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Sira A, Nawar NN, Saber SM, Kim HC. The Effect of Different Separated File Retrieval Strategies on the Biomechanical Behavior of a Mandibular Molar: A Finite Element Analysis Study. J Endod 2025; 51:64-70. [PMID: 39481752 DOI: 10.1016/j.joen.2024.10.008] [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: 07/15/2024] [Revised: 10/17/2024] [Accepted: 10/23/2024] [Indexed: 11/02/2024]
Abstract
INTRODUCTION This study evaluated the effects of retrieval strategies of separated nickel-titanium files on the biomechanical behavior of endodontically treated teeth by finite element analysis. METHODS Six FE models were created: intact tooth; simulated a scenario where the apical 3 mm of a nickel-titanium file is separated and retained; TD, simulated application of a trephine drill to expose 1 mm of the separated file; simulated troughing of 180° at the inner wall of root canal for an extra 1 mm of the separated file beyond the staging platform; simulated circumferential ultrasonic troughing done for an extra 1 mm after the TD; and PM, simulated iatrogenic perforation sealed using mineral trioxide aggregate. Occlusal loading followed the occlusal fingerprint of the tooth before maximum von Mises stresses, maximum principal stresses, safety factor, and number of cycles till failure were determined. The cervical region of the teeth and mid-root sections including the separated file was chosen as the areas of interest for further analysis. RESULTS Intact tooth recorded the highest number of cycles till failure and safety factor. Other models showed a narrow range of variation in all aspects with the PM recording the lowest number of cycles till failure. The highest von Mises stress was recorded at the mesiobuccal line angle of the PM near its cervical margin, while the lowest was found at the intact tooth. CONCLUSION Under the limitation of this study, various file retrieval strategies removing the surrounding root dentin within the amounts of general guidelines do not affect the biomechanical behavior of the tooth.
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Affiliation(s)
- Anas Sira
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Cairo, Egypt
| | - Nawar Naguib Nawar
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Cairo, Egypt
| | - Shehabeldin Mohamed Saber
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Cairo, Egypt; Center for Innovative Dental Sciences (CIDS), Faculty of Dentistry, The British University in Egypt, Cairo, Egypt.
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, Pusan National University School of Dentistry, Dental Research Institute, Dental and Life Science Institute, Yangsan, Korea.
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Thakur VS, Kankar PK, Parey A, Jain A, Jain PK. Health prediction of reciprocating endodontic instrument based on the machine learning and exponential degradation models. Proc Inst Mech Eng H 2023; 237:1202-1214. [PMID: 37668014 DOI: 10.1177/09544119231196285] [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] [Indexed: 09/06/2023]
Abstract
This study proposes an intelligent health prediction and fault prognosis of the endodontic file during the root canal treatment. Root canal treatment is the procedure of disinfecting the infected pulp through the canal with the help of an endodontic instrument. Force signals are acquired with the help of a dynamometer during the canal preparation, and statistical features are extracted. The extracted features are selected through the window-wise feature extraction process. Characteristic features for endodontic file prognostics include time-domain features of the signals are evaluated. The extracted feature has inappropriate information, that is, noise between the signals; hence the smoothing of the feature is required at this stage to observe a trend in the signals. Based on the smoothing feature and post-processing of the feature, defined the health index to calculate the health condition of the endodontic instruments. A machine learning algorithm and exponential degradation model are used to predict the health of the endodontic instrument during the root canal treatment. This model is used to forecast the degradation of the endodontic file so that actions can be taken before actual failures happen. The proposed methodology can analyze the failures and micro-crack initiation of the endodontic instruments. Endodontics practitioners can use the machine learning models as well as an exponential model for estimating the health condition of the endodontic instrument. This study may help the clinician to progress the efficiency of the root canal treatment and the competence of the endodontic instruments.
