coronal aspect of the fractured instrument. Then, a trepan bur was used to expose 1-1.5 mm of the fragmented instrument, and a microtube device was used to withdraw the fragment. Microcomputed tomographic (micro-CT) imaging was used to evaluate the geometric changes in the root canal and dentin. The time required for fractured instrument removal in each sample was recorded, and the results were statistically analyzed with a paired t test. RESULTS The trepan bur/microtube technique exhibited a success rate of 76.47%, and the average fractured instrument removal time was 8.55 ± 5.81 min. The changes in canal volume and dentin volume from the coronal end of the fractured instrument to 1.5 mm apical to the end were significantly greater than those from the cementoenamel junction (CEJ) to the coronal end of the fractured instrument during fractured instrument removal (P < 0.0001). CONCLUSIONS The study showed that the trepan bur/microtube technique had a significant impact on geometric changes in the root canal and dentin from the coronal end of the fractured instrument to 1.5 mm apical to the end. CLINICAL RELEVANCE These findings suggest that the trepan bur/microtube technique may be an optional method for fractured instrument removal from relatively straight canals.
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Seven N, Cora S. Effectiveness of different irrigation systems in the presence of intracanal-separated file. Microsc Res Tech 2019; 82:238-243. [PMID: 30636084 DOI: 10.1002/jemt.23165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 01/23/2023]
Abstract
The aim of this study was to evaluate conventional syringe irrigation and three different irrigant activation techniques' effectiveness for smear layer removal in the absence and presence of intracanal-separated file (SF) fragment. Mandibular anterior teeth (160 total) with single canal were used and each root canal preparation was finished with the ProTaper Universal F1. The samples were randomly divided into eight equal groups with n = 20 in each group. The Protaper Universal F3 file was used to simulate intracanal file separation in four groups. To remove the smear layer, final irrigation for each group was performed with conventional syringe irrigation (CSI), EndoActivator, Vibringe, and passive ultrasonic irrigation (PUI). The roots were divided into two longitudinal parts and evaluated with scanning electron microscopy, and two observers scored smear layers at 1, 2, and 3 mm away from the minor foramen. The data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests (p < .05). PUI significantly removed the smear layer better at all levels than other nonseparated file groups (p < .05). In the presence of intracanal SF, PUI had the most efficiency loss. Sonic techniques and CSI revealed statistically better smear layer removal efficiency than PUI at 3 mm level in the presence of SF (p < .05). The intragroup score analysis at all levels revealed that there were less smear layers at 3 mm than at 1 mm in all SF groups (p < .001). As a conclusion, sonic/ultrasonic methods did not yield better irrigant by-passing than CSI in the presence of intracanal SF.
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Affiliation(s)
- Naimenur Seven
- Department of Endodontics, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - Sabri Cora
- Department of Endodontics, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
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Separated Instrument in Endodontics: Frequency, Treatment and Prognosis. BALKAN JOURNAL OF DENTAL MEDICINE 2018. [DOI: 10.2478/bjdm-2018-0022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Summary
Instrument separation during endodontic therapy is a frequent accident with rotary instruments being more likely to separate than manual ones. The treatment of cases with a separated instrument can be either conservative or surgical. A conservative approach involves the following treatment choices: a) bypass of the fragment, b) removal of the fragment, c) instrumentation and obturation coronally to the fragment. Concerning the removal of a separated instrument, a variety of techniques and systems have been developed. Ultrasonics, in combination with the operative microscope constitute the most effective and reliable tools for removing a separated endodontic instrument from a root canal. The likelihood of successful removal depends on: the level of separation (coronal, middle or apical third); location in relation to the root canal curvature; the type of separated instrument; its length; the degree of canal curvature and the tooth type. Several complications may occur during the management of a separated instrument: separation of the ultrasonic tip or file used for bypassing or removing the instrument; further separation of the fragment; perforation; ledge; extrusion of the file into periapical tissues; tooth weakening due to dentin removal, as well as excessive temperature rise in periodontal tissues. Prognosis for a tooth retaining a separated instrument depends on the presence of a periapical lesion, the microbial load of the root canal during the time of separation and the quality of the obturation.
