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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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Jeong HY, Ha JH, Sigurdsson A, Peters OA, Kim HC, Kwak SW. Effects of Side Flattening on Torsional and Cyclic Fracture Resistance of Nickel-Titanium File. J Endod 2024; 50:1011-1016. [PMID: 38642733 DOI: 10.1016/j.joen.2024.04.008] [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: 01/18/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effect of side flattening of cutting flutes on the cyclic resistance and torsional resistance of nickel-titanium files. METHODS Both novel flattened Platinum V.EU (PL) and standard nonflattened CC Premium V.EU (CC) rotaries were tested. For cyclic fatigue tests, all the files were rotated in an artificial root canal with a curvature of 45° and a radius of 6.06 mm at 300 rpm (n = 15 in each group). The number of cycles to failure (NCF) was calculated. For torsional tests, the files were rotated at 2 rpm clockwise until fracture occurred. The maximum torque value at fracture was measured and the toughness and distortion angle were computed. Subsequently, 5 fragments were randomly selected in each experiment, the cross-section and longitudinal direction of the fragments were photographed using a scanning electron microscope. An unpaired t-test was performed at a significance level of 95%. RESULTS There was a statistically significant difference in NCF between CC and PL (P < .05). CC showed higher NCF than PL. There was no statistically significant difference between CC and PL with regards to the parameters related to torsional resistance (distortion angle, ultimate strength, and toughness) (P > .05). CONCLUSION Within the limitations of this study, side flattening of the file did not improve cyclic resistance or torsional resistance of the files. As side flattening may reduce a file's cyclic resistance, such files should be used with caution in clinical practice.
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Affiliation(s)
- Hee-Yoon Jeong
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Dental and Life Science Institute, Pusan National University, Yangsan, South Korea
| | - Jung-Hong Ha
- Department of Conservative Dentistry, College of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Asgeir Sigurdsson
- Department of Endodontics, New York University College of Dentistry, New York University, New York, New York
| | - Ove A Peters
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Dental and Life Science Institute, Pusan National University, Yangsan, South Korea
| | - Sang Won Kwak
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Dental and Life Science Institute, Pusan National University, Yangsan, South Korea.
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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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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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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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Altorisy A, Ahmad MZ. Assessing Confidence Levels in Endodontic Procedures Among Senior Undergraduate Dental Students at Qassim University, Saudi Arabia: A Cross-Sectional Observational Study. Cureus 2023; 15:e43649. [PMID: 37719548 PMCID: PMC10505051 DOI: 10.7759/cureus.43649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Background This study aimed to determine the confidence of senior dental students in Qassim University's undergraduate dentistry program in Saudi Arabia regarding their capacity to perform endodontic procedures. The study's objective was to pinpoint areas of weakness and offer suggestions for potential improvement of endodontic and clinical training for dental students. Methodology Using anonymous survey forms, 120 senior dental students were surveyed. Students' self-reported levels of confidence in performing various endodontic procedures, such as periapical radiographs, rubber dam placement, endodontically treated tooth restoration, anesthesia, broken instrument removal, and endodontic retreatment, were studied in this survey. A Likert-style rating scale of 1 to 5 was used in the survey, with 1 denoting high confidence and 5 denoting low confidence. Results The majority of senior dental students at Qassim University reported high levels of confidence in taking periapical radiographs, with 64.04% indicating a high level of confidence. The second most assured field was rubber dam installation, with 47.6% of students expressing high levels of assurance. Confidence levels were noticeably lower during more difficult procedures such as endodontic retreatment and the removal of broken instruments. While 12% of students expressed high confidence in endodontic retreatment, only 3.46% of students expressed high confidence in removing broken instruments. According to Pearson's correlation (r = 0.352, p = 0.001), there was a significant and favorable correlation between competency level and confidence in performing various endodontic procedure-related steps. Conclusions The study's findings suggest that senior dentistry students at Qassim University might benefit from additional training and assistance in some endodontic treatment areas. The lack of confidence displayed during more challenging procedures, such as the removal of broken instruments and endodontic retreatment, demonstrates the need for additional training and supervision in such cases. The results of this study may be useful for educators in other dental colleges who wish to consider developing new teaching techniques, utilizing simulators and digital learning tools, and increasing opportunities for hands-on training and supervision to improve dental students' self-confidence and skills.
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Affiliation(s)
- Abdullah Altorisy
- Restorative Dentistry, Qassim University College of Dentistry in Ar Rass, Al Rass, SAU
| | - Muhammad Zubair Ahmad
- Restorative Dentistry, Qassim University College of Dentistry in Ar Rass, Al Rass, SAU
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Nasiri K. Management of separated instruments in root canal therapy. J Dent Sci 2023; 18:1433-1434. [PMID: 37404615 PMCID: PMC10316507 DOI: 10.1016/j.jds.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/01/2023] [Accepted: 04/02/2023] [Indexed: 07/06/2023] Open
Affiliation(s)
- Kaveh Nasiri
- Corresponding author. Independent Researcher, Koenigraetzstrasse, Essen 45138, Germany
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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: 17] [Impact Index Per Article: 8.5] [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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