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Affiliation(s)
- Vinod Singh Thakur
- System Dynamics Lab, Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Pavan Kumar Kankar
- System Dynamics Lab, Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Anand Parey
- Solid Mechanics Lab, Department of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Arpit Jain
- Department of Oral Medicine and Radiology, College of Dental Science and Hospital, Rau, Indore, Madhya Pradesh, India
| | - Prashant Kumar Jain
- PDPM Indian Institute of Information Technology, Design and Manufacturing, Jabalpur, Madhya Pradesh, India
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Teed C, Hussein H, Kishen A. Synchronized Microbubble Photodynamic Activation to Disinfect Minimally Prepared Root Canals. J Endod 2023; 49:198-204. [PMID: 36509168 DOI: 10.1016/j.joen.2022.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the antimicrobial efficacy of a novel irrigation strategy using synchronized microbubble photodynamic activation (SYMPA) in a minimally prepared single canal. METHODS Single-canal mandibular incisors were inoculated with Enterococcus faecalis for 3 weeks and randomly allocated to 4 groups based on the irrigation protocols: (1) control (saline), (2) conventional needle irrigation (CI), (3) ultrasonic-assisted irrigation (UI), and (4) irrigation with SYMPA. The first 3 groups were instrumented to size 25.07v (WaveOne Gold Primary; Dentsply Sirona, Johnson City, TN), and the SYMPA group was minimally prepared to size 20.07v (WaveOne Gold Small, Dentsply Sirona). The apical 5 mm was resected for microbiological assessment using the culture technique (colony-forming unit), adenosine-5'-triphosphate-based viability assay (relative luminescence units), and the percentage of live bacteria using confocal laser scanning microscopy. RESULTS Log colony-forming units from the UI (2.37 ± 0.66) and SYMPA (2.21 ± 0.86) groups showed a reduction compared with the control (5.16 ± 0.75) and CI (4.08 ± 1.19) groups. Relative luminescence unit reduction was significant for UI (619.08 ± 352.78) and SYMPA (415.25 ± 329.51) compared with the control (1213.2 ± 880.03) (P < .05). The percentage of live bacteria was significantly lower in the UI and SYMPA groups compared with the control and CI groups. Although higher microbial reduction was observed in SYMPA compared with UI, there was no statistical significance (P > .05). CONCLUSION SYMPA in minimally prepared canals showed significant antimicrobial efficacy. The novel irrigation strategy using SYMPA could be an effective disinfection strategy for minimally prepared root canals.
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Affiliation(s)
- Christine Teed
- MSc Endodontics Program, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Hebatullah Hussein
- Dental Research Institute, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Endodontics, Faculty of Dentistry, Ain-Shams University, Cairo, Egypt
| | - Anil Kishen
- Dental Research Institute, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
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Dulundu M, Helvacioglu-Yigit D. The Efficiency of the BTR-Pen System in Removing Different Types of Broken Instruments from Root Canals and Its Effect on the Fracture Resistance of Roots. MATERIALS (BASEL, SWITZERLAND) 2022; 15:5816. [PMID: 36079199 PMCID: PMC9457077 DOI: 10.3390/ma15175816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
The study aimed to evaluate the efficiency of the BTR-Pen system in removing different types of instrument fragments from root canals and to assess its effect on fracture resistance of the roots after the removal of the instruments. One hundred thirty human teeth were divided into 10 groups (2 control groups and 8 study groups) according to the localization and type of the fractured fragment as well as the retrieval techniques. Broken instruments were extracted either with BTR-Pen system loops or removed using solely ultrasonic tips. The success rate of instrument removal and consumed time were recorded. All the teeth were subjected to a load at a 1 mm/min rate in a universal testing machine for mechanical testing. The success of removing broken instruments using the BTR-Pen and ultrasonic was 86.7% and 83.3%, respectively (p > 0.05). When the time is compared, the BTR-Pen system (23.97 ± 8.35 min) showed similar results to that of the ultrasonic technique (24.1 ± 8.28 min) (p > 0.05). The BTR-Pen group required less force to fracture than the ultrasonic group (p = 0.024). In conclusion, the BTR-Pen and ultrasonic groups showed no significant difference in terms of the success rate and removal time. The roots that underwent instrument removal using the BTR-Pen system had less fracture resistance.
