title: Management of intracanal separated instruments.
abstract: BACKGROUND
  Intracanal separation of endodontic instruments may hinder cleaning and shaping procedures within the root canal system, with a potential impact on the outcome of treatment. The purposes of this narrative review of separated instruments were to (1) review the literature regarding treatment options, influencing factors, and complications and (2) suggest a decision-making process for their management.
  
  
  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.
authors.affiliation: Restorative Dental Sciences Department, College of Dentistry, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia. ahmad.madarati@hotmail.co.uk
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Madarati
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hunter
authors.forename: Paul M H
authors.initials: PM
authors.lastname: Dummer
mesh_terms: D002985:Clinical Protocols; D003657:Decision Making; D004867:Equipment Design; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D006801:Humans; D018915:Root Canal Preparation / Q000009:adverse effects / Q000295:instrumentation*; D012390:Root Canal Therapy / Q000295:instrumentation