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Coelho MS, Rios MDA, Bueno CEDS. Separation of Nickel-Titanium Rotary and Reciprocating Instruments: A Mini-Review of Clinical Studies. Open Dent J 2018; 12:864-872. [PMID: 30505367 PMCID: PMC6210497 DOI: 10.2174/1745017901814010864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/26/2018] [Accepted: 09/23/2018] [Indexed: 11/22/2022] Open
Abstract
Objective: This review aimed to evaluate clinical studies that assessed separated NiTi rotary and reciprocating instruments. Design and Methods: This review assessed clinical studies involving treatments performed by undergraduate students, graduate students, and endodontic specialists. This review evaluated studies using rotary instruments, reciprocating instruments, and hybrid techniques. The number of uses of the different NiTi rotary and reciprocating systems was also assessed. Results: The incidence of separation for rotary instruments ranged from 0% to 23%. Rotary instruments were used from 1 to 50 times depending on the instrument and tooth type. The lowest rate of incidence separation for rotary instruments was obtained by undergraduate students, using a hybrid technique. The separation incidence for reciprocating instruments ranged from 0% to 1.71%. Reciprocating instruments were mostly single-used; one study reported their use up to 3 times. Separation rate in reciprocating instruments was similar in single-use or in multiple uses 0.2%. Conclusions: Separation of instruments has dropped recently and seems to be a minor problem in current Endodontics. Multiple uses of NiTi rotary instruments are a possibility without significantly increasing the risk of instrument separation. Single and multiple uses of NiTi reciprocating instruments are also associated with low incidence of separation. Attempting to remove separated instruments should be carefully evaluated.
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Affiliation(s)
- Marcelo Santos Coelho
- Department of Endodontics, São Leopoldo Mandic Dental Research Center, Campinas, SP, Brazil
| | - Marcos de Azevêdo Rios
- Department of Endodontics, State University of Feira de Santana, Feira de Santana, Brazil
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Fu M, Huang X, He W, Hou B. Effects of ultrasonic removal of fractured files from the middle third of root canals on dentinal cracks: a micro-computed tomography study. Int Endod J 2018; 51:1037-1046. [DOI: 10.1111/iej.12909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 02/07/2018] [Indexed: 12/28/2022]
Affiliation(s)
- M. Fu
- Department of Endodontics; School of Stomatology; Capital Medical University; Beijing China
| | - X. Huang
- Department of General Dentistry; School of Stomatology; Capital Medical University; Beijing China
| | - W. He
- Department of Endodontics; School of Stomatology; Capital Medical University; Beijing China
| | - B. Hou
- Department of Endodontics; School of Stomatology; Capital Medical University; Beijing China
- Department of General Dentistry; School of Stomatology; Capital Medical University; Beijing China
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Adl A, Shahravan A, Farshad M, Honar S. Success Rate and Time for Bypassing the Fractured Segments of Four NiTi Rotary Instruments. IRANIAN ENDODONTIC JOURNAL 2017; 12:349-353. [PMID: 28808464 PMCID: PMC5527213 DOI: 10.22037/iej.v12i3.16866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The aim of this in vitro study was to compare the success rate and time required for bypassing the fractured segments of four different nickel-titanium (NiTi) rotary systems. METHODS AND MATERIALS This study was conducted on the mesiobuccal canals of 60 mandibular molars with fully-formed apices. Fifteen Flex Master, K3, RaCe and Hero Shaper instruments with 0.04 taper and tip size of #30 and 25 mm in length, were obtained. These instruments were notched at a point 3 mm from the tip of the instrument and were driven into the canals using a handpiece until the instruments fractured and became lodged therein. In the next step, an endodontist tried to bypass the fractured segment using K-files. The number of bypassed samples and the time required for bypassing of each sample were recorded. The Chi-square test was used to compare the bypassing rate among the experimental groups. One-way analysis of variance followed by Tukey's post hoc test was conducted to compare the time taken for bypassing of the fractured fragments. RESULTS One instrument in Flex Master group and two broken segments in each of the K3 and Hero groups were not bypassed. All of the samples in RaCe group were bypassed. No significant difference was found among four tested groups regarding rate of bypassing (P=0.738). The time taken to bypass fragments in the Hero group was significantly more than in those of K3 (P=0.047) and RaCe (P=0.024). CONCLUSION Under the limitations of this study, design features of rotary files can influence the time needed to bypass separated fragments.
