Effects of Ultrasonic Removal of Fractured Files from the Middle Third of Root Canals on the Resistance to Vertical Root Fracture

Fu, Mei; Huang, Xianbo; Zhang, Kunya; Hou, Benxiang

doi:10.1016/j.joen.2019.08.009

Cited by 15 publications

(13 citation statements)

References 37 publications

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“…So, using the qualifying criteria, 506 papers were assessed based on their titles and abstracts, resulting in the preselection of 60 articles. 14 publications (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) were included in the systematic review after fulltext analyses, whereas 46 were excluded. Australia [11], Austria [12], China [13][14][15], the United States [16], India [17], England [18], Iran [19,20], Japan [21], Sweden [22], and Turkey [23,24] were among the countries studied.…”

Section: Resultsmentioning

confidence: 99%

Comparing techniques for removal of separated endodontic instruments

Shaik

Qadri

Deshmukh³

et al. 2022

ijhs

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Purpose: The goal of this study is to look into several approaches to approaching damaged instruments in the root canal, as well as to show possible outcomes in terms of dentin thickness, fracture resistance, technique success, and clinical time. Methodology: PubMed, Cochrane, Lilacs, Web of Science, Scopus, grey literature, and manual searches were used to conduct the bibliographic research. The titles and abstracts of 506 papers were examined using the inclusion and exclusion criteria. Sixty items were chosen and read in their entirety. This systematic review includes fourteen papers. Results: The ultrasonic approach was the most extensively researched and yielded positive results in general. The more apically positioned the tool is, the more difficult it is to remove it, the more dentin is removed, and the poorer the tooth's fracture resistance. When removal is not possible, the bypass technique (bypassing) can be employed, and the GentleWave System approach can be used on weakened teeth or with little dental fragments. Conclusion: The data from laboratory investigations showing the curvature and root third in which instrument fractures originate is related to fracture resistance and success is presented in this comprehensive review.

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Section: Resultsmentioning

confidence: 99%

Comparing techniques for removal of separated endodontic instruments

Shaik

Qadri

Deshmukh³

et al. 2022

ijhs

View full text Add to dashboard Cite

show abstract

“…This should be carefully performed to prevent further mishaps and damages, which may complicate the treatment. Some undesired complications are temperature rise on the external root surface 23 that can damage the periodontal tissues, aggressive dentine removal that increases the risk of roots perforations, 24 and post-operative vertical root fractures, 25 which could be a secondary fracture of the ultrasonic tips or the fractured fragment itself. 20 In addition, pushing the fragment more apically within the root canal or even its extrusion beyond the apex into the periapical tissues may also be encountered, especially if the ultrasonic tips are activated against the top aspect (most coronal) of the fragment.…”

Section: Discussionmentioning

confidence: 99%

Management of an over-extruded fragment in a C-shaped root canal configuration: A case report and literature review

Madarati

2020

Journal of Taibah University Medical Sciences

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Separation of root canal instruments is a common incident during root canal treatments' procedures. The complex configuration of root canal systems is one of the most influencing factors, not only during the occurrence of instrument separation but also during the management of such unpleasant incidents. There are few reports on the management of fractured instruments located in the apical third of the root canals apical, especially those extruded beyond the apex. A 37-year-old woman was referred to an endodontic specialist to complete a root canal treatment after the separation of an endodontic file in the middle-third of the C-shaped root canal configuration (Vertucci type II) of the mandibular second molar. A failed attempt at managing the fragment by the dentist resulted in the backward placement of the fragment, which was more apically, and partial extrusion beyond the root apex. The fractured instrument was successfully and safely retrieved using different procedures and techniques including bypassing the fragment, loosening the fragment using ultrasonics and then removing it by the crab-claw shaped tweezers (Zumax broken instruments removal kit). This case report demonstrates the importance of high magnification provided by the dental operating microscopes and sound clinical skills and judgment, especially in assessing the difficulty of cases that is necessary for various treatment approaches. In addition, the availability of different armamentaria to manage separated instruments is essential. Finally, this case report proposes and advocates the idea of removing fractured instruments extruding beyond the apex without surgery.

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“…It has also been reported that the use of ultrasonics to remove posts and fractured instruments from the coronal and middle thirds of the root canal system can result in a greater loss of dentine, increasing the risk of VRF, as well as initiating and/or propagating cracks (Fu et al, 2019; Riis et al, 2018).…”

Section: Contributory Risk Factorsmentioning

confidence: 99%

Present status and future directions: vertical root fractures in root filled teeth

2022

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Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co‐axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre‐existing fractures and biochemical effects of loss of vitality is highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits are imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post‐endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed ‘passively’ and excessive ‘post‐space’ preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi‐rooted teeth. Innovative techniques to ‘repair’ VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post‐endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs.

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Effects of Ultrasonic Removal of Fractured Files from the Middle Third of Root Canals on the Resistance to Vertical Root Fracture

Cited by 15 publications

References 37 publications

Comparing techniques for removal of separated endodontic instruments

Comparing techniques for removal of separated endodontic instruments

Management of an over-extruded fragment in a C-shaped root canal configuration: A case report and literature review

Present status and future directions: vertical root fractures in root filled teeth

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