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Affiliation(s)
- Merve Dulundu
- Faculty of Dentistry, Kocaeli University, Kocaeli 41190, Turkey
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Portela NN, Rech JP, Marchionatti AME, Barasuol JC. Techniques to address fractured instruments in the middle or apical third of the root canal in human permanent teeth: a systematic review of the in vitro studies. Clin Oral Investig 2021; 26:131-139. [PMID: 34698940 DOI: 10.1007/s00784-021-04235-6] [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: 05/05/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study is to investigate techniques for approaching fractured instruments in the root canal and to present possible outcomes in relation to dentin thickness, fracture resistance, technique success, and clinical time. MATERIALS AND METHODS The bibliographic research was carried out in PubMed, Cochrane, Lilacs, Web of Science, Scopus, grey literature, and manual search. Following the inclusion and exclusion criteria, the titles and abstracts of 506 articles were read. Of these, 60 articles were selected and read in full. Fourteen articles were included in this systematic review. RESULTS The most studied technique was the ultrasonic technique and obtained good general results. The more apically the instrument is located, the more difficult it is to remove, the more dentin is removed, and the lower the fracture resistance of the tooth. When removal is not possible, the bypass technique can be performed (bypassing), and on weakened teeth or with little dental remnants, the GentleWave System technique can be used. CONCLUSION This systematic review shows the evidence from laboratory studies that the curvature and the root third in which the fracture of instruments occurred is relevant to fracture resistance and success. The ultrasonic technique got the best results. Well-conducted clinical studies should be performed for clinical practice. CLINICAL RELEVANCE The approach of fractured instruments in the root canal is efficient with the use of ultrasound, bypass technique, and Gentle Wave System.
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Affiliation(s)
- Nathalia Nadalon Portela
- Faculdade CNEC, R. Prof. Dr. João Augusto Rodrigues, 471 - Harmonia, Santo Ângelo, RS, 98801-015, Brazil
| | - Júlia Petry Rech
- Faculdade CNEC, R. Prof. Dr. João Augusto Rodrigues, 471 - Harmonia, Santo Ângelo, RS, 98801-015, Brazil
| | | | - Jéssica Copetti Barasuol
- Faculdade CNEC, R. Prof. Dr. João Augusto Rodrigues, 471 - Harmonia, Santo Ângelo, RS, 98801-015, Brazil.
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Thakur VS, Kankar PK, Parey A, Jain A, Jain PK. Force and vibration analysis in biomechanical preparation of root canals using reciprocating endodontic file system: In vitro study. Proc Inst Mech Eng H 2021; 236:121-133. [PMID: 34479454 DOI: 10.1177/09544119211044236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The shaping and cleaning of the root canal are very important in root canal treatment. The excessive force and vibration during biomechanical preparation of the root canal may result in failure of the endodontic file. In this study, force and vibration analysis was carried out during root canal preparation. The samples of human extracted (premolar) teeth were provided by the College of Dental Science and Hospital. Endodontic instruments for reciprocating motion, such as the WaveOne Gold file system, had been used for root canal preparation. Force and vibration signals were recorded by dynamometer and accelerometer, respectively. The acquired signals were denoised using the db4 (SWT denoising 1-D) wavelet. Four levels of decomposition were carried out for each signal. The signal denoising technique was used to remove unwanted noise from the acquired signal. FESEM analysis was used to visualize the levels of severity of endodontic files during the cleaning and shaping of the root canal. In most of the cases, the failure occurred due to the improper use of the root canal instrumentation. The optimum amount of force was used to avoid the file failure and provided the proper instrumentation. The curve fitting regression model was used to find the interdependency between force and vibration.
