title: The impact of instrument fracture on outcome of endodontic treatment.
abstract: Adoption of rotary nickel-titanium instruments has renewed concerns regarding instrument fracture and its consequences. The frequency of instrument fracture and its impact on treatment outcome were determined from an analysis of specialist endodontic practice records involving 8460 cases. A case-control study of treatment outcomes was conducted on a subset of 146 teeth with a retained instrument fragment (plus 146 matched controls), for which clinical and radiographic follow-up of at least 1 year was available. Masked radiographs were assessed by two calibrated examiners. Overall prevalence of retained fractured instruments was 3.3% of treated teeth. In the case-control study, overall healing rates were 91.8% for cases with a fractured instrument and 94.5% for matched controls (p > 0.05, Fisher's exact test). Healing in both groups was lower in teeth with a preoperative periapical radiolucency (86.7% versus 92.9%, p > 0.05). In the hands of skilled endodontists prognosis was not significantly affected by the presence of a retained fractured instrument.
authors.affiliation: School of Dental Science, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Spili
authors.forename: Peter
authors.initials: P
authors.lastname: Parashos
authors.forename: Harold H
authors.initials: HH
authors.lastname: Messer
mesh_terms: D016022:Case-Control Studies; D003722:Dental Alloys / Q000737:chemistry; D003786:Dental Pulp Cavity / Q000000981:diagnostic imaging; D004867:Equipment Design; D004868:Equipment Failure; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000000981:diagnostic imaging; D006801:Humans; D009532:Nickel / Q000737:chemistry; D011300:Preoperative Care; D016300:Radiography, Bitewing; D019233:Retreatment; D012189:Retrospective Studies; D018915:Root Canal Preparation / Q000295:instrumentation*; D012390:Root Canal Therapy; D014025:Titanium / Q000737:chemistry; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D003722:Dental Alloys; C040654:titanium nickelide; D009532:Nickel; D014025:Titanium