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Affiliation(s)
- Alireza Adl
- Department of Endodontics, Biomaterials Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Shahravan
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Melika Farshad
- Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical sciences, Shiraz, Iran
| | - Shahab Honar
- Postgraduate Student, Department of Periodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Kowalczuck A, Silva Neto UX, Fariniuk LF, Westphalen VPD, Laurindo CAH, Carneiro E. Electrochemical dissolution of fractured nickel-titanium instruments in human extracted teeth. Int Endod J 2016; 50:578-585. [PMID: 27101226 DOI: 10.1111/iej.12654] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/19/2016] [Indexed: 11/26/2022]
Abstract
AIM To assess the effect of sodium chloride concentration in fluoridated solutions during the electrochemical dissolution of fractured rotary endodontic instruments. METHODOLOGY Two solutions were assessed (solution 1: NaF 12 g L-1 + NaCl 1 g L-1 , pH = 5.0; and solution 2: NaF 12 g L-1 + NaCl 180 g L-1 , pH = 5.0) using two tests: the ProTaper Universal F1 (PTU F1) instrument polarization test and the polarization test for intracanal PTU F1 fragments fractured in mandibular incisors. In the first test, two sets of five instruments were separately and partially immersed in each solution, and the electrical current was evaluated over 30 min. In the second test, 45 PTU F1 instruments were fractured within the root canals of mandibular incisors and subjected to potentiodynamic polarization for 30 min. The electrical current and the variations in the length of PTU F1 fragments were measured. The data were analysed statistically (anova and Wilcoxon and Mann-Whitney tests, respectively). RESULTS Solution 2 was associated with more corrosive effects in both tests. In the first test, the PTU F1 instruments immersed in solution 2 had a higher electrical current (P < 0.001) and had a total dissolution time of approximately 540 s. In the second test, a larger difference between the baseline and final lengths of the fragments was noted in solution 2 (P = 0.011). CONCLUSION Saturation of fluoridated solution with sodium chloride led to an increase in electrical current and microscopic reductions in the length of fractured instrument fragments subjected to electrochemical dissolution.
