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Endodontic instrument fracture: causes and prevention
M B McGuigan1, C Louca, H F Duncan
1Eastman CPD, UCL Eastman Dental Institute, 123 Grey's Inn Road, London, WC1X 8WD.
British Dental Journal
|April 13, 2013
Summary
Endodontic file fracture, particularly with nickel-titanium (NiTi) rotary instruments, necessitates understanding causes and prevention. Operator skill, alloy modifications, and limiting reuse significantly reduce NiTi file separation.
Area of Science:
- Endodontics
- Dental Materials Science
- Biomaterials Engineering
Background:
- Endodontic file fracture incidence perceived to be increasing with rotary nickel-titanium (NiTi) instruments.
- Fractured file removal is challenging, emphasizing the need for prevention strategies.
- NiTi alloy modifications aim to reduce instrument separation.
Purpose of the Study:
- Investigate the incidence and etiology of endodontic file fracture.
- Analyze recommended prevention protocols for instrument fracture.
- Evaluate the effectiveness of NiTi alloy modifications in reducing fracture incidence.
Main Methods:
- Literature review focusing on incidence, etiology, and prevention of endodontic file fracture.
- Analysis of in vitro evidence and its clinical relevance.
- Comparison of NiTi and stainless-steel (SS) file fracture incidence.
Main Results:
- Most literature on instrument fracture is in vitro, limiting clinical applicability.
- NiTi and SS file fracture incidence appear similar, but inconsistent methodologies hinder direct comparison.
- NiTi instruments fail via torsional overload and/or flexural fatigue, often in the apical third or due to inappropriate use.
Conclusions:
- Operator skill, manufacturer modifications, and limiting file reuse are crucial for reducing endodontic file fracture.
- A comprehensive prevention strategy is vital for minimizing instrument separation.
- Further research with consistent methodologies is needed for accurate comparison of NiTi and SS file fracture rates.
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