This document discusses endodontic instrument fracture during root canal treatment. It identifies factors that can lead to instrument fracture, such as root canal anatomy, instrument design, and operative technique. Management strategies for fractured instruments are presented, including non-surgical and surgical removal techniques as well as bypass procedures. Complications from retrieval attempts are also outlined. The document emphasizes the importance of thorough preoperative assessment and use of instruments within safety parameters to help prevent instrument fracture during root canal treatment.

1. Endodonticinstrument
fracture
Done by: Dr. Maryam salman
Supervised by : Dr. Ban saeed

2. Introduction
Root canal treatment (RCT) may require the use of a variety of instruments any
of these instruments may fracture inside the root canal during use compromising of
cleaning and shaping procedures, with a potential impact on the treatment outcome.
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3. Introduction
A great variety of foreign objects may be found in the root canal include :
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4. A great variety of foreign objects may be found in the root canal include :
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Fragments of:
(a) Endodontic explorer.
(b) Spreader.
(c) Bur.
(d) Gates Glidden bur
(with permission from Lambrianidis 2001)

5. More infrequently, the presence of foreign objects within the root canal is
attributed to patient’s related manipulations outside the canal
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7. Incidence of Fractured Instruments
• Instrument fracture may occur in both anterior and posterior teeth, but it is
most frequently reported in molars with similar instrument fracture rates
for the maxilla and the mandible
• it is particularly reported as occurring in the mesial roots of mandibular
molars
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9. Operator-Related Factors
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10. Factors Affecting Intracanal Instrument Fracture
Anatomy-Related Factors
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11. Factors Affecting Intracanal Instrument Fracture
Root Canal Anatomy
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12. Factors Affecting Intracanal Instrument Fracture
Instrument-Related Factors
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13. Factors Affecting Intracanal Instrument Fracture
Instrument-Related Factors// headstrom file
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14. Factors Affecting Intracanal Instrument Fracture
Instrument-Related Factors// headstrom file
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15. Factors Affecting Intracanal Instrument Fracture
Instrument-Related Factors // stenless steal file
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16. Factors Affecting Intracanal Instrument Fracture
Instrument-Related Factors// NITI
torsional fracture flexural fatigue
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17. Factors Affecting Intracanal Instrument Fracture
Instrument-Related Factors// NITI
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18. Factors Affecting Intracanal Instrument Fracture
Motors-Operating parameter
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19. Factors Affecting Intracanal Instrument Fracture
Motors-Operating parameter// torque
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20. Factors Affecting Intracanal Instrument Fracture
Instrumentation Technique
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21. Factors Affecting Intracanal Instrument Fracture
Instrumentation Technique
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22. Factors Affecting Intracanal Instrument Fracture
Sterilization
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23. Factors Affecting Intracanal Instrument Fracture
Irrigations
+
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24. Factors Affecting Intracanal Instrument Fracture
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27. Management Procedure
Localization and identification of the fragment
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28. Recommended management of fractured instruments in the primary
dentition based on the location of the fragment
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In all cases, retrieval
of the fragment then
RCT
A) Retrieval of the fragment +
RCT
B) Failure to retrieve the
fragment +Tooth extraction
Tooth extraction

29. Recommended management of fractured instruments in the
primary dentition based on the location of the fragment
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A) Retrieval of the
fragment +RCT
B) Failure to retrieve the
Fragment + Tooth
extraction
Tooth extraction and
removal of the fragment

30. Recommended management of fractured instruments in
permanent dentition based on the location of the fragment
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Retrieval + RCT
Retrieval + RCT
Bypass + RCT. The fragment
is incorporated inthe filling material Follow-
up
Failure toretrieve,bypass
Instrumentation and obturation up to the
fragment + Follow-up

31. Recommended management of fractured instruments in permanent
dentition based on the location of the fragment
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Retrieval + RCT
Bypass + RCT. The fragment
is incorporated inthe filling material
Follow-up
Failure toretrieve,bypass
Surgical endodontics
RCT + Follow-up