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Affiliation(s)
- A Kowalczuck
- Department of Endodontics, School of Health and Biosciences, Pontifical University Catholic of Paraná, Curitiba, Paraná, Brazil
| | - U X Silva Neto
- Department of Endodontics, School of Health and Biosciences, Pontifical University Catholic of Paraná, Curitiba, Paraná, Brazil
| | - L F Fariniuk
- Department of Endodontics, School of Health and Biosciences, Pontifical University Catholic of Paraná, Curitiba, Paraná, Brazil
| | - V P D Westphalen
- Department of Endodontics, School of Health and Biosciences, Pontifical University Catholic of Paraná, Curitiba, Paraná, Brazil
| | - C A H Laurindo
- Department of Mechanical Engineering, Polytechnic School, Pontifical University Catholic of Paraná, Curitiba, Paraná, Brazil
| | - E Carneiro
- Department of Endodontics, School of Health and Biosciences, Pontifical University Catholic of Paraná, Curitiba, Paraná, Brazil
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Wohlgemuth P, Cuocolo D, Vandrangi P, Sigurdsson A. Effectiveness of the GentleWave System in Removing Separated Instruments. J Endod 2015; 41:1895-8. [PMID: 26409807 DOI: 10.1016/j.joen.2015.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION A separated instrument in a root canal system has the potential of severely affecting the outcome of endodontic therapy. This study evaluated the effectiveness of the minimally invasive GentleWave System (Sonendo Inc, Laguna Hills, CA) in removing separated stainless steel endodontic files from the apical and midroot regions of molar root canals. METHODS Thirty-six extracted human molars were accessed, and the glide path was confirmed to the apex. ISO #10, #15, and #20 K-file fragments of 2.5-mm length were separated at the apical (n = 18) or midroot (n = 18) region of the molars by engaging a weakened file with downward pressure. During analysis, the teeth were divided into 2 curved groups based on the curvature of the root (<30° and >30°). The success rate of instrument removal and the treatment time were noted. Statistical comparison was done with the Fisher exact test and independent 2-sample t test (P < .05). RESULTS The overall success rate of instrument removal when the separated files were engaged in the apical region was 61%, and for the midroot region, it was 83%. Less curved canals (<30°) showed a 91% success rate (n = 24), whereas canals with an angle of curvature greater than 30° showed a 42% success rate (n = 12). The median treatment time for instrument retrieval was 10 minutes 44 seconds. CONCLUSIONS The results revealed that the GentleWave System is effective in retrieving separated instruments while conserving the dentinal structure.
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Affiliation(s)
- Pierre Wohlgemuth
- Department of Endodontics, New York University College of Dentistry, New York, New York
| | - Davide Cuocolo
- Department of Endodontics, New York University College of Dentistry, New York, New York
| | | | - Asgeir Sigurdsson
- Department of Endodontics, New York University College of Dentistry, New York, New York.
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Tang WR, Smales RJ, Chen HF, Guo XY, Si HY, Gao LM, Zhou WB, Wu YN. Prevention and management of fractured instruments in endodontic treatment. World J Surg Proced 2015; 5:82-98. [DOI: 10.5412/wjsp.v5.i1.82] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/12/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
Intracanal instrument fracture is an unpredictable and problematic occurrence that can prevent adequate cleaning and shaping procedures and influence the prognosis of endodontic treatment. The prevalence of instrument fracture is reported to range between 0.28% and 16.2%. This article presents an overview of the prevention and management of instruments fractured during endodontic therapy on the basis of literature retrieved from PubMed and selected journal searches. Instrument fracture occurs because of reduced metal fatigue and/or torsional resistance. The reasons include canal morphology and curvature, manufacturing processes and instrument design, instrument use times and technique, rotational speeds and operator experience. With the development of various equipment and techniques, most of the retained instrument separations can be removed safely. However, in canals without associated periapical disease not every fractured separation should be removed from difficult locations because of the increased risk for root perforation and fracture. In difficult cases, either retain or bypass the fragment in the root canal and ensure regular follow-up reviews. Fractured instruments retained in the presence of periapical disease reduce significantly the prognosis of endodontically treated teeth, indicating a greater need to attempt the removal or bypass of the file separations. Apical surgery might be required in some instances, emphasizing the importance of preventing instrument fracture.
