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Authors

Fleming CH, Litaker MS, Alley LW, Eleazr PD

Year

2010

Title

Comparison of classic endodontic techniques versus contemporary techniques on endodontic treatment success

Reference

Journal of Endodontics 36(3):414−8

Findings:

More teeth in the classic group underwent posttreatment interventions (6.7% vs 0.9%, respectively)

Abstract

INTRODUCTION: Many recent technological advancements have been made in the field of endodontics; however, comparatively few studies have evaluated their impact on tooth survival. This study compared the survival rates of endodontic treatment performed by using classic techniques (eg, instrumentation with stainless steel hand files, alternating 5.25% NaOCl and 3% H2O2 irrigation, mostly multiple treatment visits, and so on) versus those performed using more contemporary techniques (eg, instrumentation with hand and rotary nickel-titanium files, frequent single-visit treatment, NaOCl, EDTA, chlorhexidine, H2O2 irrigation, warm vertical or lateral condensation obturation, use of surgical microscopes, electronic apex locators, and so on).

METHODS: Using a retrospective chart review, clinical data were obtained for 984 endodontically treated teeth in 857 patients. Survival was defined as radiographic evidence of the treated tooth being present in the oral cavity 12 months or more after initial treatment. A mixed-model Poisson regression analysis was used to compare failure rates.

RESULTS: Of the 459 teeth in the classic group, there was an overall survival rate of 98% with an average follow-up time of 75.7 months. Of 525 teeth in the contemporary group, there was an overall survival rate of 96%, with an average follow-up time of 34 months. Considerably more treatments in the classic group were completed in multiple appointments (91%) than in the contemporary group (39%). More teeth in the classic group underwent posttreatment interventions (6.7% vs 0.9%, respectively).

CONCLUSIONS: No statistically significant difference was noted between the two technique groups or between single or multiple visits in terms of survival.

Authors

Yeo JF, Loh FC

Year

1989

Title

Retrograde removal of fractured endodontic instruments

Reference

Annals of the Academy of Medicine, Singapore 18(5):594−8

Findings:

May not be relevant but may provide references for evidence that a procedure has to be redone due to file breakage

Abstract

During root canal therapy, accidental fracture of endodontic instruments may occur. While in the majority of such cases the fragment concerned can be retrieved non-surgically, there are some occasions that surgical intervention is needed in order to remove the broken tip lodged within the root canal. In this paper the authors would like to suggest a management approach to this uncommon and extremely unpleasant complication in dental practice.

Authors

Madarati AA, Watts DC, Qualtrough AJE

Year

2008

Title

Opinions and attitudes of endodontists and general dental practitioners in the UK towards the intra-canal fracture of endodontic instruments. Part 2

Reference

International Endodontic Journal 41(12):1079−87

Findings:

81.5% of respondents would not retrieve fractured instruments in the apical third of root canals

Abstract

Aim: To investigate the attitudes of general dental practitioners (GDPs) and endodontists in the UK towards management of fractured endodontic instruments. Methodology: A questionnaire was sent to 330 systemically selected GDPs and all endodontists working in the UK (170). It was accompanied by a covering letter explaining the aims of the study and indicating that all the information given would remain confidential. Those who did not respond to the first mailing were sent another two mailings. Data were analysed using chi-square test at P ≤ 0.05. Results: The overall response rate was 75%. Only 18.5% of respondents reported that they would retrieve instruments located in the apical third of root canals with a significantly higher proportion of endodontists (25.9%) compared with that of GDPs (14%) doing so. A significantly higher proportion of endodontists (98.5%) used ultrasonics for removal of fractured instruments compared with GDPs (75.8%). The most common complication of fractured instrument retrieval was thought to be excessive removal of dentine (67%). The majority of respondents (88.5%) reported that they would leave the unsuccessfully removed file in situ and obturate the root canal. Conclusion: Both endodontists and GDPs were aware of the limitations of root canal anatomy when removal of fractured instruments was considered. Excessive removal of dentine, the most common complication associated with the removal process, suggests the need for more conservative techniques. Both endodontists and GDPs demonstrated a conservative approach when management of fractured instruments failed. Further studies regarding attitudes of GDPs and endodontists towards some specific aspects of fractured instruments management are required.

Authors

Simon S, Machtou P, Tomson P, Adams N, Lumley P

Year

2008

Title

Influence of fractured instruments on the success rate of endodontic treatment

Reference

Dental Update 35(3):172−4, 176, 178−9

Findings:

Review

Abstract

The fracture of an instrument is a recognized complication in endodontics. The immediate response to a fractured instrument is frequently to regard the treatment as a failure. Several factors must, however, be taken into account to evaluate the prognosis of the tooth in this situation. The objective of the endodontic treatment with or without a fractured instrument remains the same, namely to disinfect the root canal system and prevent its recontamination. The time at which file fracture occurred during treatment and the degree of canal infection should be considered when determining the potential effect of instrument fracture on treatment outcome. Patients must be informed about an instrument fracturing in their tooth for ethical and legal reasons. The aim of this paper is to attempt to place fractured instruments in context, not to provide an in depth description of fractured instrument management techniques. CLINICAL RELEVANCE: To understand the influence of fractured instruments on prognosis in endodontics.

Authors

Panitvisai P, Parunnit P, Sathorn C, Messer HH

Year

2010

Title

Impact of a retained instrument on treatment outcome: a systematic review and meta-analysis

Reference

Journal of Endodontics 36(5):775−80

Findings:

May provide a reference for occurrence of broken instruments left in root canal; a fractured instrument fragment left in the canal does not affect prognosis

Abstract

Introduction: Fracture of root canal instruments is one of the most troublesome incidents in endodontic therapy. This systematic review and meta-analysis aim to determine the outcome difference between retained fractured instrument cases and matched conventional treated cases. Methods: The MEDLINE database, EMBASE, Web of Science, and the Cochrane Database were searched. Reference lists were scanned. A forward search was undertaken on identified articles. Papers citing these articles were identified through Science Citation Index to identify potentially relevant subsequent primary research. A systematic data extraction sheet was constructed. Data in these studies were independently extracted. Risk differences of included studies were combined by using the generic inverse variance data and fixed effects method. A 2-stage analysis was conducted. The first was limited to case-control studies, and the second included case series in which data were available for teeth with and without periradicular lesions. Results: Two case-control studies were identified and included, covering 199 cases. Weighted mean healing for teeth with a retained instrument fragment was 91%. The 2 studies were homogeneous. Risk difference of the combined data was 0.01, indicating that a retained fragment did not significantly influence healing. Overall, 80.7% of lesions healed when a periapical lesion was present, compared with 92.4% remaining healthy when no lesion was present initially (P < .02). Conclusions: On the basis of the current best available evidence, the prognosis for endodontic treatment when a fractured instrument fragment is left within a root canal is not significantly reduced.