title: Success of ultrasonic technique in removing fractured rotary nickel-titanium endodontic instruments from root canals and its effect on the required force for root fracture.
abstract: BACKGROUND
  Fracture of rotary nickel-titanium files is a real concern among endodontists; it affects the long-term prognosis of treatment. Ultrasound is a favorable technique for removing broken files, although it may result in some complications. The aim of this study was to determine the success rate of ultrasonic technique in removing file fragments and to evaluate its influence on the force required to fracture a tooth root.
  
  
  METHODS
  An in vitro study was carried out on 70 extracted maxillary premolars. In the experimental group a #30/.04 taper Hero file was guided into the canal to break and lodge therein. The lodged file was removed by ultrasonic vibration and use of a dental operating microscope. The canals were instrumented with Hero files by using crown-down technique and then obturated. All the teeth were prepared for mechanical testing in Testometric machine to measure the required force for root fracture. The Fisher exact test and independent two-sample t test were used to analyze data.
  
  
  RESULTS
  Ultrasonic technique exhibited a success rate of 80% in removing broken files. Success rate in the roots with file fracture before the curve was 11.5 times more than that of file fracture cases beyond the curve. Other factors such as bypass possibility did not affect success rate. The average time required for removing file fragments was 36.3 ± 7.15 minutes, which did not significantly differ in different file locations within the canal. According to mechanical test results, ultrasonic application did not significantly affect the required force for root fracture. The force required to fracture a root did not significantly differ in various file locations. Vertical fracture in the buccolingual direction (split tooth) was the most incident fracture pattern. Procedural errors observed in this study predominantly included transportation, perforation, and craze line.
  
  
  CONCLUSIONS
  Ultrasonic technique was successful in removing 80% of fractured rotary files and did not significantly affect the required force for root fracture.
authors.affiliation: Kerman Oral and Dental Diseases Research Center, Kerman University of Medical Science, Kerman, Iran.
authors.forename: Hasan
authors.initials: H
authors.lastname: Shahabinejad
authors.forename: Amirreza
authors.initials: A
authors.lastname: Ghassemi
authors.forename: Lida
authors.initials: L
authors.lastname: Pishbin
authors.forename: Arash
authors.initials: A
authors.lastname: Shahravan
mesh_terms: D001641:Bicuspid / Q000473:pathology; D003722:Dental Alloys / Q000737:chemistry*; D003786:Dental Pulp Cavity / Q000473:pathology*; D003799:Dental Stress Analysis / Q000295:instrumentation; D004868:Equipment Failure; D005547:Foreign Bodies / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008866:Microsurgery / Q000379:methods; D009532:Nickel / Q000737:chemistry*; D061646:Operative Time; D018915:Root Canal Preparation / Q000295:instrumentation*; D013314:Stress, Mechanical; D014025:Titanium / Q000737:chemistry*; D019227:Tooth Apex / Q000473:pathology; D014082:Tooth Fractures / Q000503:physiopathology; D014092:Tooth Root / Q000293:injuries; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation / Q000379:methods*
chemical_list: D003722:Dental Alloys; C040654:titanium nickelide; D009532:Nickel; D014025:Titanium