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Gao Y, Shen Y, Zhou X, Haapasalo M. Remaining root dentin thickness in mesiobuccal canals of maxillary first molars after attempted removal of broken instrument fragments. AUST ENDOD J 2015; 41:122-7. [PMID: 25808862 DOI: 10.1111/aej.12103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yuan Gao
- State Key Laboratory of Oral Diseases; West China College and Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Ya Shen
- Division of Endodontics; Department of Oral Biological and Medical Sciences; University of British Columbia; Vancouver British Columbia Canada
- Department of Materials Engineering; University of British Columbia; Vancouver British Columbia Canada
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases; West China College and Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Markus Haapasalo
- Division of Endodontics; Department of Oral Biological and Medical Sciences; University of British Columbia; Vancouver British Columbia Canada
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Brito-Júnior M, Normanha JA, Camilo CC, Faria-e-Silva AL, Saquy PC, Ferraz MÃAL, Silva-Sousa YTC. Alternative techniques to remove fractured instrument fragments from the apical third of root canals: report of two cases. Braz Dent J 2015; 26:79-85. [PMID: 25672390 DOI: 10.1590/0103-6440201302446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 12/14/2014] [Indexed: 11/21/2022] Open
Abstract
This paper describes two cases of instrument fragment removal from the apical thirds of root canals using a customized extractor and a modified needle technique, respectively. In case 1, a customized extractor was manufactured to remove a bur fragment located in the apical root canal of a maxillary central incisor. The use of this extractor enabled successful and conservative removal of the instrument fragment. In case 2, a modified injection needle was used as a trepan to gain access around an instrument fragment located in the curved apical portion of the mesiobuccal canal of a mandibular molar. A segment of steel wire was inserted into the needle lumen to engage the metallic fragment, enabling its removal with counter-clockwise rotation and a simultaneous pull-out motion. Alternative and creative methods are useful for the management of intracanal metallic fragments during root canal treatment.
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Affiliation(s)
- Manoel Brito-Júnior
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | - João Américo Normanha
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | - Carla Cristina Camilo
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | - André Luis Faria-e-Silva
- Department of Dentistry, , School of Dentistry, UFS - Federal University of Sergipe, Aracaju, SE, Brazil
| | - Paulo César Saquy
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
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Brito-Júnior M, Silva-Sousa YTC, Bruniera JFB, Camilo CC, Faria-E-Silva AL, Saquy PC. Obturation over an S1 ProTaper instrument fragment in a mandibular molar with three years of follow-up. Braz Dent J 2015; 25:571-5. [PMID: 25590208 DOI: 10.1590/0103-6440201302436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 10/21/2014] [Indexed: 11/22/2022] Open
Abstract
This case report describes root canal filling performed over a large S1 ProTaper file fragment in a second mandibular molar with irreversible pulpitis. An S1 ProTaper file was fractured during the instrumentation of the mesiobuccal canal. Approximately 10 mm of file fragment remained in the apical and middle thirds of the canal. The obturation was performed over this fragment using thermomechanically compacted gutta-percha and sealer. Radiographic findings and the absence of clinical signs and symptoms at 3-year follow up indicated successful treatment. Cone-beam computed tomography images revealed absence of periapical lesion and details of intracanal file fragment related to root fillings and apex morphology. In this case, the presence of a large intracanal fractured instrument did not have a negative impact on the endodontic prognosis during the follow up evaluation period.
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Affiliation(s)
- Manoel Brito-Júnior
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | | | | | - Carla Cristina Camilo
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | - André Luis Faria-E-Silva
- Department of Dentistry, School of Dentistry, UFS - Federal University of Sergipe, Aracaju, SE, Brazil
| | - Paulo César Saquy
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
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Jadhav GR. Endodontic management of a two rooted, three canaled mandibular canine with a fractured instrument. J Conserv Dent 2014; 17:192-5. [PMID: 24778521 PMCID: PMC4001281 DOI: 10.4103/0972-0707.128046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/20/2013] [Accepted: 12/27/2013] [Indexed: 11/26/2022] Open
Abstract
It is important to assess the root canal morphology and its variations before initiating the endodontic procedure. This is because the inability to clean the complete root canal system forms the seat for the persistent infection which ultimately leads to endodontic treatment failure. This case reports the use of dental operating microscope for the successful endodontic management of a two rooted and three canaled mandibular canine with the fractured instrument in the middle canal of a 38-year-old healthy Asian woman. This case report highlights the need to use the dental operating microscope and ultrasonics in locating the elusive canal orifices. It is important to note the internal and external root canal morphological variations before starting the endodontic treatment without any pre-operative assumptions about the usual anatomy of the toot.