32. Management Procedure
• No intervention
• Non-surgical management
• Surgical management
•Tooth extraction
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33. Management Procedure
No intervention
Cases in which there is no point in intervening when the fragment
is located to a nonrestorable and/or severely compromised
periodontal tooth.
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34. Management Procedure
No intervention
Cases in which there is no need to intervene when no clinical or
radiographic signs of pathosis
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35. Bypass technique
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36. Management Procedure
Non-surgical management (The File Bypass Technique)
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37. Management Procedure
Non-surgical management (The File Bypass Technique)
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38. Retrival technique
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39. Management Procedure
Ultrasonic tip
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40. Management Procedure
Ultrasonic tip
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41. Management Procedure
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42. Management Procedure
HoldingTechniques
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43. Management Procedure
The Masserann Technique
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44. Management Procedure
The MasserannTechnique
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45. Management Procedure
The MasserannTechnique
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46. Management Procedure
Tube Techniques
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47. Management Procedure
File Retrieval System
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48. Management Procedure
ElectrolyticTechnique
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49. Management Procedure
Laser Irradiation (Laser-Assisted Removal of Fractured Instruments)
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50. Complications During and Following
Orthograde Attempts of Removing or
Bypassing Fractured Instruments
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51. Complications During and Following Orthograde Attempts of
Removing or Bypassing Fractured Instruments
• Root perforation
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52. Complications During and Following Orthograde Attempts of
Removing or Bypassing Fractured Instruments
• Excessive removal of tooth structure
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53. Complications During and Following Orthograde Attempts of
Removing or Bypassing Fractured Instruments
• Fracture of another file
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54. Complications During and Following Orthograde Attempts of
Removing or Bypassing Fractured Instruments
• Ledge formation
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55. Complications During and Following Orthograde Attempts of
Removing or Bypassing Fractured Instruments
• Transportation of the instrument fragment deeper into the root canal
• Extrusion of the fragment beyond the apex
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56. Complications During and Following Orthograde Attempts of
Removing or Bypassing Fractured Instruments
• • Extrusion of the fragment beyond the apex
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57. Complications During and Following Orthograde Attempts of
Removing or Bypassing Fractured Instruments
• Transportation of the root canal
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58. Complications During and Following Orthograde Attempts of
Removing or Bypassing Fractured Instruments
•Thermal injury of dental and periodontal tissues
• Predisposition of the root to a vertical root fracture
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59. Surgical Endodontics
to Manage Fractured
Instruments
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60. Surgical Endodontics to Manage Fractured Instruments
Prior to non-surgical management
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61. Surgical Endodontics to Manage Fractured Instruments
Immediate surgical endodontics
1. In cases of intense persistent clinical symptomatology
2.When a biopsy of periradicular tissue is required
3. If the patient, after being fully informed, insists for his own reasons on
having the operation performed immediately
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62. Surgical Endodontics to Manage Fractured Instruments
Surgical treatment at a later time upon future evaluation
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63. Surgical Endodontics to Manage Fractured Instruments
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64. Tooth Extraction
This is performed when all other therapeutical options (non-surgical and
surgical) have proved unsuccessful or are considered to be a failure.
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65. Parameters Influencing the Removal of
Fractured Instruments
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66. Parameters Influencing the Removal of Fractured Instruments
Tooth Factors
As a generalized finding, the success rate of retrieving instrument fragments is
higher in straight and wide canals than in curved and narrow canals
It was concluded that root canal curvature and the depth of the fractured
instrument were significantly correlated with the retrieval rate.With the
increase of curvature and depth, the retrieval rate decreased significantly
Even if the canal appears straight, a curve in the plane of the radiographic beam
might be present.
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67. Parameters Influencing the Removal of Fractured Instruments
Localization of the Fragment
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68. Parameters Influencing the Removal of Fractured Instruments
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what cannot be seen cannot be properly managed.

69. Parameters Influencing the Removal of Fractured Instruments
Patient Factors
The extent of mouth opening and difficulties in accessing the canal with the
fragment are the two main anatomical factors to be carefully evaluated
before commencing any attempt as they greatly influence management
efficiency and eventually decision-making.
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71. PREVENTION
 Thorough preoperative clinical and radiographic examination of the
anatomy of the tooth to be treated must be performed
 Assessment of the “difficulty level”
 Adequate/appropriate access cavity
 Endodontic instruments should be carefully inspected prior to, during,
and after use
 The incorporation of new types of instruments and, in particular, new
rotary NiTi file systems and/or new techniques requires a learning curve. 71

72. PREVENTION
 NiTi systems should be used within safe torque and speed limits for
optimal performance, provided by the manufacturer
Rotary endodontic instruments have non-cutting tips; thus, they should
beadvanced only into an explored and patent canal section
 Instruments in the root canal should always be used in a wet
environment
 Instrument should be advanced down the canal by a “pecking” or
“watch-winding”motion (for hand instruments).
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73. PREVENTION
 Instruments should always be used in sequence of sizes without skipping
sizes
 Each instrument “should be rendered” loose in the root canal prior to the
use of the next one.
 During the use of an instrument, debris that has accumulated between
its blades should be periodically removed.
 NiTi instruments should be used exerting very slight apical pressure
 Instruments should not be overused.
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