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The Cost of Instrument Retrieval on the Root Integrity.

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Ultrasonic retrieval of fractured endodontic instruments was faster but caused more dentine loss than the ultrasonic/lasso technique. Both methods effectively removed fragments with similar changes in canal volume and area.

Keywords:
broken instrumentfractured instrumentinstrument removallasso techniquemandibular molarmicro‐CTroot canalultrasonics

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Area of Science:

  • Endodontics
  • Dental Materials Science
  • Biomaterials

Background:

  • Instrument fracture is a common complication during root canal treatment.
  • Retrieval of fractured instruments is challenging and can lead to further procedural complications.
  • Dentine loss during retrieval can compromise the structural integrity of the tooth.

Purpose of the Study:

  • To compare dentine loss in mandibular molars after retrieving fractured rotary instruments using ultrasonic versus a combined ultrasonic/lasso technique.
  • To evaluate the efficacy and time efficiency of each retrieval method.

Main Methods:

  • Ten mesial roots of mandibular molars with Type II canal configuration were scanned using micro-computed tomography (CT).
  • A size 35/0.04 rotary instrument fragment was fractured in the middle third of each mesial canal.
  • Fragments were retrieved using either ultrasonic or combined ultrasonic/lasso techniques, with removal time recorded.
  • Pre- and post-retrieval micro-CT scans assessed changes in dentine thickness, volume, canal volume, and cross-sectional area.

Main Results:

  • All fragments were successfully retrieved by both techniques.
  • Ultrasonic retrieval was significantly faster (p=0.023) but resulted in greater dentine thickness reduction (p=0.029).
  • No significant differences were found in canal area increase between the groups (p=0.698).
  • Overall, canal volume increased by 23.8% and dentine volume decreased by 2.2% after retrieval.

Conclusions:

  • Both ultrasonic and combined ultrasonic/lasso techniques are effective for retrieving fractured endodontic instruments.
  • The ultrasonic technique offers faster retrieval but at the expense of increased dentine thickness reduction.
  • Both methods resulted in comparable changes in canal volume and area, with no significant differences in the proportion of cross-sections below 0.5mm dentine thickness.