Assessment of Incidence, Management and Contributory Factors of Root Canal Instrument Separation in an Endodontics Post- Graduate Program: A Retrospective Clinical Study

Abstract

ABSTRACT Background: The successful outcome of nonsurgical root canal treatment (NS-RCT) is largely dependent on the technical quality of the procedure. Objective: To investigate the incidence of separated instruments in endodontic postgraduate clinics between January 2018 and December 2021, and to determine the potential contributory factors that increase the risk of instrument separation. Materials and Methods: A retrospective observational study was conducted in the Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. Data was collected to determine the incidence of separated instruments and their associated variables. Seven variables were analyzed separately: nonsurgical initial or retreatment case, tooth type, tooth arch, tooth location, canal type, root curvature, level of fracture, and file type. Results: A total of 3150 cases were treated, of which 108 cases had separated instruments. The overall incidence of instrument separation was 3.4% while 53.7% of separated instruments occurred in the mandibular molars, followed by 42.6% in the maxillary molars. The highest frequency of instrument separation was recorded in the mesiobuccal canal (35.2%). The level of separation was found to be statistically significant in relation to the management (P < .001). Conclusion: Nickel-titanium instruments tend to separate more inside the root canal system than stainless steel instruments. However, under the limitation of this study, the incidence of instrument separation is still quite low, even with postgraduate endodontic residents with limited experience.