Removal of fractured instruments in root canals: Challenges, strategies, and clinical perspectives
DOI:
https://doi.org/10.33448/rsd-v14i10.49749Keywords:
Fracture of Endodontic Instruments, Removal of Fragments, Endodontic Ultrasound, Microscopy, Endodontic Guides.Abstract
Fracture of endodontic instruments is a frequent challenge during root canal treatment and represents a significant complication for the clinician. This study aimed to critically review the main methods of fractured instrument removal, reporting their indications, advantages, limitations, and scientific evidence. The methodology consisted of an integrative literature review, selecting articles indexed in PubMed, Scopus, and SciELO, prioritizing publications between 2010 and 2025. The results of this review indicated that ultrasonics combined with the aid of an operating microscope is the first-choice technique for fragments located in the coronal and middle thirds, whereas static or dynamic endodontic guides are indicated in complex cases, such as curved canals or apical fragments, as they provide directed preparation and greater dentin preservation. Tube systems remain a secondary option, recommended only when less invasive approaches fail, due to their greater root dentin removal. In extreme cases, the bypass technique may be considered as a last resort, allowing partial canal de-obstruction and maintenance of tooth function. Technologies such as GentleWave® and AReneto® are presented as promising solutions to diversify and improve therapeutic alternatives; however, they still lack sufficient clinical evidence to confirm their effectiveness. It is concluded that no universally superior technique exists for all cases, and clinical decision-making should be individualized, guided by the principle of minimal intervention and the operator’s experience, in order to optimize clinical outcomes, reduce complications, and preserve tooth structure to the greatest extent possible.
References
Algarni, Y. (2024). Fracture Incidence of New Reciprocating Nickel-Titanium (NiTi) Files: A Cross-Sectional Retrospective Study. Cureus. 16(8), e67762. doi:10.7759/cureus.67762.
Aminsobhani, M., Hashemi, N., Hamidzadeh, F. & Sarraf, P. (2024). Broken Instrument Removal Methods with a Minireview of the Literature. Case Rep Dent. 2024, 9665987. doi:10.1155/2024/9665987.
Bürklein, S., Donnermeyer, D., Wefelmeier, M., Schäfer, E. & Urban, K. (2019). Removing Fractured Endodontic NiTi Instruments with a Tube Technique: Influence of Pre-Treatment with Various Agents on Adhesive Forces In Vitro. Materials (Basel). 13(1), 144. doi:10.3390/ma13010144.
Connert, T., Zehnder, M. S., Weiger, R., & Kühl, S. (2018). Microguided endodontics: Accuracy of a miniaturized technique for apically extended access cavity preparation in anterior teeth. International Endodontic Journal, 51(5), 573–583. https://doi.org/10.1111/iej.12878
Dioguardi, M., Dello Russo, C., Scarano, F. et al. (2024). Analysis of Endodontic Successes and Failures in the Removal of Fractured Endodontic Instruments during Retreatment: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis. Healthcare (Basel). 12(14),1390. doi:10.3390/healthcare12141390.
Eskibağlar, M., Özata, M. Y., Ocak, M. S. & Öztekin, F. (2023). Investigation of fracture prevalence of instruments used in root canal treatments at a faculty of dentistry: a prospective study. Restor Dent Endod. 48(4), e38. doi:10.5395/rde.2023.48.e38.
Gomes, M. S., Vieira, R. M., Böttcher, D. E., Plotino, G., Celeste, R. K. & Rossi-Fedele, G. (2021). Clinical fracture incidence of rotary and reciprocating NiTi files: A systematic review and meta-regression. Aust Endod J. 47(2):372-385. doi:10.1111/aej.12484.
Karaś, B., Kotela, A., Laszczyńska, M., Majchrzak, Z., Trafalski, M., Matys, J. & Dobrzyński, M. (2025). Efeito dos irrigantes endodônticos na resistência à fadiga cíclica de instrumentos rotativos de níquel-titânio: uma revisão sistemática. Materials (Basel). 18(17), 4056. doi:10.3390/ma18174056. PMID: 40942482; PMCID: PMC12429284.
