Complications associated with fractured file removal using an ultrasonic technique

Area of Science:

• Endodontics
• Dental Materials Science
• Restorative Dentistry

Background:

• Fractured endodontic instruments in root canals present a clinical challenge.
• Current techniques for fractured file removal, including modified Gates Glidden burs and ultrasonics, may compromise tooth structure.
• Understanding the complications associated with fractured file removal is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the in vitro and in vivo complications of fractured endodontic file removal.
• To assess the success rate, perforation frequency, and root strength related to fractured file location.

Main Methods:

• In vitro study involving removal of fractured instrument fragments from coronal, middle, and apical thirds of human mandibular molar root canals.
• Evaluation of success rate, perforation incidence, and root fracture resistance.
• In vivo review of 60 clinical cases of fractured file removal.

Main Results:

• Perforations and unsuccessful removal were exclusively observed with fragments located in the apical third.
• Significant decline in root fracture resistance was associated with more apical file fragments.
• Clinical case review indicated comparable success and perforation rates to in vitro findings.

Conclusions:

• Fractured file removal from the apical third of curved root canals is associated with significant complications.
• Routine attempts to remove apical fractured files should be avoided due to risks of perforation and root weakening.
• Clinical judgment is paramount when deciding on the management of fractured endodontic instruments.