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Affiliation(s)
- Ganesh Ranganath Jadhav
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Terauchi Y, O'Leary L, Yoshioka T, Suda H. Comparison of the time required to create secondary fracture of separated file fragments by using ultrasonic vibration under various canal conditions. J Endod 2013; 39:1300-5. [PMID: 24041396 DOI: 10.1016/j.joen.2013.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/17/2013] [Accepted: 06/29/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Nickel-titanium files often separate because of mechanical fatigue. The purpose of this study was to determine safe preparation techniques for separated file removal by using ultrasonics. METHODS Fifty nickel-titanium file fragments were divided into 5 groups. An ultrasonic tip was activated on a file fragment positioned between dentin blocks simulating several canal conditions: Group 1 consisted of the fragment protruding from a pair of straight dentin blocks. For group 2, the fragment was also positioned between 2 straight dentin blocks except one block was positioned 1 mm more apically than the other block, simulating a troughed area that is often created during file removal attempts. For groups 3-5, the fragment was positioned similarly as group 2 but between blocks with 30°, 45°, and 60° curvatures, respectively. The time it took for secondary fracture to occur was recorded, and the data were statistically analyzed. RESULTS Fragments with dentin wall supporting on the opposite side of ultrasonic activation site resisted fracture significantly longer than those without it. Fragments in 30° and 45° curved blocks took significantly longer to fracture than the other groups (Fisher protected least significant difference, P < .05). CONCLUSIONS Secondary fracture of separated files appeared to be reduced when the ultrasonic tip was applied to the inner curvature of the canal.
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Affiliation(s)
- Yoshitsugu Terauchi
- Pulp Biology and Endodontics Section, Tokyo Medical and Dental University, Tokyo, Japan.
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Hansen JR, Beeson TJ, Ibarrola JL. Case series: tooth retention 5 years after irretrievable separation of LightSpeedLSX instruments. J Endod 2013; 39:1467-70. [PMID: 24139276 DOI: 10.1016/j.joen.2013.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 05/14/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Of 3,216 root canals treated endodontically at the Creighton University School of Dentistry from September 1, 2005, to August 31, 2007, with LightSpeedLSX instruments (LightSpeed Technology, Inc, San Antonio, TX), there were 12 cases of irretrievable instrument separation. More than 5 years after the separations, an attempt was made to contact the patients and assess for healing and tooth retention. METHODS Third- and fourth-year dental students performed root canal procedures according to protocol from September 1, 2005, to August 31, 2007. A database was collected during the 24-month period recording cases with irretrievable LightspeedLSX separation. Efforts were made from July 2011 to December 2011 to contact the 12 patients for endodontic follow-up. Clinical and radiographic evaluations of healing were performed. RESULTS Of the 12 patients with irretrievable separations, 8 patients were contacted and 5 returned to Creighton University School of Dentistry for follow-up. All 8 contacted patients confirmed the presence of the root canal-treated tooth in question, and the teeth of the 5 evaluated patients were determined to be asymptomatic and functional. Radiographic analysis resulted in 2 teeth being classified as complete healing, 2 as uncertain healing, and 1 as no healing. CONCLUSIONS The 100% tooth retention rate and the lack of symptoms in 8 contacted (5 evaluated) patients 5 years after treatment suggests that long-term retention and functionality can occur after irretrievable instrument separation. Although tooth retention and functionality are desirable outcomes, radiographic findings may be indicative of inadequate periapical healing, thus requiring the clinician to evaluate whether additional treatment is necessary.
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Affiliation(s)
- Jason R Hansen
- Postgraduate Endodontic Program, UMKC School of Dentistry, Kansas City, Missouri.