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Affiliation(s)
- Vinod Singh Thakur
- System Dynamics Lab, Discipline of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Pavan Kumar Kankar
- System Dynamics Lab, Discipline of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Anand Parey
- Solid Mechanics Lab, Discipline of Mechanical Engineering, Indian Institute of Technology Indore, Indore, Madhya Pradesh, India
| | - Arpit Jain
- Department of Oral Medicine and Radiology, College of Dental Science and Hospital, Rau, Indore, India
| | - Prashant Kumar Jain
- PDPM Indian Institute of Information Technology, Design and Manufacturing, Jabalpur, Madhya Pradesh, India
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Pruthi PJ, Nawal RR, Talwar S, Verma M. Comparative evaluation of the effectiveness of ultrasonic tips versus the Terauchi file retrieval kit for the removal of separated endodontic instruments. Restor Dent Endod 2020; 45:e14. [PMID: 32483532 PMCID: PMC7239682 DOI: 10.5395/rde.2020.45.e14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/24/2019] [Accepted: 11/05/2019] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of this study was to perform a comparative evaluation of the effectiveness of ultrasonic tips versus the Terauchi file retrieval kit (TFRK) for the removal of broken endodontic instruments. Materials and Methods A total of 80 extracted human first mandibular molars with moderate root canal curvature were selected. Following access cavity preparation canal patency was established with a size 10/15 K-file in the mesiobuccal canals of all teeth. The teeth were divided into 2 groups of 40 teeth each: the P group (ProUltra tips) and the T group (TFRK). Each group was further subdivided into 2 smaller groups of 20 teeth each according to whether ProTaper F1 rotary instruments were fractured in either the coronal third (C constituting the PC and TC groups) or the middle third (M constituting the PM and TM groups). Instrument retrieval was performed using either ProUltra tips or the TFRK. Results The overall success rate at removing the separated instrument was 90% in group P and 95% in group T (p > 0.05) The mean time for instrument removal was higher with the ultrasonic tips than with the TFRK (p > 0.05). Conclusion Both systems are acceptable clinical tools for instrument retrieval but the loop device in the TFRK requires slightly more dexterity than is needed for the ProUltra tips.
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Affiliation(s)
- Preeti Jain Pruthi
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, DL, India
| | - Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, DL, India
| | - Sangeeta Talwar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, DL, India
| | - Mahesh Verma
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, DL, India
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Fu M, Huang X, Zhang K, Hou B. Effects of Ultrasonic Removal of Fractured Files from the Middle Third of Root Canals on the Resistance to Vertical Root Fracture. J Endod 2019; 45:1365-1370. [PMID: 31564462 DOI: 10.1016/j.joen.2019.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/09/2019] [Accepted: 08/16/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study aimed to analyze the effects of ultrasonic removal of fractured files from the middle third of root canals on the vertical root fracture resistance. METHODS This study was an extension of a previous study assessing the effects of fractured file removal on dentinal microcracks. It included 18 bilaterally matched pairs of human mandibular incisors prepared and analyzed in the previous study. Briefly, 1 member of each pair was assigned to an ultrasonic or a control group. In the ultrasonic group, K-files were fractured in the middle third of canals followed by ultrasonic file removal and canal preparation. In the control group, the root canals were simply prepared. Micro-computed tomographic imaging was performed before and after treatment, and the cross-sectional root images were screened for microcracks. For the present study, 3-dimensional reconstruction was performed for volumetric assessments. The fracture resistance was measured using a universal testing machine. All data were statistically analyzed. RESULTS Fracture loads were significantly smaller in the ultrasonic group (P < .05). The percentage increase in the canal volume significantly influenced the root fracture resistance (P < .05), whereas microcracks had no significant effect (P > .05). CONCLUSIONS Ultrasonic removal of fractured instruments from the middle third of root canals lowers the vertical root fracture resistance, with increased dentin removal being the primary cause.
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Affiliation(s)
- Mei Fu
- Department of Endodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Xiaoxiang Huang
- Department of General Dentistry, School of Stomatology, Capital Medical University, Beijing, China
| | - Kunya Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Benxiang Hou
- Department of Endodontics, School of Stomatology, Capital Medical University, Beijing, China.
