Decision Support for Removing Fractured Endodontic Instruments: A Patient-Specific Approach

Abstract

The instrumental fracture is a common endodontic complication that is treated by surgical or non-surgical removal approaches. However, no tool exists to help the clinician to choose between available strategies, and decision-making is mostly based on clinical judgment. Digital solutions, such as Finite Element Analysis (FEA) and Virtual Treatment Planning (VTP), were recently proposed in maxillofacial surgery. The aim of the current study is to present a digital tool to help decide between non-surgical and surgical strategies in a clinical situation of a fractured instrument. Five models have been created: the initial state of the patient, two non-surgical removal strategies using a low or high root canal enlargement, and two surgical removal strategies using a 3- or 6-mm apicoectomy. Results of the VTP found a risk of perforation for the non-surgical strategies and sinus proximity for surgical ones. FEA showed the lowest mechanical risk for the apicoectomy strategy. A 3-mm apicoectomy approach was finally chosen and performed. In conclusion, this digital approach could offer a promising decision support for instrument removal by planning the treatment and predicting the mechanical impact of each strategy, but further investigations are required to confirm its relevance in endodontic practice.

Multifactorial Analysis of Endodontic Microsurgery Using Finite Element Models

“…Imagining all possible interactions between parameters and their clinical impact is difficult and can require relying on one’s own experience rather than scientific evidence [ 26 ]. Interestingly, the results of the present study indicate that interactions of order 1 are sufficient to model the biomechanics of the resected tooth, and a perspective of this work will be to integrate the current equation into decision support software to assist endodontists during the decision-making process [ 27 ].…”

Civil Liability in Endodontics: educational analysis

“…Failures resulting from endodontic treatments are much more related to the presence of the microbial factor than to instrument fractures16. Several means for removing instruments were protocolled, among them: removal using ultrasonic tips (mainly cervical and middle thirds), rotary devices developed for this procedure, endodontic surgery (access to the fractured instrument); all aimed at maintaining the healthy dental element in the oral cavity 17 . Fracture of instruments must be considered a common occurrence due to the complexity of the treatment, and not inherent to the professional's will.…”