- 作者：Ahmad A. Madarati ; PhD ; MSc ; BDS&lowast ; ; &dagger ; ; ahmad.madarati@hotmail.co.uk" class="auth_mail" title="E-mail the corresponding author ; Mark J. Hunter ; MSc ; BDS&Dagger ; ; Paul M.H. Dummer ; PhD ; MSc ; BDS§ ;
- 关键词：Broken ; bypassing ; complications ; files ; fractured ; instruments ; management ; removal ; retrieval ; separated
- 刊名：Journal of Endodontics
- 出版年：2013
- 出版时间：May 2013
- 年：2013
- 卷：39
- 期：5
- 页码：569-581
- 全文大小：1227 K
Methods
An online search was conducted in peer-review journals listed in PubMed to retrieve clinical and experimental studies, case reports, and review articles by using the following key words: instruments, files, obstructions, fractured, separated, broken, removal, retrieval, management, bypassing, and complications with or without root canal and endodontic.
Results
There is a lack of high-level evidence on management of separated instruments. Conventional conservative management includes removal of or bypassing the fragment or filling the root canal system to the coronal level of the fragment. A surgical intervention remains an alternative approach. These approaches are influenced by a number of factors and may be associated with complications. On the basis of current clinical evidence, a decision-making process for management is suggested.
Conclusions
Guidelines for management of intracanal separated instruments have not been formulated. Decisions on management should consider the following: (1) the constraints of the root canal accommodating the fragment, (2) the stage of root canal preparation at which the instrument separated, (3) the expertise of the clinician, (4) the armamentaria available, (5) the potential complications of the treatment approach adopted, and (6) the strategic importance of the tooth involved and the presence/or absence of periapical pathosis. Clinical experience and understanding of these influencing factors as well as the ability to make a balanced decision are essential.