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Microcomputed tomographic investigation of the trepan bur/microtube technique for the removal of fractured instruments from root canals without a dental operating microscope. Clin Oral Investig 2019; 24:1717-1725. [PMID: 31346785 DOI: 10.1007/s00784-019-03032-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/16/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the removal of fractured instruments in mandibular incisor canals by using the trepan bur/microtube technique without a dental operating microscope (DOM). MATERIALS AND METHODS Thirty-four mandibular incisors were selected, and 5-mm apical segments of #25/.06 taper K3 NiTi instruments were fractured in the apical portion of each canal. Coronal enlargement was performed, and a staging platform was prepared at the coronal aspect of the fractured instrument. Then, a trepan bur was used to expose 1-1.5 mm of the fragmented instrument, and a microtube device was used to withdraw the fragment. Microcomputed tomographic (micro-CT) imaging was used to evaluate the geometric changes in the root canal and dentin. The time required for fractured instrument removal in each sample was recorded, and the results were statistically analyzed with a paired t test. RESULTS The trepan bur/microtube technique exhibited a success rate of 76.47%, and the average fractured instrument removal time was 8.55 ± 5.81 min. The changes in canal volume and dentin volume from the coronal end of the fractured instrument to 1.5 mm apical to the end were significantly greater than those from the cementoenamel junction (CEJ) to the coronal end of the fractured instrument during fractured instrument removal (P < 0.0001). CONCLUSIONS The study showed that the trepan bur/microtube technique had a significant impact on geometric changes in the root canal and dentin from the coronal end of the fractured instrument to 1.5 mm apical to the end. CLINICAL RELEVANCE These findings suggest that the trepan bur/microtube technique may be an optional method for fractured instrument removal from relatively straight canals.
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Separated Instrument in Endodontics: Frequency, Treatment and Prognosis. BALKAN JOURNAL OF DENTAL MEDICINE 2018. [DOI: 10.2478/bjdm-2018-0022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Summary
Instrument separation during endodontic therapy is a frequent accident with rotary instruments being more likely to separate than manual ones. The treatment of cases with a separated instrument can be either conservative or surgical. A conservative approach involves the following treatment choices: a) bypass of the fragment, b) removal of the fragment, c) instrumentation and obturation coronally to the fragment. Concerning the removal of a separated instrument, a variety of techniques and systems have been developed. Ultrasonics, in combination with the operative microscope constitute the most effective and reliable tools for removing a separated endodontic instrument from a root canal. The likelihood of successful removal depends on: the level of separation (coronal, middle or apical third); location in relation to the root canal curvature; the type of separated instrument; its length; the degree of canal curvature and the tooth type. Several complications may occur during the management of a separated instrument: separation of the ultrasonic tip or file used for bypassing or removing the instrument; further separation of the fragment; perforation; ledge; extrusion of the file into periapical tissues; tooth weakening due to dentin removal, as well as excessive temperature rise in periodontal tissues. Prognosis for a tooth retaining a separated instrument depends on the presence of a periapical lesion, the microbial load of the root canal during the time of separation and the quality of the obturation.