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Shahabinejad H, Ghassemi A, Pishbin L, Shahravan A. Success of ultrasonic technique in removing fractured rotary nickel-titanium endodontic instruments from root canals and its effect on the required force for root fracture. J Endod 2013; 39:824-8. [PMID: 23683286 DOI: 10.1016/j.joen.2013.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/30/2013] [Accepted: 02/20/2013] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Fracture of rotary nickel-titanium files is a real concern among endodontists; it affects the long-term prognosis of treatment. Ultrasound is a favorable technique for removing broken files, although it may result in some complications. The aim of this study was to determine the success rate of ultrasonic technique in removing file fragments and to evaluate its influence on the force required to fracture a tooth root. METHODS An in vitro study was carried out on 70 extracted maxillary premolars. In the experimental group a #30/.04 taper Hero file was guided into the canal to break and lodge therein. The lodged file was removed by ultrasonic vibration and use of a dental operating microscope. The canals were instrumented with Hero files by using crown-down technique and then obturated. All the teeth were prepared for mechanical testing in Testometric machine to measure the required force for root fracture. The Fisher exact test and independent two-sample t test were used to analyze data. RESULTS Ultrasonic technique exhibited a success rate of 80% in removing broken files. Success rate in the roots with file fracture before the curve was 11.5 times more than that of file fracture cases beyond the curve. Other factors such as bypass possibility did not affect success rate. The average time required for removing file fragments was 36.3 ± 7.15 minutes, which did not significantly differ in different file locations within the canal. According to mechanical test results, ultrasonic application did not significantly affect the required force for root fracture. The force required to fracture a root did not significantly differ in various file locations. Vertical fracture in the buccolingual direction (split tooth) was the most incident fracture pattern. Procedural errors observed in this study predominantly included transportation, perforation, and craze line. CONCLUSIONS Ultrasonic technique was successful in removing 80% of fractured rotary files and did not significantly affect the required force for root fracture.
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Affiliation(s)
- Hasan Shahabinejad
- Kerman Oral and Dental Diseases Research Center, Kerman University of Medical Science, Kerman, Iran
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Madarati AA, Hunter MJ, Dummer PMH. Management of intracanal separated instruments. J Endod 2013; 39:569-81. [PMID: 23611371 DOI: 10.1016/j.joen.2012.12.033] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 12/22/2012] [Accepted: 12/30/2012] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Intracanal separation of endodontic instruments may hinder cleaning and shaping procedures within the root canal system, with a potential impact on the outcome of treatment. The purposes of this narrative review of separated instruments were to (1) review the literature regarding treatment options, influencing factors, and complications and (2) suggest a decision-making process for their management. METHODS An online search was conducted in peer-review journals listed in PubMed to retrieve clinical and experimental studies, case reports, and review articles by using the following key words: instruments, files, obstructions, fractured, separated, broken, removal, retrieval, management, bypassing, and complications with or without root canal and endodontic. RESULTS There is a lack of high-level evidence on management of separated instruments. Conventional conservative management includes removal of or bypassing the fragment or filling the root canal system to the coronal level of the fragment. A surgical intervention remains an alternative approach. These approaches are influenced by a number of factors and may be associated with complications. On the basis of current clinical evidence, a decision-making process for management is suggested. CONCLUSIONS Guidelines for management of intracanal separated instruments have not been formulated. Decisions on management should consider the following: (1) the constraints of the root canal accommodating the fragment, (2) the stage of root canal preparation at which the instrument separated, (3) the expertise of the clinician, (4) the armamentaria available, (5) the potential complications of the treatment approach adopted, and (6) the strategic importance of the tooth involved and the presence/or absence of periapical pathosis. Clinical experience and understanding of these influencing factors as well as the ability to make a balanced decision are essential.
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Affiliation(s)
- Ahmad A Madarati
- Restorative Dental Sciences Department, College of Dentistry, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia.
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Riccitiello F, Maddaloni G, D’Ambrosio C, Amato M, Rengo S, Simeone M. Microscopio operatorio: diffusione e limiti. GIORNALE ITALIANO DI ENDODONZIA 2012. [DOI: 10.1016/j.gien.2012.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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