Kaul, R., Gupta, R., Chhabra, S. & Koul, R. (2022). Dental Operating Microscope-guided Retrieval of Broken Instrument from a Deciduous Molar Using Ultrasonics. Int J Clin Pediatr Dent. 15(Suppl 1), S114-S118. doi:10.5005/jp-journals-10005-1892.
Lakshmaiah, D., Raj Kumar, J., Sakthi, N., Karunakaran, J. & Vishwanath, S. (2023). The Management of Fractured Dental Instruments: A Case Series. Cureus. 15(11), e49132. doi:10.7759/cureus.49132.
Machado, R., Júnior, C. S., Colombelli, M. F. et al. (2018). Incidence of ProTaper Universal System Instrument Fractures - A Retrospective Clinical Study. Eur Endod J. 3(2), 77-81.doi:10.14744/eej.2018.30592.
Madárati, A. A., Hunter, M. J. & Dummer, P. M. (2013). Management of intracanal separated instruments. J Endod. 39(5), 569-81. doi:10.1016/j.joen.2012.12.033.
Mahale, V. D., Saxena, T., Sharma, S. & Mohan, E. A. (2025). Quantitative analysis of troughing depth for successful instrument retrieval using the loop technique: A cross-sectional in vivo study. J Conserv Dent Endod. 28(4), 360-5. doi:10.4103/JCDE.JCDE_844_24.
McGuigan, M. B., Louca, C. & Duncan, H. F. (2013). Endodontic instrument fracture: causes and prevention. Br Dent J. 214(7), 341-8. doi:10.1038/sj.bdj.2013.324.
Panitvisai, P., Parunnit, P., Sathorn, C. & Messer, H. H. (2010). Impact of a retained instrument on treatment outcome: a systematic review and meta-analysis. J Endod. 36(5), 775-80. doi:10.1016/j.joen.2009.12.029.
Pereira, A. S. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria. Editora da UFSM.
Portela, N. N., Rech, J. P., Marchionatti, A. M. E. & Barasuol, J. C. (2022). Techniques to address fractured instruments in the middle or apical third of the root canal in human permanent teeth: a systematic review of the in vitro studies. Clin Oral Investig. 26(1), 131-9. doi:10.1007/s00784-021-04235-6.
Prabhuji, V., Manaswini, P. S., Srirekha, A., Champa, C. & Archana, S. (2025). Instrument retrieval using ultrasonics and minimally invasive guided endodontics using AReneto® system: a case report. J Med Case Rep. 19(1), 172. doi:10.1186/s13256-025-05121-5.
Ruddle, C. J. (2018). Nonsurgical retreatment of endodontic failures. Dent Today, 37(3), 94–99.
Shajahan, S., Dhanavel, C., Raja, S. V., Sornamalar, M. & Balavaishnavi, G. (2024). Comparative Evaluation of the Efficiency in Retrieving Separated Reciprocating Instruments Using Three Different File Retrieval Systems in Maxillary First Molars: An In Vitro Study. J Pharm Bioallied Sci. 16(Suppl 5): S4544-S4547. doi:10.4103/jpbs.jpbs_1195_24.
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business 3.1. Research, 104, 333–339. https://doi.org/10.1016/J.JBUSRES.2019.07.039.
Terauchi, Y., Ali, W. T. & Abielhassan, M. M. (2022). Present status and future directions: Removal of fractured instruments. Int Endod J. 55(Suppl 3), 685-709. doi:10.1111/iej.13743.
Yassa, S. A. A., Nabeel, M., Ghobashy, A. M. & Alkhawas, M. B. (2025). Fracture resistance and volumetric dentin change after management of broken instrument using static navigation - An in vitro study. J Conserv Dent Endod. 28(4), 319-324. doi:10.4103/JCDE.JCDE_27_25.
Zadfatah, F., Galledar, S., Pourasgar, S. & Fathiazar, A. (2023). Effect of Cryotherapy on Fracture Resistance of Neoniti Rotary Instruments. Front Dent. 20, 28. doi:10.18502/fid.v20i28.13346.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 João Victor da Fonseca Barbosa, Eduardo Kitto Miranda Teixeira , Laura Rodrigues Barbosa, Martinelle Ferreira da Rocha Taranto, Jáder Camilo Pinto
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