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Aslan T, Üstün Y, Çınar F, Düzgün S, Şener İ. Fortification of Fractured Instrument Removal Simulated Roots Using Several Calcium Silicate-Based Materials. CUMHURIYET DENTAL JOURNAL 2018. [DOI: 10.7126/cumudj.391219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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GÖKTÜRK H, ÖZKOÇAK İ. REMOVAL OF SEPARATED INSTRUMENTS WITH MASSERANN TECHNIQUES: TWO CASE REPORTS. CUMHURIYET DENTAL JOURNAL 2017. [DOI: 10.7126/cumudj.369127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Garg H, Grewal MS. Cone-beam Computed Tomography Volumetric Analysis and Comparison of Dentin Structure Loss after Retrieval of Separated Instrument by Using Ultrasonic EMS and ProUltra Tips. J Endod 2016; 42:1693-1698. [DOI: 10.1016/j.joen.2016.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/24/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Tang WR, Smales RJ, Chen HF, Guo XY, Si HY, Gao LM, Zhou WB, Wu YN. Prevention and management of fractured instruments in endodontic treatment. World J Surg Proced 2015; 5:82-98. [DOI: 10.5412/wjsp.v5.i1.82] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/12/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
Intracanal instrument fracture is an unpredictable and problematic occurrence that can prevent adequate cleaning and shaping procedures and influence the prognosis of endodontic treatment. The prevalence of instrument fracture is reported to range between 0.28% and 16.2%. This article presents an overview of the prevention and management of instruments fractured during endodontic therapy on the basis of literature retrieved from PubMed and selected journal searches. Instrument fracture occurs because of reduced metal fatigue and/or torsional resistance. The reasons include canal morphology and curvature, manufacturing processes and instrument design, instrument use times and technique, rotational speeds and operator experience. With the development of various equipment and techniques, most of the retained instrument separations can be removed safely. However, in canals without associated periapical disease not every fractured separation should be removed from difficult locations because of the increased risk for root perforation and fracture. In difficult cases, either retain or bypass the fragment in the root canal and ensure regular follow-up reviews. Fractured instruments retained in the presence of periapical disease reduce significantly the prognosis of endodontically treated teeth, indicating a greater need to attempt the removal or bypass of the file separations. Apical surgery might be required in some instances, emphasizing the importance of preventing instrument fracture.
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Gao Y, Shen Y, Zhou X, Haapasalo M. Remaining root dentin thickness in mesiobuccal canals of maxillary first molars after attempted removal of broken instrument fragments. AUST ENDOD J 2015; 41:122-7. [PMID: 25808862 DOI: 10.1111/aej.12103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yuan Gao
- State Key Laboratory of Oral Diseases; West China College and Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Ya Shen
- Division of Endodontics; Department of Oral Biological and Medical Sciences; University of British Columbia; Vancouver British Columbia Canada
- Department of Materials Engineering; University of British Columbia; Vancouver British Columbia Canada
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases; West China College and Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Markus Haapasalo
- Division of Endodontics; Department of Oral Biological and Medical Sciences; University of British Columbia; Vancouver British Columbia Canada
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Brito-Júnior M, Normanha JA, Camilo CC, Faria-e-Silva AL, Saquy PC, Ferraz MÃAL, Silva-Sousa YTC. Alternative techniques to remove fractured instrument fragments from the apical third of root canals: report of two cases. Braz Dent J 2015; 26:79-85. [PMID: 25672390 DOI: 10.1590/0103-6440201302446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 12/14/2014] [Indexed: 11/21/2022] Open
Abstract
This paper describes two cases of instrument fragment removal from the apical thirds of root canals using a customized extractor and a modified needle technique, respectively. In case 1, a customized extractor was manufactured to remove a bur fragment located in the apical root canal of a maxillary central incisor. The use of this extractor enabled successful and conservative removal of the instrument fragment. In case 2, a modified injection needle was used as a trepan to gain access around an instrument fragment located in the curved apical portion of the mesiobuccal canal of a mandibular molar. A segment of steel wire was inserted into the needle lumen to engage the metallic fragment, enabling its removal with counter-clockwise rotation and a simultaneous pull-out motion. Alternative and creative methods are useful for the management of intracanal metallic fragments during root canal treatment.
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Affiliation(s)
- Manoel Brito-Júnior
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | - João Américo Normanha
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | - Carla Cristina Camilo
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | - André Luis Faria-e-Silva
- Department of Dentistry, , School of Dentistry, UFS - Federal University of Sergipe, Aracaju, SE, Brazil
| | - Paulo César Saquy
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
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Hagiwara R, Suehara M, Fujii R, Kato H, Nakagawa KI, Oda Y. Laser Welding Method for Removal of Instruments Debris from Root Canals. THE BULLETIN OF TOKYO DENTAL COLLEGE 2013; 54:81-8. [DOI: 10.2209/tdcpublication.54.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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