Does Low-Taper Root Canal Shaping Decrease the Risk of Root Fracture? A Systematic Review

Minimal root-canal preparation has been suggested to reduce the risk of root fracture, but as a result, satisfactory cleaning and shaping do not take place. Large-scale taper instrumentation can contribute to removing infected tissue; however, it may weaken the tooth structure. The aim of this systematic review is to evaluate whether root-canal shaping with low-taper instruments decreases the risk of root fracture, compared to high-conicity shaping. A search was performed on Ovid MEDLINE, PubMed, and the Web of Science. The inclusion criteria were: studies comparing the root fracture resistance of endodontically treated teeth, shaped with low- and high-conicity taper instruments, in human trials, and via in vitro study. The review includes all types of endodontically treated teeth, with various instrument tapers. The scientific search engines produced 328 results. Only 20 of the results were evaluated after screening. Based on the articles analyzed, it is not clear whether a taper difference can determine differences in root fracture resistance. No randomized controlled trial (RCTs) with long follow-ups have been published to date. It must also be taken into account that the in vitro studies do not consider the numerous differences that there are between in vitro and clinical evaluation. The review was registered on the PROSPERO website, with the protocol number CRD42020151451.